Category Archives: Voices from the Field
Italo M. Brown, MPH, is a third year medical student at Meharry Medical College. He holds a BS from Morehouse College, and an MPH in epidemiology and social and behavioral sciences from Boston University, School of Public Health. He is a Health Policy Scholar at the Robert Wood Johnson Foundation Center for Health Policy at Meharry Medical College.
In an ad-hoc poll among classmates, I recently inquired about the most important date (in 2013) to a second year medical student. The overwhelming majority of respondents cited their respective STEP 1 exam dates as most important, followed closely by the season finales of ABC’s Scandal and Grey’s Anatomy. While the top three responses are noteworthy, the one date that should bear the most gravity in the minds of medical students across cohorts is October 1st.
This October marks the launch of open enrollment for health insurance exchanges, a much-anticipated provision of the Affordable Care Act (ACA). The ACA seeks to reduce the number of nonelderly uninsured Americans by half; in other words, a projected 20 million new patients will enter the health care system over the next 18 months.
Imani Baker is an alumna of Project L/EARN, a graduate education preparation program supported by the Robert Wood Johnson Foundation (RWJF). She recently earned her bachelor’s degree in public health from Rutgers, the State University of New Jersey, and plans to become a nurse practitioner.
The two words that I can use to describe my journey through Project L/EARN are: life changing.
I learned about the RWJF-funded program from an advisor who referred me to its faculty program director, Jane Miller, PhD. Dr. Miller warned me that the program would be “intense” and “much more work than you are used to.”
However, there are no words that could have ever prepared me for what I was about to experience that summer. Before I was admitted to Project L/EARN, I was not confident in my abilities to compete outside of my comfort zone, which included subjects specifically related to the health sciences.
This program forced me to face many of my weaknesses and confront my worst fears head on. Each day, I was overwhelmed with self-doubt. I was not the best public speaker; I struggled in statistics; and there were times when I questioned why I was picked for the program.
I said to myself, “I want to be a nurse. I don’t want to sit behind a computer and look at numbers all day. What did I get myself into?” However, my mentor, Dr. Judith Lucas, EdD, RN, GCNS-BC, taught me why it was so important for nurses to be involved in research and to have advanced graduate degrees.
During the week of April 15, the United States faced several natural and man-made disasters: the Boston Marathon bombings, an explosion at a Texas fertilizer plant, and ricin-laced letters mailed to politicians. Federal and local officials—including Nicole Lurie, MD, MSPH, an alumna of the Robert Wood Johnson Foundation (RWJF) Clinical Scholars program (1982-1984) and assistant secretary for preparedness and response at the U.S. Department of Health and Human Services—were ready, and quickly responded to these events.
In the second video in a series of RWJF Clinical Scholars Health Policy Podcasts, Clinical Scholar Chileshe Nkonde-Price, MD, interviews Lurie about that week and the state of the country’s disaster preparedness. They also explore the impact of budget cuts on public health jobs, and what aspects of disaster response are ripe for scholarly study.
The video is republished with permission from the Leonard Davis Institute.
Efrain Talamantes, MD, MBA, is a Robert Wood Johnson Foundation/U.S. Department of Veterans Affairs Clinical Scholar at the University of California, Los Angeles. This is part of a series of posts looking at diversity in the health care workforce.
Diversity in health care is critical in providing quality health care to all Americans. As physicians, we care for patients from all walks of life and we strive to heal with our expertise, compassion and open-mindedness. Our health system and patients benefit greatly from health professionals who can speak and understand different languages, and who always strive to understand different backgrounds, cultures, practices, and beliefs. Research shows that diversity in the health care workforce enhances training for health professionals and improves access to quality health care.
There is an unprecedented demographic transformation happening in our country today; the majority of births are from Hispanics, Blacks, Asians and other racial and ethnic minorities. Since 1985, the number of underrepresented ethnic and racial minority medical school applicants, matriculates, and graduates has leveled off at about 15 percent, while their representation in the U.S. population has been nearly twice as high—and they are on pace to become the majority.
Deborah Gross, DNSc, RN, FAAN, is the Leonard and Helen Stulman Endowed Chair in Mental Health & Psychiatric Nursing at the Johns Hopkins University Schools of Nursing, Medicine, and Public Health. She is also an alumna of the Robert Wood Johnson Executive Nurse Fellows program (2006-2009).
As a child psychiatric nurse, my mission is to make a difference in the lives of families with young children, particularly those living in low-income, urban communities.
There is now wide consensus that early childhood is the most cost-effective time for targeting prevention and early intervention. The foundation for children’s mental health is formed during the first five years of life, when 90 percent of brain development occurs. Since parents are the primary mediators of their young children’s earliest social and learning environments, any effort to promote mental health in young children must first and foremost engage parents and help them build up their strengths and caregiving capacities.
Nearly 20 years ago, I began searching the literature for parenting programs that had a strong evidence base and demonstrated substantial and enduring effects on parenting quality and children’s behavior. What I discovered is that the strongest programs available had been originally developed and tested on White, middle-class families. As a result, their content and delivery methods were often built on values and assumptions many families I knew could not relate to.
Amal Trivedi, MD, MPH, is an alumnus of the Robert Wood Johnson Foundation/U.S. Department of Veterans Affairs Physician Faculty Scholars program. He is an assistant professor of health services, policy and practice at Brown University and a hospitalist at the Providence VA Medical Center. His co-author, Danya Qato, PharmD, MPH, is a pharmacist and doctoral candidate in health services research at Brown University. They recently published a study that finds older patients are routinely prescribed potentially harmful drugs, particularly in the South.
Human Capital Blog: Why did you decide to look at this particular topic? And why are some drugs considered high-risk for elderly patients?
Danya Qato and Amal Trivedi: Adverse drug events are an important public health problem. For the elderly, such events are often precipitated by use of potentially inappropriate or high-risk medications. Over the past several decades, clinicians and researchers have sought to identify medications that should be used with caution in the elderly. These high-risk medications should be avoided among people 65 years of age or older because the associated adverse effects outweigh potential benefits or because safer alternatives are available. Elderly patients are susceptible to these medications because they have more chronic illness, greater frailty, and an altered ability to metabolize drugs. The Centers for Medicare and Medicaid Services now require all Medicare Advantage plans to report on the use of high-risk medications among their enrollees.
We undertook this study because successful efforts to reduce high-risk medication use in the elderly require knowledge of how prescribing of these agents varies geographically and the factors that predict their use. Half of persons aged 65 and older use three or more prescription medications a day. Therefore, potentially inappropriate use of medications in the elderly has important implications for health care spending and quality.
Martin Schiavenato, PhD, RN, is an assistant professor at the University of Miami School of Nursing and Health Studies, and a Robert Wood Johnson Foundation Nurse Faculty Scholar. This is part of a series of posts looking at diversity in the health care workforce.
It is human nature. The old adage “opposites attract” is a myth; in fact, the contrary is true. We feel more comfortable with and welcome those who share in our definition of “us” than not. Accordingly, this also forms the basis to how we define “them.” It is intuitive that we feel connected to and prefer those who share in what we believe to be our experience, and that we are suspicious and even spurn those who we feel do not. This phenomenon is referred to by psychologists as “in-group bias.”
"When it comes to providing best clinical care, race and culture matter."
In my field of pain research, there is ample documentation of how clinician preferences impact the care of patients. Clinicians better address pain management in patients who “match” their reference group or their preferences more closely. For example, better pain care is given to patients who speak the same language, are of similar socioeconomic status, or even those considered more attractive to the clinician. Subtle cues from the patient—their physical appearance, the circumstances that brought them to seek care, their behaviors and expressions—all will have a consequence on the nature of the care that they will receive. Thus, the race and culture of the clinician have the potential to be significant contributors in the quality of care that a patient will receive. This inherent tension between “us” and “them” may be particularly relevant in a country with a history of institutionalized racism.
Mable Smith, PhD, JD, MSN, BSN, RN, is founding dean of the College of Nursing at Roseman University of Health Sciences (formerly the University of Southern Nevada) and an alumna of the Robert Wood Johnson Foundation Executive Nurse Fellows program. This is part of a series of posts looking at diversity in the health care workforce.
A diverse nursing student body builds the foundation for a diverse workforce that can become effective in the provision of culturally competent care to patients. Our student body at Roseman University of Health Sciences is reflective of the diversity seen in the population that consists of Caucasians, African Americans, Hispanics, Asians, Native Hawaiian and other Pacific Islanders, to name a few. This diversity is reflected in the health care system among workers and patients. Students bring a wealth of information that is shared with each other and with faculty.
For example, in a class discussion on nutrition, students from various cultures shared how and what types of foods are used to treat certain illnesses. There were discussions on how food should be presented, such as hot versus cold, raw versus cooked. Some students shared the significance of family presence during meals even for hospitalized patients. These discussions quickly incorporated religious practices and certain etiquettes to promote “religious correctness” when interacting with various cultural and religious groups. Students also provided insight into generational differences and changes with emphasis on the fact that many in the younger generation have not adopted the strict traditions of their parents and grandparents.
Richard W. Valachovic, DMD, MPH, is the president and CEO of the American Dental Education Association (ADEA) and co-director of the Robert Wood Johnson Foundation (RWJF) Summer Medical and Dental Education Program. ADEA is also a partner in the Dental Pipeline National Learning Institute project supported by RWJF. This post originally appeared on the blog of the Sullivan Alliance. This is part of a series of posts looking at diversity in the health care workforce.
Despite significant recent efforts and investments by the American Dental Education Association (ADEA), various foundations, and many others, there has not been significant substantial increase in the percentage of underrepresented minorities (URMs) entering dental schools.
For example, the National Dental Pipeline Program, which is funded by the Robert Wood Johnson Foundation, has helped dental schools increase access to dental care for underserved populations. Specifically, the Dental Pipeline Program aimed to increase cultural competency of all students, educate dental students through community rotations in health centers and other safety-net settings, and to recruit and admit more students who come from underserved communities. A complementary program, the Summer Medical and Dental Education Program (SMDEP) is a six-week summer residential program funded by the Robert Wood Johnson Foundation and led by ADEA and the Association of American Medical Colleges (AAMC) that strengthens the knowledge and skills of underserved college students in order to increase their chances of getting into medical and dental schools. Throughout the 2000s, the program helped to increase the number of URM applicants and enrollees. However, during this same period the overall number of applicants grew dramatically by 55%, which means the growth in non-URM applicants has overshadowed the URM applicants and now we see a leveling off of the number of African American applicants, which is of great concern.
LisaMarie Turk, RN, MSN, is a fellow with the Robert Wood Johnson Foundation Nursing and Health Policy Collaborative at the University of New Mexico, working toward a PhD in nursing with a health policy concentration. She was awarded a Hearst Foundation Scholarship in 2010. This is part of a series of posts looking at diversity in the health care workforce.
Ample scientific and empirical evidence supports increasing diversity in the health care workforce in order to decrease health disparities and advance health equity.
I am a registered nurse and PhD student in Nursing and Health Policy at the University of New Mexico. New Mexico is known for its depth of cultural diversity; however, this state joins the nation in experiencing negligible diversity in its health care workforce.
I was honored with the opportunity to complete a policy internship focusing on nursing workforce diversity at the Division of Nursing of the Health Resources and Services Administration’s Bureau of Health Professions. From this experience, I gained increased awareness and resources to affect change in nursing and health care workforce diversity in New Mexico.