Exploring The Impact of Acceptance and Commitment Based Cultural Humility Training on Standardized Patient Interactions: Revisiting the Measurement Process.

Recent findings in health sciences and medical education highlight the importance of training healthcare professionals to interact with their patients in a culturally humble manner (Nadal et al., in Journal of Counseling and Development 92: 57-66, 2014; Pascoe & Smart Richman, in Psychological Bulletin 135: 531, 2009; Sirois & Burg, in Behavior Modification 27: 83-102, 2003; Williams & Mohammed, in Journal of Behavioral Medicine 32: 20-47, 2009). An important piece in the progression of our ability to address training challenges is the assessment of cultural humility. As an extension of previous research (Lombardero et al., in Journal of Clinical Psychology in Medical Settings, 30: 261-273, 2023), this study implemented an evidence-based cultural humility intervention (based on Acceptance and Commitment Training) to improve medical students' interactions with standardized patients (SPs) which was assessed via direct behavioral observation. Specifically, the observational measurement system was focused on culturally humble responses to patients reporting microaggressions to the medical professional. A pre-post comparison of the results demonstrated statistically significant improvements pertaining to participants' culturally humble responses to SPs' reports of microaggressions for one of the measurement scales used (i.e., ARISE), but not the other (i.e., Responsiveness to Racial Challenges Scale). Further analyses, on the bottom quartile of performers, were conducted to assess a possible ceiling effect of the scale that did not demonstrate significant change. These results and implications for future research will be discussed.

An Acceptance and Commitment Training (ACT) Framework for Teaching Cultural Humility: A Guide for Translating ACT from a Therapeutic Context into a Medical Education Curriculum.

The objective of this project was to train future physicians to work effectively and thoughtfully with diverse populations by teaching them to employ Acceptance and Commitment Training (ACT) skills to increase cultural humility, with the goal of improving attitudes, knowledge, and beliefs about working with diverse patients. We developed ACT for cultural humility online interactive modules as part of an elective course to teach Medical Spanish to 4th-year medical students. Pre- and post-pilot data pertaining to the cultural humility training modules on the Work-Related Acceptance and Action questionnaire, Multidimensional Cultural Humility Scale, knowledge, attitudes, and beliefs were analyzed using paired samples t-tests and Wilcoxon signed-rank tests. We also included descriptive data pertaining to overall satisfaction with the cultural humility modules and intent to apply the material learned to patient care. Our data showed a significant increase in the cultural humility of our participants as well as an increase in psychological flexibility, a higher favorability rating toward various ethnicities, improvements in attitude, and positive changes in beliefs and knowledge following completion of the modules. The modules were well received by the medical students, with high social validity ratings. The ACT for cultural humility curriculum has great potential to enhance medical education in diversity, equity, and inclusion by increasing both the understanding and the cultural humility of medical students and future professionals to work with diverse populations. The current paper provides a framework that can be used by other programs to shape the education of the future medical workforce to help promote culturally humble care.

Diversifying academic medicine: One search committee at a time.

Despite increasing attention to lack of diversity among medical education faculty, those traditionally underrepresented in medicine remain so. In 2017, the University of Nevada, Reno School of Medicine approved a new policy to increase diversity in the faculty search process, which includes a mandatory 2-h workshop on best practices in search processes and implicit bias training. Workshop participants were 179 search committee members making up 55 committees from February 2017 to March 2020. Participants completed two separate social validity surveys, one immediately following the workshop and another following the close of their search, and rated various aspects of the workshop. Each search committee completed a Diversity Checklist (DCL) of various mandatory and best practices to be implemented during each search. Historical data on diversity of job applicants, interviewees, and hires over the 5-year period immediately preceding workshop implementation were compared with corresponding diversity data from the participant search committees for a 3-year period following implementation of the workshop. Social validity surveys indicated high ratings pertaining to the benefits of the workshop (means 3.82-4.39 out of 5). Implementation of practices outlined in the DCL were high (94% of mandatory and 87% of best practices). Chi-square analyses of diversity data before and after implementation revealed significant increases in overall diversity (both race and gender) of applicants (p < 0.001), interviewees (p = 0.002), and those offered a position (p = 0.002), in the time period following implementation. Follow-up comparisons found greater increases for gender relative to race/ethnicity.

Assessment of medical student burnout: toward an implicit measure to address current issues.

The feasibility of implicitly assessing medical student burnout was explored, using the Implicit Relational Assessment Procedure (IRAP), to measure longitudinal student burnout over the first two years of medical school and directly comparing it with an existing explicit measure of burnout (Maslach Burnout Inventory; MBI). Three successive cohorts of medical students completed both implicit and explicit measures of burnout at several time points during their first two years of medical school. Both assessments were conducted via the internet within a one-week period during the first week of medical school, the end of the first year of medical school, and the end of the second year, though not all cohorts were able to complete the assessments at all time points. Mixed linear models were used to compare the two measures directly, as well as to evaluate changes over time in each measure separately. Minimal correspondence was observed between the implicit and explicit measures of burnout on a within-subject basis. However, when analyzed separately, all subscales of both measures detected significant change over time in the direction of greater levels of burnout, particularly during the first year of medical school. These results provide preliminary evidence the IRAP is able to assess implicit attitudes related to burnout among medical students, though additional research is needed. The IRAP detected consistent improvements in positive implicit attitudes toward medical training during students' second year of medical school, which was not detected by the MBI. Possible implications of these findings are discussed.

Restructuring Law Enforcement Agencies to Support Prosocial Values: A Behavior-Scientific Model for Addressing Police Brutality.

Policing in the United States is irrefutably a component of systemic racism. The history of police brutality against the Black community can be found in our amendments, laws, and cultural practices-it is an infrastructure of oppression. Though police brutality is not a new development, it has reached a fever pitch with the deaths of George Floyd and Breonna Taylor. Recent calls to defund the police put law enforcement agencies squarely, and rightly, in the spotlight of social justice movements and reform. Current issues operating within law enforcement agencies ensure the perpetuation of a system that reinforces the status quo and gives nothing back to the communities that have been victims of brutality. A philosophical restructuring of how law enforcement agencies interact with the communities they serve is paramount. The purpose of this article is to propose a behavior-scientific model aimed at both the individual and organizational levels of law enforcement agencies using elements of acceptance and commitment training and Elinor Ostrom's core design principles, called Prosocial. The Prosocial model promotes the clarification of values within organizations and the communities they serve and reinforces values-consistent action. The model therefore has the potential to be a useful tool to combat systemic racism and police brutality within law enforcement agencies. The proposed model will be discussed in the context of who created it (White academicians), who will be implementing it (law enforcement), and ultimately who should benefit from it above and beyond the cessation of police brutality and without psychological or financial cost (Black communities).

Creating Inclusive and Equitable Cultural Practices by Linking Leadership to Systemic Change.

From a global pandemic to the killings of George Floyd, Breonna Taylor, Ahmaud Arbery, Rayshard Brooks, and others in the Black community, the year 2020 has cast light on long-standing social injustices. With this has come a critical social movement and a call for change-specifically, a call for transformative solutions that address not only new challenges but also centuries of systemic issues, such as systemic oppression and systemic racism. Leadership across the globe has scrambled to answer the call, some issuing statements committed to change, others engaging in necessary action. What is critical, however, is that leadership understands the cultural factors that have given rise to centuries of oppressive practices, and that leaders are held accountable for the commitments they have expressed. Leadership must promote, create, and maintain prosocial, inclusive, and healthy work environments. This requires new cultural practices and a focused organizational model. Equally important is the need to resolve ambiguity and communicate effectively, with strategic consideration of constituent perspectives and needs. Therefore, the purpose of this article is to discuss the contribution of behavior analysis to addressing systemic oppression, as well as the pivotal role leadership communication plays in occasioning social change. It is our hope that this conceptual work will inspire behavior scientists to advance the field of behavior analysis and social movements in the direction of equitable, prosocial change that dismantles systemic oppression.

The Will to Fight: Aversion-Induced Aggression and the Role of Motivation in Intergroup Conflicts.

Aggressive behavior is a source of many significant human problems, most notably the catastrophic loss of life and resources that can result from violent conflicts between groups. Aggressive behavior is particularly likely to arise from aversive conditions that function as motivating operations (MOs) that establish the stimulation produced by aggressive acts as reinforcing. We describe the behavior that arises from these circumstances as aversion-induced aggression (AIA) and argue that the MOs associated with AIA are important factors in initiating and sustaining violent conflicts between groups. In support of this, we survey the basic nonhuman research that has demonstrated the aggression-motivating functions of aversive stimuli. We extend our analysis of AIA to humans and describe how the special properties of verbal stimuli serve as the basis for notable differences between AIA in humans and nonhumans. We describe how aversive conditions may be exploited by leaders to establish support for aggression against another group in the pursuit of their objectives. We suggest that conflicts between groups cannot be resolved in the long term unless the motivational conditions from which conflicts arise are alleviated. Aggression is rarely effective in this regard because it exacerbates these conditions. For this reason, we advocate against the use of aggression as a tool for resolving conflicts between groups and consider how behavior science may contribute to the development and evaluation of alternative nonviolent practices.

The Origin and Evolution of the Behavior Analysis Program at the University of Nevada, Reno.

The origins of the Behavior Analysis program at the University of Nevada, Reno by way of a self-capitalized model through its transition to a more typical graduate program is described. Details of the original proposal to establish the program and the funding model are described. Some of the unusual features of the program executed in this way are discussed, along with problems engendered by the model. Also included is the diversification of faculty interests over time. The status of the program, now, after 25 years of operation, is presented.