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AHRQ Research Studies
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Research Studies is a monthly compilation of research articles funded by AHRQ or authored by AHRQ researchers and recently published in journals or newsletters.
Results1 to 22 of 22 Research Studies Displayed
Purnell TS, Bignall ONR, Norris KC
Centering anti-racism and social justice in nephrology education to advance kidney health equity.
This article discusses actions necessary to effectively prepare a new generation of nephrology thought leaders who understand the roles of structural racism and social determinants of health (SDOH) in continuing racial disparities as critical issues in efforts that promote kidney health equity. The authors provide their recommendations for centering antiracism and social justice in nephrology education to advance kidney health equity, including: 1 Acknowledging and adopting evidence-based strategies to address implicit biases and explicit acts of interpersonal racism in healthcare encounters that may perpetuate kidney health disparities; 2) Strive to remove structural racism at the societal and health system levels that systematically introduce inequities in kidney care; 3) incorporate research training inclusive of methodologic and content areas that are vital to health equity; 4) foster role modeling within nephrology education through faculty mentorship and professional networking opportunities. The authors conclude that to effectively advance kidney research and practice, sustainable solutions to eradicate disparities must be developed and a prepared nephrology workforce must be trained, one that centers antiracism and social justice in sustained efforts to advance kidney health equity.
Citation: Purnell TS, Bignall ONR, Norris KC . Centering anti-racism and social justice in nephrology education to advance kidney health equity. J Am Soc Nephrol 2022 Nov;33(11):1981-84. doi: 10.1681/asn.2022040432..
Keywords: Racial and Ethnic Minorities, Kidney Disease and Health, Disparities, Education: Continuing Medical Education, Education: Curriculum
Franklin PD, Drane D, Wakschlag L
Development of a learning health system science competency assessment to guide training and proficiency assessment.
This paper describes the development of the learning health systems (LHS) Competency Assessment by the AHRQ-funded ACCELERAT K12 training program. Domain experts and trainees were recruited to define and operationalize items to include in an LHS Competency Assessment to support emerging and existing LHS scientists in prioritizing and monitoring proficiency development. The method used was to conduct sequential interviews with 18 experts who iteratively defined skills and tasks to illustrate stage in proficiency and its progression for each of 42 competencies in the seven LHS expertise domains: systems science; research questions and standards of scientific evidence; research methods; informatics; ethics of research and implementation in health systems; improvement and implementation science; and engagement, leadership, and research management. The LHS Competency Assessment was reviewed, and pilot tested by current trainees and further refinement was completed using their feedback. The LHS Competency Assessment was found to offer consistent, graded criteria across the seven LHS domains.
Citation: Franklin PD, Drane D, Wakschlag L . Development of a learning health system science competency assessment to guide training and proficiency assessment. Learn Health Syst 2022 Oct;6(4):e10343. doi: 10.1002/lrh2.10343..
Keywords: Learning Health Systems, Health Systems, Health Services Research (HSR), Training, Education: Curriculum
Jindal M, Thornton RLJ, McRae A
Effects of a curriculum addressing racism on pediatric residents' racial biases and empathy.
The authors sought to evaluate the impact of participation in a curriculum addressing racism on pediatric residents' racial biases and empathy. They conducted a pre-post survey study in two urban, university-based, midsized pediatric residency programs. They found that, among participants with baseline pro-White bias, there was a statistically significant shift toward no preference, while among participants with a baseline pro-Black bias, there was a statistically significant shift toward no preference. Among all residents, there was a modest but statistically significant decrease in mean empathy.
Citation: Jindal M, Thornton RLJ, McRae A . Effects of a curriculum addressing racism on pediatric residents' racial biases and empathy. J Grad Med Educ 2022 Aug;14(4):407-13. doi: 10.4300/jgme-d-21-01048.1..
Keywords: Children/Adolescents, Racial and Ethnic Minorities, Education: Curriculum
Shields AD, Battistelli J, Kavanagh L
Staying current: developing just-in-time evidence-ased learning objectives for a maternal cardiac arrest simulation curriculum.
The authors’ objective was to review the latest evidence on resuscitation care for maternal cardiac arrest (MCA) and to gain expert consensus on best practices to inform an evidence-based curriculum. A multidisciplinary panel of stakeholders in MCA developed an evidence-based simulation training, Obstetric Life Support™ (OBLS). The researchers found that a novel three-step process including reaffirmation of evidence process, systematic review, and a modified Research and Development technique resulted in unanimous consensus from experts in MCA resuscitation on existing and new just-in-time best practices to inform the learning objectives for an evidence-based curriculum.
Citation: Shields AD, Battistelli J, Kavanagh L . Staying current: developing just-in-time evidence-ased learning objectives for a maternal cardiac arrest simulation curriculum. Cardiol Cardiovasc Med 2022 Jun;6(3):245-54. doi: 10.26502/fccm.92920260..
Keywords: Evidence-Based Practice, Education: Curriculum, Simulation, Heart Disease and Health, Cardiovascular Conditions, Women, Education: Academic
Fraiman YS, Cheston CC, Cabral HJ
Effect of a novel mindfulness curriculum on burnout during pediatric internship: a cluster randomized clinical trial.
This study examined the effectiveness of a monthly mindfulness curriculum (Mindfulness Intervention for New Interns) for medical interns on emotional exhaustion (EE) as measured by the Maslach Burnout Inventory 9-question EE subscale as well as secondary outcomes of depersonalization, personal accomplishment, and burnout. This was a randomized clinical trial of 340 pediatric interns participating in 15 US pediatric training programs from June 2017 to February 2019. The intervention included 7 hour-long sessions and a monthly mindfulness refresher implemented during internship. The active control arm also included monthly 1-hour social lunches. Follow-up was done at 6 months and at month 15. Both arms’ EE scores were higher at 6 and 15 months than at baseline, but EE did not significantly differ by arm in multivariable analyses. There were also no significant differences in the 6 secondary outcomes at month 6 or month 15.
Citation: Fraiman YS, Cheston CC, Cabral HJ . Effect of a novel mindfulness curriculum on burnout during pediatric internship: a cluster randomized clinical trial. JAMA Pediatr 2022 Apr;176(1):365-72. doi: 10.1001/jamapediatrics.2021.5740..
Keywords: Education: Curriculum, Burnout, Provider: Physician
Jindal M, Mistry KB, McRae A
AHRQ Author: Mistry KB,
"It makes me a better person and doctor": a qualitative study of residents' perceptions of a curriculum addressing racism.
The purpose of this study was to explore how pediatric residents perceive the impact of a curriculum addressing racism on their knowledge, motivation, skills and behaviors and investigate the contextual factors that promote or impede the curriculum's effectiveness. Semi structured interviews were conducted at two academic medical centers among pediatric residents. Findings showed that medical education addressing racism can facilitate the perceived acquisition of foundational knowledge regarding race and racism, motivation and skill-building to combat racism, and action planning aimed at improving patient care.
Citation: Jindal M, Mistry KB, McRae A . "It makes me a better person and doctor": a qualitative study of residents' perceptions of a curriculum addressing racism. Acad Pediatr 2022 Mar;22(2):332-41. doi: 10.1016/j.acap.2021.12.012..
Keywords: Education: Curriculum, Education: Continuing Medical Education, Racial and Ethnic Minorities, Provider: Physician
Rodriguez N, Kintzer E, List J
Implicit bias recognition and management: tailored instruction for faculty.
This study assessed the impact and feasibility of single seminars on implicit bias and the approach to its management in clinical settings. The authors delivered five department/divisional grand rounds across three different medical centers in New York between September 2016 and November 2017. The instruction provided background information on implicit bias, highlighted its relevance to clinical care, and discussed proposed interventions. Participants completed a twelve-item retrospective pre-intervention/post-intervention survey. The authors received 116 completed surveys from 203 participants. Participants self-reported confidence and increased comfort levels for all questions. Three themes resulted from qualitative analysis: looking inward, looking outward, and taking action at individual and institutional levels.
Citation: Rodriguez N, Kintzer E, List J . Implicit bias recognition and management: tailored instruction for faculty. J Natl Med Assoc 2021 Oct;113(5):566-75. doi: 10.1016/j.jnma.2021.05.003..
Keywords: Education: Curriculum
Gleason K, Harkless G, Stanley J
The critical need for nursing education to address the diagnostic process.
In this paper, the authors reviewed the history and current state of diagnostic education in pre-licensure registered nurse preparation, introduced interprofessional individual- and team-based competencies to improve diagnostic safety, and discussed the next steps for nursing education.
Citation: Gleason K, Harkless G, Stanley J . The critical need for nursing education to address the diagnostic process. Nurs Outlook 2021 May-Jun;69(3):362-69. doi: 10.1016/j.outlook.2020.12.005..
Keywords: Diagnostic Safety and Quality, Provider: Nurse, Education: Curriculum
Daya S, Choi N, Harrison JD
Advocacy in action: medical student reflections of an experiential curriculum.
Researchers created an experience-based learning curriculum called Advocacy in Action (AiA) to promote the development and application of health advocacy knowledge and skills during an Internal Medicine (IM) clerkship rotation. They found that written reflections had prominent themes surrounding advocacy skills development, meaningful personal experiences, interprofessional dynamics in patient advocacy, and discovery of barriers to optimal patient care. They concluded that AiA is a novel method to apply classroom knowledge of social determinants of health to the clinical setting in order to incorporate advocacy in daily patient care.
Citation: Daya S, Choi N, Harrison JD . Advocacy in action: medical student reflections of an experiential curriculum. Clin Teach 2021 Apr;18(2):168-73. doi: 10.1111/tct.13283..
Keywords: Education: Curriculum
Williams C, Familusi OO, Ziemba J
Adapting to the educational challenges of a pandemic: development of a novel virtual urology subinternship during the time of COVID-19.
The purpose of this study was to design, implement, and evaluate learner attitudes of a virtual urologic surgery clinical rotation for medical students. The investigators concluded that virtual medical student rotations were scalable and effective at delivering surgical material and could approximate the interpersonal teaching found in clinical learning environments. The investigators suggested that they may be a useful tool to supplement or augment clinical learning in select situations.
Citation: Williams C, Familusi OO, Ziemba J . Adapting to the educational challenges of a pandemic: development of a novel virtual urology subinternship during the time of COVID-19. Urology 2021 Feb;148:70-76. doi: 10.1016/j.urology.2020.08.071..
Keywords: Education: Curriculum, COVID-19, Surgery, Education: Continuing Medical Education
Ajayi TB, Remein CD, Stafford RS
Cross-center virtual education fellowship program for early-career researchers in atrial fibrillation.
This paper discusses the results of the establishment of the atrial fibrillation (AF) Strategically Focused Research Network Cross-Center Fellowship Program to enhance the competencies of early-stage AF basic, clinical, and population health researchers through experiential education and mentorship. The effectiveness of the fellowship model was evaluated via mixed methods formative and summative surveys for the first 2 years. Productivity metrics were as high for the 12 fellows as they hoped with 50 AF-related manuscripts, 7 publications, 28 presentations, and 3 grant awards applications. The fellows reported medium to high satisfaction with the overall fellowship, webinar content and facilitation, staff communication and support, and program organization.
Citation: Ajayi TB, Remein CD, Stafford RS . Cross-center virtual education fellowship program for early-career researchers in atrial fibrillation. Circ Arrhythm Electrophysiol 2020 Nov;13(11):e008552. doi: 10.1161/circep.120.008552..
Keywords: Heart Disease and Health, Cardiovascular Conditions, Education: Curriculum, Education: Academic
Bi S, Vela MB, Nathan AG
Teaching intersectionality of sexual orientation, gender identity, and race/ethnicity in a health disparities course.
Intersectionality considers how different identities simultaneously affect an individual's experiences. Those of multiple minority statuses may experience effects of intersecting systems of oppression. Most health disparities curricula do not focus on intersectionality. The investigators studied the impact of an innovative module teaching intersectionality of sexual orientation, gender identity, and race/ethnicity issues in the required Pritzker School of Medicine course Health Care Disparities: Equity and Advocacy.
Citation: Bi S, Vela MB, Nathan AG . Teaching intersectionality of sexual orientation, gender identity, and race/ethnicity in a health disparities course. MedEdPORTAL 2020 Jul 31;16:10970. doi: 10.15766/mep_2374-8265.10970..
Keywords: Racial and Ethnic Minorities, Disparities, Education: Curriculum
Elison DM, McConnaughey S, Freeman RV
Focused cardiac ultrasound training in medical students: using an independent, simulator-based curriculum to objectively measure skill acquisition and learning curve.
Using simulators built and validated at the University of Washington (UW), the study sought to test whether medical students could learn the basic skills of focused cardiac ultrasound (FoCUS) from an individually paced, simulator-based curriculum, how skills improved, and the rate at which these skills were acquired. The study described the learning curve and technical skill acquisition in FoCUS. The investigators concluded that the simulator-based curriculum improved medical student's skills in an objective and quantifiable manner.
Citation: Elison DM, McConnaughey S, Freeman RV . Focused cardiac ultrasound training in medical students: using an independent, simulator-based curriculum to objectively measure skill acquisition and learning curve. Echocardiography 2020 Apr;37(4):491-96. doi: 10.1111/echo.14641..
Keywords: Education: Curriculum, Simulation
Anton NE, Bean EA, Myers E
Optimizing learner engagement during mental skills training: a pilot study of small group vs. individualized training.
This study compared small group versus individualized training results for a group of residents learning laparoscopic suturing. Residents at one institution completed small group training and the second institution completed individualized training. After mental skills training, the completed FLS training at which time they completed the Short State Stress Questionnaire detailing the training. Twenty-one residents completed the training. Individualized training showed greater engagement and mental skills than small group training.
Citation: Anton NE, Bean EA, Myers E . Optimizing learner engagement during mental skills training: a pilot study of small group vs. individualized training. Am J Surg 2020 Feb;219(2):335-39. doi: 10.1016/j.amjsurg.2019.12.022..
Keywords: Training, Education: Continuing Medical Education, Simulation, Surgery, Education: Curriculum
Gonzalez CM, Deno ML, Kintzer E
A qualitative study of New York medical student views on implicit bias instruction: implications for curriculum development.
The purpose of this study was to explore student perceptions of challenges and opportunities when participating in implicit bias instruction. The authors indicated that their analysis suggested a range of attitudes toward implicit bias instruction and identified contextual factors that may have influenced these attitudes. The themes were (1) resistance; (2) shame; (3) the negative role of the hidden curriculum; and (4) structural barriers to student engagement.
Citation: Gonzalez CM, Deno ML, Kintzer E . A qualitative study of New York medical student views on implicit bias instruction: implications for curriculum development. J Gen Intern Med 2019 May;34(5):692-98. doi: 10.1007/s11606-019-04891-1..
Keywords: Education: Curriculum, Education: Continuing Medical Education, Education: Academic
Anton NE, Beane J, Yurco AM
Mental skills training effectively minimizes operative performance deterioration under stressful conditions: results of a randomized controlled study.
This study demonstrated that giving residents mental skills training significantly increases performance during surgery under stressful conditions. A randomized controlled study was done with twenty-four residents to test laparoscopic suturing skills with and without external stressors. Both groups experienced decreased performance when stress was applied, but the group who had gone through the mental skills curriculum (MSC) significantly outperformed the control group. The researchers feel this finding supports including this training in the curriculum for surgical residents.
Citation: Anton NE, Beane J, Yurco AM . Mental skills training effectively minimizes operative performance deterioration under stressful conditions: results of a randomized controlled study. Am J Surg 2018 Feb;215(2):214-21. doi: 10.1016/j.amjsurg.2017.09.039..
Keywords: Education: Continuing Medical Education, Education: Curriculum, Stress, Surgery
Hanley K, Zabar S, Altshuler L
Opioid vs nonopioid prescribers: variations in care for a standardized acute back pain case.
This paper describes the design and use of an opioid-related unannounced standardized patient case (USP) used in a residency curriculum. Researchers designed and fielded an unannounced standardized patient case involving a patient with acute back pain who requested Vicodin (5/325 mg). They described residents' case management and examined whether their management decisions, including opioid prescribing, were related to their core clinical skills. The case designers found that most Vicodin prescribers did not follow prescribing guidelines, and demonstrated better communication and assessment skills than the nonprescribers. Results suggest the need to guide residents in using a systematic approach to prescribing opioids safely and to develop an acceptable alternative pain management plan when they decide against prescribing.
Citation: Hanley K, Zabar S, Altshuler L . Opioid vs nonopioid prescribers: variations in care for a standardized acute back pain case. Subst Abus 2017 Jul-Sep;38(3):324-29. doi: 10.1080/08897077.2017.1319894..
Keywords: Back Health and Pain, Education: Curriculum, Opioids, Practice Patterns
Sterling M, Leung P, Wright D
The use of social media in graduate medical education: a systematic review.
The authors conducted a systematic review of the peer-reviewed literature to understand the effect of social media on resident (1) education, (2) recruitment, and (3) professionalism. Their review of 29 studies concluded that the effect of social media platforms on residency education, recruitment, and professionalism is mixed, and the quality of existing studies is modest at best.
Citation: Sterling M, Leung P, Wright D . The use of social media in graduate medical education: a systematic review. Acad Med 2017 Jul;92(7):1043-56. doi: 10.1097/acm.0000000000001617.
Keywords: Education: Continuing Medical Education, Education: Curriculum, Provider, Social Media
Washington DM, Paasche-Orlow MK, Liebschutz JM
Promoting progress or propagating problems: strategic plans and the advancement of academic faculty diversity in U.S. medical schools.
The aim of this study was to investigate whether academic institutions that have engaged in strategic planning for faculty diversity, as exhibited by plan presence on their websites, had a higher rate of underrepresented minorities in medicine (URM) faculty growth than institutions who do not have evidence of such planning.
Citation: Washington DM, Paasche-Orlow MK, Liebschutz JM . Promoting progress or propagating problems: strategic plans and the advancement of academic faculty diversity in U.S. medical schools. J Natl Med Assoc 2017 Summer;109(2):72-78. doi: 10.1016/j.jnma.2016.10.001..
Keywords: Education: Curriculum, Racial and Ethnic Minorities, Workforce
Rinke ML, Mock CK, Persing NM
The Armstrong Institute Resident/Fellow Scholars: a multispecialty curriculum to train future leaders in patient safety and quality improvement.
The purpose of the study was to determine if a year-long, multispecialty resident and fellow quality improvement (QI) curriculum was feasible and led to improvements in QI beliefs and self-reported behaviors.
AHRQ-funded; HS021282; HS017952.
Citation: Rinke ML, Mock CK, Persing NM . The Armstrong Institute Resident/Fellow Scholars: a multispecialty curriculum to train future leaders in patient safety and quality improvement. Am J Med Qual 2016 May;31(3):224-32. doi: 10.1177/1062860614568523..
Keywords: Education: Continuing Medical Education, Education: Curriculum, Patient Safety, Quality Improvement
O'Toole JK, West DC, Starmer AJ
Placing faculty development front and center in a multisite educational initiative: lessons from the I-PASS Handoff study.
The authors describe their experience developing a multi-institutional faculty development program to support the I-PASS (IIPE-PRIS Accelerating Safe Signouts) Study and offer a set of generalizable strategies to guide the creation of other large-scale, multi-institutional faculty development programs. They conclude that the lessons learned inform a set of key strategies that can be applied to a broad range of similar large-scale faculty development projects in the future.
Citation: O'Toole JK, West DC, Starmer AJ . Placing faculty development front and center in a multisite educational initiative: lessons from the I-PASS Handoff study. Acad Pediatr 2014 May-Jun;14(3):221-4. doi: 10.1016/j.acap.2014.02.013.
Keywords: Education: Curriculum, Provider, Patient-Centered Healthcare, Transitions of Care
Pershing S, Fuchs VR
Restructuring medical education to meet current and future health care needs.
The authors ask whether the duration, sequencing, and requirements of medical education are appropriate to meet current and future challenges to medical care. They conclude that a much more agile system that prepares physicians to practice in a changing environment is needed. This will require change at both the macro regulatory level (e.g., accreditation bodies and specialty boards) as well as the micro level of individual programs taking initiative in innovation.
Citation: Pershing S, Fuchs VR . Restructuring medical education to meet current and future health care needs. Acad Med 2013 Dec;88(12):1798-801. doi: 10.1097/acm.0000000000000020..
Keywords: Education: Academic, Education: Continuing Medical Education, Education: Curriculum