Race as a Predictor of Palliative Care Referral Time, Hospice Utilization, and Hospital Length of Stay: A Retrospective Noncomparative Analysis.

BACKGROUND: Palliative care is associated with significant benefits, including reduced pain and suffering, an increased likelihood of patients dying in their preferred location, and decreased health-care expenditures. Racial and ethnic disparities are well-documented in hospice use and referral patterns; however, it is unclear whether these disparities apply to inpatient palliative care services. OBJECTIVE: To determine if race is a significant predictor of time to inpatient palliative care consult, patient enrollment in hospice, and patients' overall hospital length of stay among patients of an inpatient palliative care service. DESIGN: Retrospective noncomparative analysis. SETTING: Urban academic medical center in the United States. PATIENTS: 3207 patients referred to an inpatient palliative care service between March 2006 and April 2015. MEASUREMENTS: Time to palliative care consult, disposition of hospice/not hospice (excluding patients who died), and hospital length of stay among patients by racial (Asian, black, Native American/Eskimo, Hispanic, white, Unknown) and ethnic (Hispanic/Latino, non-Hispanic, Unknown) background. RESULTS: Race was not a significant predictor of time to inpatient palliative care consult, discharge to hospice, or hospital length of stay. Similarly, black/white, Hispanic/white, and Asian/white variables were not significant predictors of hospice enrollment ( Ps > .05). LIMITATIONS: Study was conducted at 1 urban academic medical center, limiting generalizability; hospital race and ethnicity categorizations may also limit interpretation of results. CONCLUSIONS: In this urban hospital, race was not a predictor of time to inpatient palliative care service consult, discharge to hospice, or hospital length of stay. Confirmatory studies of inpatient palliative care services in other institutions are needed.

Student Reflections on Interprofessional Education: Moving from Concepts to Collaboration.

PURPOSE: We analyzed student reflection essays to evaluate the impact of an interprofessional education (IPE) curriculum on what students value and personally learn from their participation. METHODS: After completing a 2-year IPE curriculum in the Health Mentors Program (HMP), while partnered with a mentor with chronic disease(s), 264 students from six health professions submitted personal reflection papers, using the Rolfe Reflection-in-Action model. A sample of 60 essays was analyzed using conventional content analysis guided by grounded theory. RESULTS: Qualitative analysis revealed 15 themes and 14 subthemes in the essays. The themes and subthemes were organized into four main categories: program, mentor, team, and self. Most students viewed the HMP curricular design positively. In particular, they cited the team-based home visit as a critical piece in changing their perceptions of the impact of chronic disease on their health mentor. Mentors' positive attitude and approach toward life also had a profound impact on students. Approximately half of the students identified positive team dynamics as a key component for optimal patient care and better health outcomes, noting improved understanding of team members' professional roles and responsibilities after working together in this longitudinal IPE program. The "self" category had the highest frequency count, with students describing positive changes in self-assessed knowledge, skills, and attitudes. CONCLUSIONS: Our findings suggest that reflective writing is an effective exercise through which students can explore their attitudes toward IPE and team-based care of individuals with chronic diseases. After participation in this IPE curriculum, students identified having an improved understanding of collaborative practice goals, indicative of meeting an IPE core competency, and described a new understanding of patient-centeredness.

Urban underserved program: an analysis of factors affecting practice outcomes.

BACKGROUND AND OBJECTIVES: Fewer medical students are choosing to work in primary care, and it is difficult to recruit and retain physicians to work in underserved communities. Positive exposures with underserved communities are known to increase a physician's likelihood of practicing in an underserved area. While a number of medical school programs are designed to address the rural physician workforce shortage, there are fewer medical school programs designed to specifically recruit and retain physicians to work in urban underserved areas. This article describes a multifaceted, longitudinal medical school curriculum at Jefferson Medical College known as the Urban Underserved Program (UUP) and a survey administered to UUP graduates exploring the association between program participation and practice outcomes. METHODS: A mixed methods analysis of an online survey was administered to UUP graduates. RESULTS: Results indicated that 75% of UUP graduates work in urban areas, 75% in an underserved or physician shortage area, and 61% in a primary care capacity. Additionally, results indicate that the UUP supports and encourages medical students to work with urban underserved populations by increasing knowledge of health disparities and empathy for underserved populations. CONCLUSIONS: Urban underserved communities have greater health disparities and less access to health care, and programs that promote and prepare students to enter practice in these communities can potentially impact the health of these populations.

Evaluation of the validity of medical students' self-assessments of proficiency in clinical simulations.

BACKGROUND: The accuracy of self-assessments has not been well supported in the literature. This study was undertaken to examine the validity of medical students' ratings of their proficiency during encounters with simulated patients and simulation devices. METHODS: Confidential self-assessments for 10 skills were collected from 195 students during a formal clinical skills assessment related to 3 cases at the end of a surgery clerkship. The cases required students to gather data from simulated patients and perform procedures such as rectal examinations, nasogastric tube insertions, and suturing on bench simulation models. The patients were trained to assess student performance. RESULTS: There were significant differences between student self-assessments and simulated patient scores for general clinical skills as opposed to procedural skills. Students' mean self-assessments in the data gathering and interpersonal skills were 2-6 % points higher than ratings of their proficiency by simulated patients. However, self-assessments on procedures were 5-8 points lower than patient ratings. The median correlation between self-assessments and patient ratings for general clinical skills such as data gathering and interpersonal skills was 0.08 (not significant), whereas the median correlation between student and patient ratings in procedures was 0.22 (P < 0.01). CONCLUSIONS: Third-year medical students' self-assessments for specific procedures are more valid than self-assessments of general clinical skills. Students are less confident in their procedural skills compared with general clinical skills. Although self-assessments should not be used as the sole measure of performance in clinical simulations, self-assessments for specific procedures can provide supplemental information on proficiency.