Engaging the community on colorectal cancer screening: Additional factors identified by African Americans as potential barriers during focus groups.

OBJECTIVE: African-Americans have the highest rate of colorectal cancer deaths. Adherence to colorectal cancer screening guidelines can improve outcomes. The objective of this study was to evaluate physician trust and barriers to screening utilizing a unique bi-directional learning focus group involving African-American adults and health care learners. METHODS: A focus group of African-American adults from a community church and university health care learners was conducted to identify colon cancer screening barriers. Health care learners were medical students, resident physicians and gastroenterology fellows. Pre-focus group surveys, including the Wake Forest Physician Trust Scale (WFPTS) and a colon cancer screening knowledge survey, were administered. Audio recording of the focus group was transcribed with subsequent thematic analysis. A post-focus group survey evaluated the colorectal cancer screening barriers identified during the focus group. Analysis of pre- and post- focus group surveys was performed using Fisher Exact test with significance set at p<0.05. RESULTS: The focus group consisted of 18 members (7 African-American community members, 11 non-African American health care learners). WFPTS revealed that 83% (86% community members, 82% health care learners; p = 1.0) strongly agree / agree that their physician would advocate for their health. 77% (86% community members, 73% health care learners; p = 1.0) strongly agree / agree that they trusted their physician. 100% recognized that colon cancer screening is recommended. The focus group identified lack of awareness (81%), colonoscopy preparation (81%), trust in physician (60%), lack of insurance coverage (56%), transportation (56%), colonoscopy wait time (50%), insufficient physician discussion (50%) and fear of procedure or cancer (35%) as screening barriers. Post-focus group surveys revealed that community members more frequently identified racial disparity in health care (p = 0.0474), physician respect toward patients (p = 0.0128) and insufficient physician discussion (p = 0.0006) as screening barriers. CONCLUSIONS: Focus group discussion identified multiple barriers for colorectal cancer screening. Notably, differences in the perceptions of African-American community members and non-African-American health care learners about racial disparity in health care, physician respect toward patients and insufficient physician discussion were revealed. The integration of bi-directional focus group learning can be considered as a potential strategy to assist in the development of focused screening interventions.

A Call to Improve Conditions for Conducting Holistic Review in Graduate Medical Education Recruitment.

This article was migrated. The article was marked as recommended. The authors identify several components of the application for residency and fellowship recruitment that impede progress toward conducting holistic review in graduate medical education (GME). As well, important differences between undergraduate (UME) and graduate medical education (GME) recruitment are discussed. The authors call for inclusion of questions about family background and disadvantaged status in the GME application, which is a standard practice within applications for health professions. The second recommendation encourages a question about non-cognitive strengths. Many specialties have adopted standardized letters of recommendation (SLORs) or standardized letters of evaluation (SLOEs) that collect this information from letters writers. Programs and applicants would benefit from uniformity across specialties. The authors also call for a centralized, searchable database that provides applicants with each program's mission, educational goals, and alumni outcomes. To support this paradigm shift in GME recruitment, reinforced with new Accreditation Council for Graduate Medical Education standards in July 2019, a task force should provide theoretical, evidence-based reasoning, along with development of new tools.

Optimizing Upstream Health in the Community-Oriented Integrative Domain.

Three domains define major challenges facing U.S. health care. Although engagement in the clinical and service domains directly impacts health, integrative engagement operates at the community level to address social determinants of health. Relying on examples from the Rodham Institute, an academically-based community organization, the authors describe principles and practices for promoting community self-efficacy and capacity-building to improve health. These include effective listening, allowing the self-identified needs of the community to drive engagement, and facilitating physician learning involving community education. If social determinants are to be effectively addressed, such approaches provide valuable insight.

The Impact of "See the City You Serve" Field Trip: An Educational Tool for Teaching Social Determinants of Health.

BACKGROUND: There has been limited evaluation of tools for teaching social determinants of health (SDOH). OBJECTIVE: We evaluated a field trip as a tool for teaching SDOH to incoming medical interns. METHODS: Incoming interns from The George Washington University participated in a bus field trip of Washington, DC, guided by community partners. The field trip introduced trainees to local neighborhoods. Pre- and postactivity surveys developed by the authors were analyzed using a Wilcoxon signed rank test. Reflection responses were recorded and counted for recurrent themes. RESULTS: Incoming interns participated in 2015 (85 of 90, 94%) and in 2016 (96 of 116, 83%). Postactivity, basic knowledge of DC geographic health disparities increased, and a greater percentage of interns reported being at least somewhat comfortable understanding the neighborhoods from which their patients come (2015: 58% versus 89%, P < .0001; 2016: 65% versus 88%, P < .0001); identifying challenges to health care that affect low-income patients (2015: 74% versus 90%, P < .0023); describing community resources (2015: 29% versus 67%, P < .0001; 2016: 29% versus 50%, P < .0001); and referring patients to local community resources (2015: 25% versus 64%, P < .0001; 2016: 36% versus 52%, P < .0001). Interns reported that this experience improved their understanding of patients' background and local resources, and that they would change the way they practice. CONCLUSIONS: A bus field trip guided by community partners is a feasible way to increase residents' perception of their understanding of local disparities and comfort in addressing SDOH.

Pelvic examination training for interns: a randomized controlled trial.

PURPOSE: To evaluate the effectiveness of pelvic examination training for internal medicine interns conducted by instructors who also serve as models for the examination. METHOD: In 2001, 80 interns from three university internal medicine residencies completed questionnaires about their experiences with pelvic examinations. Interns who were available for training underwent baseline assessment of their pelvic examination skills and were randomized to training or to a control group that received only educational literature. Skills were assessed with a 29-item checklist at baseline and at follow-up by evaluators blinded to group assignment, and interrater agreement was estimated by review of audiotapes. RESULTS: Seventy-two interns were randomized and underwent baseline skills assessment. Seventy interns returned for follow-up assessment after approximately 14 weeks (range, 10-17 weeks). The 39 interns randomized to training and 33 randomized to the control group did not differ with respect to age, gender, or prior pelvic examination training. In both groups there was substantial variability in skills at baseline, with graduates of U.S. medical schools scoring significantly higher than did graduates of non-U.S. medical schools (0.66 versus 0.41, p < 10(-5)). Interns randomized to training had significantly higher scores at follow-up than did interns in the control group (0.79 versus 0.57, p < 10(-6)). For seven items verifiable by audiotape, interrater agreement was good (overall kappa, 0.54; range among items, 0.3-0.85). CONCLUSION: Specialized trainers can reliably evaluate and improve the pelvic examination skills of interns, and improvements are demonstrable three months after training. Further research is needed to ascertain whether training efficiency can be improved and to measure the impact of training on patient satisfaction and clinical outcomes.