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Throughout the world, a record 68.5 million people have been forced from their homes due to war, conflict and persecution. The United States provided resettlement for 53,716 refugees in 2017 with 4,768 settling in Texas. Refugees face several challenges as they adjust to life in the US, including health problems. Current literature exploring healthcare needs of the resettled refugee population is focused on refugees' self-perspective and /or databank sources. To enhance the understanding of refugee healthcare needs in south Texas, we aimed to examine the issue from the perspective of health and social service professionals who work regularly with refugees. Participants for this initiative were recruited through purposive sampling. Between August 2015 and February 2016, seventeen professionals participated in one-on-one interviews that were recorded, transcribed, and analyzed for themes. We used a semi-structured interview guide based upon community assessment models. Themes that emerged included 1) noncommunicable chronic conditions are most common and often masked, undiagnosed, or present with a complaint of pain; 2) the importance of reflective listening, cultural sensitivity and understanding the refugee experience; and 3) limited access to healthcare exacerbates vulnerable health states. These findings highlight the need for healthcare professionals to be aware of undiagnosed conditions and somatization of mental health issues among refugees, as well as providing guidance for cultural sensitivity training for professionals. Lastly, refugees need improved access to care that is community-engaged, affordable, and incorporates health promotional activities. Policymakers in Texas should pursue healthcare reform to tackle the foremost barrier to healthcare, which is cost. [ABSTRACT FROM AUTHOR]

The article offers information on San Antonio Refugee Health Clinic (SARHC), Texas in overcoming the barriers refugees face when accessing health care as of 2014. The topics discussed include "Assessing Barriers to Healthcare Access Among Refugees Living in San Antonio, Texas" published in a past issue, inter-professional education (IPE) among the different disciplines of medicine. Also discussed is the potential impact of U.S. Affordable Care Act (ACA) in improving health care coverage.

Introduction: Now widespread in emergency medicine (EM) residency programs, asynchronous curriculum (AC) moves education outside of classic classrooms. Our program's prior AC had residents learning in isolation, achieving completion via quizzes before advancing without the benefit of deliberate knowledge reinforcement. We sought to increase engagement and spaced repetition by creating a social AC using gamification., Methods: We created a website featuring monthly options from textbooks and open-access medical education. Residents selected four hours of material, and then submitted learning points. Using these learning points, trivia competitions were created. Residents competed in teams as "houses" during didactic conference, allowing for spaced repetition. Residents who were late in completing AC assignments caused their "house" to lose points, thus encouraging timely completion., Results: Completion rates prior to deadline are now >95% compared to ~30% before intervention. Surveys show increased AC enjoyment with residents deeming it more valuable clinically and for EM board preparation., Conclusion: Socially synchronized AC offers a previously undescribed method of increasing resident engagement via gamification., Competing Interests: Conflicts of Interest: By the WestJEM article submission agreement, all authors are required to disclose all affiliations, funding sources and financial or management relationships that could be perceived as potential sources of bias. No author has professional or financial relationships with any companies that are relevant to this study. There are no conflicts of interest or sources of funding to declare.