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Proposed Topics

Cultural Competence

Strategic Map Priority:
A. Educate Outstanding Graduates Who Meet the Needs of the State and Its Communities

Strategic Map Strategy:
A4. Provide Training and Development to Increase Graduates’ Readiness Across Missions

Brief Summary of Proposal
As the U.S. becomes more diverse, our graduates must be prepared to live and work in an increasingly multicultural environment. Raising the cultural competence of health care professionals is key to dealing effectively with individuals from varying backgrounds. Cultural competence in health care refers to the ability to provide care to patients with diverse values, beliefs and behaviors, tailoring delivery to meet their social, cultural and linguistic needs. A Quality Enhancement Plan designed to address cultural competency in students at UTHSC would improve our students’ interactions with those they serve. and their patients. educational and clinical program will address this issue.

It has long been recognized that many health inequities exist in Memphis. Disparity in health status across our diverse population is evident in life expectation, disease and mortality. Examples are the prevalence of stroke, diabetes, heart disease, cancer, and infant mortality. Higher rates of death, disease and disability are particularly found among populations of color and the poor.

In stark juxtaposition to the troubling health status of Memphis is the University of Tennessee Health Science Center, with its mission of bringing the benefits of the health sciences to the achievement and maintenance of human health, with a focus on the citizens of Tennessee and the region.

The literature is replete with research studies and publications that submit that a meaningful way to improve health outcomes, i.e., to bring the benefits of the health sciences to the citizens of the state and region, and to eliminate health inequity is to address the cultural competence of healthcare providers. The theoretical framework for this project will be cultural humility. Cultural humility incorporates a lifelong commitment to self-evaluation and self-critique, to redressing the power imbalances in the patient-physician dynamic, and to developing mutually beneficial and nonpaternalistic clinical and advocacy partnerships with communities on behalf of individuals and defined populations” (Tervalon and Murray-Garcia, 1998). There are many definitions of cultural competence. Betancourt, Green and Carrillo (2002) cite that cultural competence in health care refers to the ability to provide care to patients with diverse values, beliefs and behaviors, tailoring delivery to meet patients’ social, cultural and linguistic needs.

QEP Programming
The planning process will require campus and community collaboration and will address the impactful outcome that UTHSC students will: 1) demonstrate a progression in their lifelong development of cultural competence; 2) be able to practice effectively within the context of the cultural beliefs, practices, and needs presented by patients and their communities; and, 3) conduct culturally respectful research (AAMC, 2005).

Programmatic objectives will include:

  1. understanding the relationships among race and ethnicity, social class, disability status, gender, sexual orientation, age, and religion on health beliefs, practices, status and outcomes;
  2. reflection about one’s culture and one’s biases;
  3. understanding of the impact of cultural stereotyping and insensitivity of practitioners and systems;
  4. development of culturally effective communication skills; and,
  5. understanding ways to achieve culturally competent care in health care.

Sample Instructional strategies include:

  1. campus, local and national experts speaking on cultural influences on health;
  2. readings,
  3. online instruction;
  4. reflective journaling;
  5. directed cultural immersion so students can appreciate the value of cultural competence,
  6. small-group interaction, and
  7. interprofessional collaboration.

Data Supporting Need for the Project:
SACSCOC requires a direct and strong relationship of the QEP topic to institutional needs. Therefore, data must be obtained to demonstrate institutional need for a campus-wide cultural competence program. Curriculum mapping is one way to gather institutional data. To assess gaps in the curriculum, faculty will be asked to examine where in course syllabi cultural diversity subject matter is included. Additional assessment mechanisms will be developed.

Sample Student Learning Outcomes:
Each students’ personal development of cultural competence, can be scored from: Level 1: No insight about the influence of culture on health care, to Level 5: Integration of attention to culture into all areas of interprofessional practice, with assessments being conducted at determined intervals (Crandall et al., 2003).

Students will:

  • Identify impact of practitioner bias and stereotyping on interaction with patients (knowledge, AAMC 2005).
  • Use negotiating and problem-solving skills in shared decision-making with a patient (skills, AAMC 2005).
  • Ask questions and listen to patients discuss their health beliefs in a nonjudgmental manner (attitudes, AAMC 2005).
  • Understand the impact of race and ethnicity, social class, disability status, gender, sexual orientation, age, and religion on health beliefs, practices, status, and outcomes.
  • Understand own cultural beliefs and perspectives
  • Describe how subconscious and conscious bias impacts delivery of care

Submitted by: Noma Anderson & Ashanti Braxton

Leadership in Healthcare

Strategic Map Priority:
A. Educate Outstanding Graduates Who Meet the Needs of the State and Its Communities

Strategic Map Strategy:
A4. Provide Training and Development to Increase Graduates’ Readiness Across Missions

Brief Summary of Proposal
Justification
Healthcare is an ever-changing landscape confronted with varying workforce, consumer, fiscal, and quality challenges. Effective leadership is a key ingredient to ensuring a high-quality health delivery system. Leadership in healthcare is very often complex and faces unique contextual challenges. To accomplish this commitment, the university must be intentional in educating students how to succeed in various leadership roles, helping them identify and develop their strengths, and consider plans for further leadership development. For optimum results, leadership development opportunities must also extend to faculty. Methods must be interprofessional, innovative and empowering. UTHSC is uniquely positioned to accomplish this with its new Interprofessional Simulation and Patient Safety Center. UTHSC students can emerge as leaders in their individual areas in a variety of ways.

QEP Programming
The goal of QEP Programming would be to teach students how to succeed in various leadership roles, identify their strengths, and consider plans for further leadership development in their professional career. A sample of QEP activities may include:

  • Personality type assessment and understanding
  • Emotional intelligence assessment and understanding
  • Participation in Interprofessional panels focused on different areas of healthcare leadership
  • Application of shared mental models for teamwork that underscore the importance of leadership
  • Various leadership sessions on topics such as: motivation, negotiation, patient safety, ethics, finances, etc.

Any of the leadership development initiatives should be interprofessional, diversity based, adaptive, experimental, innovative and empowering.

Data Supporting Need for the Project:
Effective leadership is globally recognized as essential to a high-quality health care delivery system.1-3 Literature supporting clinical leadership is available for most healthcare professions including nursing4, medicine5 and pharmacy6. Importance of leadership development in other graduate students is also available.7

Sample Student Learning Outcomes: Sample outcomes may include:

  1. Students will demonstrate techniques for effective change,
  2. Students will identify personal leadership strengths and how strengths may be applied to everyday challenges,
  3. Students will articulate a personal leadership style,
  4. Students will demonstrate successful communication strategies.
  5. Articulate the characteristics of good leadership and the different types of leadership, (e.g., Transformational, Collaborative, Transactional)
  6. Develop a personal profile of leadership traits and goals for future leadership development
  7. Create a leadership vision and communication plan to share the vision based on the mission of a healthcare system
  8. Identify strategies to support different cultures and approaches to healthcare
  9. Work effectively in interprofessional teams

Resources for administering QEP programming including personality and EI assessments.

  1. Department of Health. High Quality Care for All, NHS Next Stage Review Final Report (The Darzi Report). London, UK: Department of Health. Available from: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/228836/7432.pdf. Accessed Feb 12, 2017
  2. Francis R. Report of the Mid Staffordshire NHS Trust Public Inquiry-Executive Summary. London, UK: The Stationary Office; 2013. Available from: http://www.midstaffspublicinquiry.com/sites/default/files/report/Executive%20summary.pdf. Accessed Feb 12, 2017
  3. Garling P. Final Report of the Special Commission of Inquiry: Acute Care in NSW Public Hospitals, 2008 – Overview. Sydney, NSW: NSW Government., Available from: http://www.dpc.nsw.gov.au/__data/assets/pdf_file/0003/34194/Overview_-_Special_Commission_Of_Inquiry_Into_Acute_Care_Services_In_New_South_Wales_Public_Hospitals.pdf. Accessed Feb 12, 2017
  4. Emerging nurse leader seminar provides inspirational topics related to leadership. (2016). Tennessee Nurse, 79(2), 9
  5. Abbas, M. R., Quince, T. A., Wood, D. F., & Benson, J. A. (2011). Attitudes of medical students to medical leadership and management: A systematic review to inform curriculum development. BMC Medical Education, 11(1), 93.
  6. Feller, T. T., Doucette, W. R., & Witry, M. J. (2016). Assessing opportunities for student pharmacist leadership development at schools of pharmacy in the United States. American Journal of Pharmaceutical Education, 80(5).
  7. Jackson, V. (2012). Service learning and student organization initiatives: Facilitating leadership among graduate students. Internet Journal of Allied Health Sciences & Practice, 10(1), 4p-4p.

Submitted by: Chad Epps & Bob Hannah

Professionalism

Strategic Map Priority:
A. Educate Outstanding Graduates Who Meet the Needs of the State and Its Communities

Strategic Map Strategy:
A2. Support Innovation & Adapt to Evolving Educational Models
A4. Provide Training and Development to Increase Graduates’ Readiness Across Missions

Brief Summary of Proposal
Health care professionals are faced with ethical dilemmas every day. It is essential students develop skills to assume the mantle of professionalism required by their disciplines. Only then, will our graduates be prepared to face and appropriately deal with the ethical dilemmas they will encounter in practice. Designing curricular and campus activities to enhance professionalism will prepare students to with the tools they need for their academic and clinical careers.

This QEP would study the issue of professionalism across all academic disciplines, identify areas that need improvement, develop and implement recommendations for intervention, and assess the outcomes of the interventions.

In recent years, the professions of pharmacy, medicine and nursing (among others) have all identified a need for improvement in the level of professional behavior of their respective members. Each profession has identified a need for curricular changes aimed at improving the professional attitudes and behaviors of students in their respective programs. Based on feedback from preceptors and employers, and on the anecdotal experience of individual faculty members, there is reason to believe that these nationally-identified concerns apply in some measure to our own student body. The purpose of this QEP would be study the issue of professionalism across all academic disciplines; identify areas of commonality that need improvement; develop and implement recommendations for intervention; assess the outcomes of the interventions; and modify the program as indicated.

Data Supporting Need for the Project
A QEP Steering Committee will be identified that is inclusive of all academic, student and staff constituencies. A fundamental group of articles will be identified and distributed to the Committee prior to the first face to face meeting. The Committee (and appropriate sub-committees) will be charged with developing the plan that will highlight and infuse professionalism across the campus, thus adopting/enhancing a culture of professionalism across the campus.

Healthcare professionals are faced with ethical dilemmas every day. The following scenarios demonstrate the need for continued ethics training and development to prepare students for situations where they may find themselves in an ethical dilemma.

  • Patient Freedom Versus Healthcare Professional Control
    Health care professionals are highly educated and therefore aware of the best clinical course of action when one exists. But what happens when a patient rejects medical advice and makes a decision that may result in less optimal outcomes? From deciding whether or not a labor and delivery patient would benefit from pain medication, to encouraging a patient to eat when they are refusing food, nurses walk a fine line every day. While nurses do not sign the Hippocratic Oath, they are still bound by the promise to devote themselves to the welfare of the patients committed to the care, as well as to live up to the standards of the profession.
  • Reproductive Rights
    The pro-choice vs. pro-life argument is an intensely personal one based on an individual's core set of values and beliefs. If you are pro-life, can you support a patient’s right to an abortion? If you are pro-choice, can you respect a patient’s choice to continue a pregnancy even if it threatens her own life?
  • Honesty vs. Information
    Families will often choose to withhold truthful information to “protect” a patient from emotional distress. For healthcare professionals, this poses another common ethical dilemma: does a patient have the right to know everything about their condition, even if sharing the information will cause harm? Is honesty always best? What if sparing a patient this information can promote happier, less stressful final days? Deciding what information will be shared – along with how and when to share it – can be a difficult part of a professional’s responsibilities. Web reference: http://elearning.loyno.edu/masters-nursing-degree-online/resource/ethicalissues-in-nursing

The literature concerning medical education contains numerous references to the need for and the importance of teaching and assessing professionalism. There, however, does not appear to be a common definition of medical professionalism used across medical education. In addition, there is no particular theoretical model supported by medical schools to design and develop curricular elements that teach and assess medical professionalism. (Archer et al., 2008)

Because there no uniform definition of professionalism, it is imperative that we develop a standard/acceptable definition for our campus as well as criteria that support professionalism.

Sample Student Learning Outcomes

  1. Improve the professional attitudes and behaviors in all students
  2. Assess/improve/model the professional attitudes of faculty and staff
  3. Display honesty and integrity in all interactions
  4. Demonstrate caring, compassionate care
  5. Assume responsibility for self-learning and all actions for your education
  6. Recognize and avoid conflict of interests
  7. Identify and recognize conscious and unconscious bias
  8. Work effectively as a team member
  9. Exhibit knowledge and understanding of the discipline of ethical studies.
  10. Develop and utilize skills in ethical decision making.
  11. Heighten capacity for self-examination through learning environments that encourage critical thinking and self-assessment in matters of morality and social integrity.
  12. Internalize a commitment to life-long ethical leadership in their careers and communities.

Submitted by MaryAnn Clark & Chandra Alston

Social Determinants of Health

Strategic Map Priority:
A. Educate Outstanding Graduates Who Meet the Needs of the State and Its Communities

Strategic Map Strategy:
A4. Provide Training and Development to Increase Graduates’ Readiness Across Missions

Brief Summary of the Proposal
Social and economic factors can interfere with the ability to remain healthy. Everything from safety in the community, access to healthy food, availability of safe housing, and adequate public transportation affect our health status, and must be included in the health professional’s assessment of need when interacting with a patient. Across the nation, health professions education programs are becoming aware that traditional “medical model” of care is inadequate for improving overall health in a population, and reducing health disparities and inequities. Programs must focus on familiarizing students with social determinants as well as the impact of health disparities on vulnerable populations. UTHSC has the opportunity to make Shelby County and Memphis a learning laboratory through partnerships that have as the ultimate goal – providing accessible, high quality care to all.

Good health starts in our homes, schools, workplaces, neighborhoods, and communities. We train our students to understand what is needed to be and remain healthy using a medical model (i.e., presence of illness directs interaction with healthcare system) but often neglect teaching them the social factors that interfere with accomplishing this goal. Failure to recognize the challenges facing many communities related to eating well and staying active, not smoking, getting the recommended immunizations and screening tests, and seeing a doctor for preventive care, before we get sick, often results in frustration in the health professional and missed opportunities to assist patients in utilizing available social and economic community supports.

There is now adequate knowledge and available scientific evidence to appreciate the role of social factors in having good health. Preparation will focus on a review of the literature in this area and existing training curricula to shape the design of a Social Determinants of Health training curriculum customized to the UTHSC/Shelby County community. This will include identifying the key social factors that create barriers to achieving improved health outcomes, creating metrics to determine effectiveness of our approach, and measuring student satisfaction (personal and professional) with this learning approach.

Data Supporting Need for the Project
Preliminary literature review indicates:

  1. Most of the evidence on the effectiveness of physician intervention in SDOH is from small scale, observational studies.
  2. Healthcare providers recognize social determinants influence health of patients but are unsure how to intervene.
  3. Healthcare providers can be trained to adequately address SDOH. Interventions are available to address known SDOH.
  4. Communities (individuals and organizations) can be engaged in working with health care professionals to address SDOH.
  5. Health professional schools that incorporate training in SDOH report positive impact on learning and attitudes of students, students more likely to stay in rural or disadvantaged areas, students more skilled in meeting the needs of underserved communities.
  6. Failure to identify social challenges can lead to 'misdiagnosis and inappropriate interventions.
  7. Student comments (from participants in training programs that include SDOH in the curriculum): "There is a limit to how much you can learn from reading about social determinants of health - understanding a community and its specific health challenges comes from interacting directly with community members and building their trust", "The better we know our patients, the better we can serve them. This type of course should be a critical component to our formal education in any health care setting."
  8. Participating students provided two primary suggestions for improvement: a) spend less class time on lectures and more time on facilitated group discussion, and 2) provide more hands-on guidance in planning and implementing community-based projects.

Sample Student Learning Outcomes

  1. Demonstrate an increased clinical competency related to understanding the social factors that affect effectively addressing health needs of a diverse community
  2. Demonstrate ability to identify and describe appropriate responses and utilization of community resources in providing optimal patient care
  3. Demonstrate ability to create a sense of connection between
  4. health professionals and the surrounding community
  5. Demonstrate increased student satisfaction with their role as a health
  6. Identify strategies to assess social determinants of health
  7. Value the principle that good health is a human right
  8. Understand how personal values and beliefs can impact delivery of care
  9. Demonstrate knowledge of health disparities, their impact on health and strategies for elimination of disparities
  10. Identify health outcomes from an individual and population perspective
  11. Identify the “upstream” causes of disparities

Submitted by: Michael Alston, Kelley Smith, Altha Stewart

Wellness & Resilience

Strategic Map Priority:
A. Educate Outstanding Graduates Who Meet the Needs of the State and Its Communities

Strategic Map Strategy:
A2. Support Innovation & Adapt to Evolving Educational Models
A4. Provide Training and Development to Increase Graduates’ Readiness Across Missions

Brief Summary of Proposal
It’s no secret that health science students face academic, clinical, and personal demands that can hinder their success. Without adequate support and training in how to cope with the stress they face, mental and physical health can suffer. For example, medical students have rates of depression 15 to 30 percent higher than the general population. A focus on resilience and wellness can lessen the impact of stressors associated with the rigors of the academic and clinical curricula and the demands of the health professions. Fostering wellness and resilience could enhance students’ biopsychosocial functioning and skill mastery during their academic careers and beyond. Institutions play an integral role in preparing students not only for the explicit curriculum but also those silent factors needed to be successful professionally and personally.

Data Supporting Need for the Project

  • According to the American Foundation for Suicide Prevention, medical students have rates of depression 15-30 percent higher than the general population.
  • From a UTHSC student survey, anxiety and adjustment are the two most crucial factors in thriving in this environment.
  • Among medical students, suicide is the second most common cause of death.
  • 13.6% of medical students exhibited probably major depression.
  • The suicide rate for female physicians is 250-400 percent higher than the general population.

Sample Student Learning Outcomes

  1. Demonstrate skills to handle the emotional, academic, social and physical demands of the health science curricula and health science professions.
  2. Engage in activities and programs on campus and online focused on mental hygiene, wellness, suicide and substance abuse prevention.
  3. Increase help-seeking behaviors of students in distress including under represented students who may be impacted by health disparities.
  4. Develop personal wellness plan and track progress
  5. Evaluate interpersonal skills as a mechanism to develop strong, healthy relationships with others
  6. Articulate the links between health and wellness to academic and personal success
  7. Summarize research on resilience and wellness

Last Published: Dec 8, 2017