Intersectional Antiracist Advocacy Practice in Health Care Organizations.

Health care organizations, like individuals, can evolve to become antiracist and promote racial equity within and beyond the organization. In this brief article, we introduce an intersectional antiracist advocacy practice framework applicable to health care organizations that seek restorative and transformative change, as well as participation in social and economic justice action. Becoming an antiracist organization requires an acknowledgment that no organization is impervious to racist and other oppressive ideologies. Organizations can then begin to interrogate, interrupt, and address how racism permeates agency policies, procedures, and culture. The implementation of an intersectional antiracist advocacy practice framework within organizations involves a multifaceted approach, including both internal and external practices. Internally facing practices include providing mandatory antiracist trainings to all employees; promoting a representative and equitable workplace; and developing an organizational power structure based on inclusion, transparency, and accountability. Externally facing practices include fostering nonexploitative, reciprocal community partnerships; contributing to social and economic justice movements; and demonstrating transparency and accountability for the negative impact of operations in Black, Indigenous, and People of Color (BIPOC) communities and lands. We conclude with key questions for health care organizations to consider in regard to their racial equity efforts, specifically around organizational readiness, risk tolerance, and long-term commitment.

Pandemic and protest in 2020: Questions and considerations for social work research.

The convergence of the COVID-19 pandemic and social/political protest concerning structural anti-Black racism marks a moment for deep reflection and revision of many taken-for-granted assumptions about our research and academic lives as social work scholars. In this reflexive essay we, as two non-Black qualitative social work scholars, explore some of the questions and considerations for social work research that have surfaced since the emergence of these complex social, political, and economic crises. We organize our reflection around what we study, why, and how we go about studying it. We then offer a discussion of various constraints and challenges that emerge in this type of reflective scholarly practice, including an analysis of how contexts of white supremacy culture and neoliberalism shape social work scholarship. We close the essay with a number of recommendations for further reflection for social work scholars, such as reviewing research practices, seeking external research funding, practicing reflexivity, interrogating assumptions about knowledge production, self and community care, and integrating scholarly work into social work curriculum.

CATALYST: Piloting a Longitudinal Assessment and Learning Program for Board Recertification and Continuous Professional Development.

CONTEXT: As a proposed alternative to the traditional recertification examination, CATALYST is a longitudinal formative assessment platform created on cognitive learning principles. CATALYST was designed by the National Board of Osteopathic Medical Examiners to encourage more complex and durable practice-relevant learning and demonstration of ongoing competencies. OBJECTIVE: To investigate the value of the CATALYST platform using board diplomates' subjective feedback and comparison of performance on CATALYST questions with performance on board examinations. METHODS: Diplomates from 3 osteopathic specialty boards (the American Osteopathic Board of Internal Medicine, the American Osteopathic Board of Pediatrics, and the American Osteopathic Board of Obstetricians and Gynecologists) participated in this pilot study. Over the course of 16 weeks, participants were provided 2 questions per week via the CATALYST platform. An evaluation survey was emailed at the end of the study period to collect participants' feedback. Survey results and correlations of CATALYST performance with past or upcoming board examination scores were analyzed. RESULTS: A total of 196 diplomates completed the surveys, with 95% reporting that participation in the platform would help them stay current in their specialties and 91% reporting that participation would help them provide better care to their patients. For the AOBIM, a significant correlation was found between the number of CATALYST questions answered correctly and performance on the board examination (r=0.51, P<.001). The correlations found for the AOBP and AOBOG were not significant (r=0.197, P=.296, and r=0.370, P=.075, respectively). CONCLUSION: The CATALYST platform could offer valuable contributions to the board recertification process and to patient safety. Further investigations are being conducted on a new user-friendly platform.

CATALYST: Piloting a Longitudinal Assessment and Learning Program for Board Recertification and Continuous Professional Development.

Context: As a proposed alternative to the traditional recertification examination, CATALYST is a longitudinal formative assessment platform created on cognitive learning principles. CATALYST was designed by the National Board of Osteopathic Medical Examiners to encourage more complex and durable practice-relevant learning and demonstration of ongoing competencies. Objective: To investigate the value of the CATALYST platform using board diplomates' subjective feedback and comparison of performance on CATALYST questions with performance on board examinations. Methods: Diplomates from 3 osteopathic specialty boards (the American Osteopathic Board of Internal Medicine, the American Osteopathic Board of Pediatrics, and the American Osteopathic Board of Obstetricians and Gynecologists) participated in this pilot study. Over the course of 16 weeks, participants were provided 2 questions per week via the CATALYST platform. An evaluation survey was emailed at the end of the study period to collect participants' feedback. Survey results and correlations of CATALYST performance with past or upcoming board examination scores were analyzed. Results: A total of 196 diplomates completed the surveys, with 95% reporting that participation in the platform would help them stay current in their specialties and 91% reporting that participation would help them provide better care to their patients. For the AOBIM, a significant correlation was found between the number of CATALYST questions answered correctly and performance on the board examination (r=0.51, P<.001). The correlations found for the AOBP and AOBOG were not significant (r=0.197, P=.296, and r=0.370, P=.075, respectively). Conclusion: The CATALYST platform could offer valuable contributions to the board recertification process and to patient safety. Further investigations are being conducted on a new user-friendly platform.

"We Are Powerful People": Health-Promoting Strengths of LGBTQ Communities of Color.

Lesbian, gay, bisexual, transgender, and queer (LGBTQ) communities of color experience intersecting systems of oppression that limit access to health care, safety, and other basic resources. Important research has documented these disparities, their antecedents, and consequences. However, little research has examined the strengths of multiply marginalized LGBTQ communities. Drawing from a health equity framework, this study is based on interviews with 38 LGBTQ-identified people of color in New York City. We used framework analysis to examine participants' perspectives on the role of community in enhancing health and well-being. Community strengths identified by participants included (a) safety, acceptance, and support; (b) interconnectedness and resource sharing; and (c) advocacy, collective action, and community potential. Recommendations for policy, practice, and future research are suggested, including efforts toward community power building.

A Validity Study of COMLEX-USA Level 2-CE and COMAT Clinical Subjects: Concurrent and Predictive Evidence.

BACKGROUND: The Comprehensive Osteopathic Medical Licensure Examination (COMLEX-USA) Level 2-Cognitive Examination (CE) and the Comprehensive Osteopathic Medical Achievement Test (COMAT) are administered to similar populations (third- and fourth-year osteopathic students) at similar points in time. Examining the relationship between scores on the 2 assessments that measure similar constructs ultimately supports the validity of both. OBJECTIVE: The purpose of this study is to provide empirical evidence of the concurrent and predictive validity of COMAT and COMLEX-USA Level 2-CE. METHODS: In 2018, first-attempt scores on Level 2-CE were aggregated from June 2015 to May 2018 and matched with first-attempt scores on each COMAT clinical subject. We conducted correlational analyses between performance on COMAT and Level 2-CE, and COMAT scores and Level 2-CE discipline subscores. Additionally, we used multivariate regression to analyze the predictive relationship between performance on all COMAT clinical subjects and Level 2-CE. RESULTS: The results from correlational analyses indicated statistically significant, positive associations between COMAT and Level 2-CE scores (r = 0.49-0.68, P < .0001), and statistically significant, but slightly weaker relationships between COMAT scores and Level 2-CE discipline subscores (r = 0.31-0.60, P < .0001). Furthermore, results from the multiple regression indicated that scores on COMAT explained 68% of the variance in Level 2-CE scores, and that COMAT internal medicine and emergency medicine were weighted more heavily than other specialties. CONCLUSIONS: The findings from this study can inform assessment practices by supporting the use of COMAT for osteopathic medical schools that do not administer COMAT.

Association Between Performance on COMLEX-USA and the American College of Osteopathic Family Physicians In-Service Examination.

BACKGROUND: The primary goal of residency programs is to select and educate qualified candidates to become competent physicians. Program directors often use performance on licensure examinations to evaluate the ability of candidates during the resident application process. The American College of Osteopathic Family Physicians (ACOFP) administers an in-service examination (ISE) to residents annually. There are few prior studies of the relationship between the Comprehensive Osteopathic Medical Licensing Examination of the United States of America (COMLEX-USA) series and formative assessments of residents in training. OBJECTIVE: We explored the relationship between performance on COMLEX-USA and the ACOFP in-service examination to offer support on the use of licensing examinations in resident selection. METHODS: In 2016, performance data from the COMLEX-USA and the ISE were matched for 3 resident cohorts (2011-2013, inclusive; N = 1384). Correlations were calculated to examine the relationship between COMLEX-USA and ISE scores. Multiple linear regression models were used to determine if performance on COMLEX-USA significantly predicted third-year ISE (ISE-3) scores. RESULTS: Findings indicated that correlations among performance on COMLEX-USA and ISE were statistically significant (all P < .001), and there was strong intercorrelation between COMLEX-USA Level 3 and ISE-1 performance (r = 0.57, P < .001). Performance on the COMLEX-USA Levels 1 and 2-Cognitive Examination significantly predicted performance on the ISE-3 (F(2,1381) = 228.8, P < .001). CONCLUSIONS: The results support using COMLEX-USA as a part of resident selection in family medicine. Additionally, program directors may use performance on COMLEX-USA to predict success on the ISE-3.

Individual and systemic barriers to health care: Perspectives of lesbian, gay, bisexual, and transgender adults.

Access to effective services is imperative to address the many health and mental health disparities that lesbian, gay, bisexual, and transgender (LGBT) people face. This population, however, remains underserved and often ill-served in health care environments. Furthermore, interactions between system- and individual-level dimensions of access create barriers to service engagement. Within much of the extant literature surrounding health care barriers among LGBT people, the rich narratives and varied experiences of LGBT community members from diverse backgrounds have often been excluded. The current interview-based study was conducted with a sample of 40 self-identified LGBT adults living in New York City. Participants were recruited through flyers distributed to LGBT-specific social and health service organizations. Twenty-nine participants who discussed health care access as a major health concern were included in the current study. Framework analysis revealed barriers stemming from characteristics of services and providers (system-level) and characteristics of care-seekers (individual-level) as major health concerns. The root causes of system-level barriers were all attributed to social-structural factors that worked to exclude and erase LGBT people from the institutions that shape the health and mental health systems. Individual-level barriers were attributed to both individual and social-structural factors, such as health literacy and stigma. Participants linked access barriers to forgone care and to other health and mental health concerns within their communities. We argue that addressing barriers at the individual and sociostructural levels will better serve LGBT communities. (PsycINFO Database Record

Developing a Family-Centered Care Model for Critical Care After Pediatric Traumatic Brain Injury.

OBJECTIVES: This study examined the family experience of critical care after pediatric traumatic brain injury in order to develop a model of specific factors associated with family-centered care. DESIGN: Qualitative methods with semi-structured interviews were used. SETTING: Two level 1 trauma centers. PARTICIPANTS: Fifteen mothers of children who had an acute hospital stay after traumatic brain injury within the last 5 years were interviewed about their experience of critical care and discharge planning. Participants who were primarily English, Spanish, or Cantonese speaking were included. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Content analysis was used to code the transcribed interviews and develop the family-centered care model. Three major themes emerged: 1) thorough, timely, compassionate communication, 2) capacity building for families, providers, and facilities, and 3) coordination of care transitions. Participants reported valuing detailed, frequent communication that set realistic expectations and prepared them for decision making and outcomes. Areas for capacity building included strategies to increase provider cultural humility, parent participation in care, and institutional flexibility. Coordinated care transitions, including continuity of information and maintenance of partnerships with families and care teams, were highlighted. Participants who were not primarily English speaking reported particular difficulty with communication, cultural understanding, and coordinated transitions. CONCLUSIONS: This study presents a family-centered traumatic brain injury care model based on family perspectives. In addition to communication and coordination strategies, the model offers methods to address cultural and structural barriers to meeting the needs of non-English-speaking families. Given the stress experienced by families of children with traumatic brain injury, careful consideration of the model themes identified here may assist in improving overall quality of care to families of hospitalized children with traumatic brain injury.