Journal of general internal medicine
-
Diversity in the physician workforce is critical for quality patient care. Students from low-income backgrounds represent an increasing proportion of medical school matriculants, yet little research has addressed their medical school experiences. ⋯ Previously reported attrition and adverse academic outcomes among low-income students may be linked to challenges they experience trying to more fully meet important human needs. This finding underscores the need to approach wellness holistically and ensure students do not exist in a prolonged state of unmet needs. Recommendations that accreditation bodies and medical schools could implement to promote tailored support for low-income and other marginalized learners are provided.
-
Hospitalization is a "reachable" moment to engage people in addiction care. Addiction consult services (ACSs) have been shown to improve outcomes for hospitalized patients with substance use disorders (SUDs). Despite this, most hospital systems do not provide hospital-based addiction care or have an ACS. ⋯ Barriers to ACS implementation are common and significant and the process of obtaining leadership support for implementation is often long and iterative. Broad adoption of ACSs will require support from hospital systems and policymakers including incentives, funding, and infrastructure to support clinical champions.
-
The Experience of Undocumented Individuals Denied Stem Cell Transplant for Hematologic Malignancies.
Undocumented individuals with hematologic malignancies in the United States face barriers to receiving often-curative stem cell transplant (SCT), instead receiving inferior treatment with higher mortality. Federal and state policies' impact on undocumented individuals' lived experiences goes unnoticed. ⋯ Seven individuals (2 (29%) female, 5 (71%) male, mean age [SD] 44 [15.8]) were interviewed. Themes were divided into those unique to the undocumented immigrant experience and those unifying with the cancer illness experience. Themes unique to the immigrant experience Theme 1: Cancer and immigration status Debilitating cancer symptoms disrupt legal immigration process Feeling dehumanized when health insurance determines ability to live Fatalism and resignation to inadequate care Theme 2: Appreciation and Gratitude for Advocacy Awareness of physician advocacy Theme 3: Pride and purpose in the United States Desire to make a positive impact on society Pride in immigrants' contribution to US workforce Unifying themes related to cancer experience were Theme 4: Adversity related to cancer care and treatment Feeling dismissed and delayed diagnosis Financial hardships intensify emotional and physical burden Burdening family Social isolation Theme 5: Support and coping mechanisms Embracing positivity Religion as a source of comfort Critical support from family and friends Gratitude for compassionate care Appreciation for care that is unavailable in home country CONCLUSIONS: This unique population faces intersectional challenges due to immigration status, insurance access, and cancer. The experiences of undocumented individuals highlight the need for state policymakers to expand coverage for comprehensive cancer care.
-
Our purpose was to evaluate the characteristics of highly and poorly rated teachers as well as to assess the validity and reliability of those evaluations. ⋯ Most attendings received high ratings, while lower ratings were uncommon. Most teachers receiving lower ratings received more than one, suggesting that lower ratings may be a better discriminator of teaching effectiveness than outstanding ones. Teaching ratings had low inter-rater reliability, suggesting either low validity or that learners value different characteristics in teachers.