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The application of continuous systems improvement in medical education can provide actionable information for curriculum development, improvement, and future planning (as reported by Bowe and Armstrong, Acad Med 92:585-92, 2017). After receiving a medical education grant, we developed a curriculum to teach medical students how to use quality improvement (QI) to address health disparities in vulnerable populations. During the process of developing and implementing this curriculum, we learned several lessons.One of the major surprises was that our proposed project work took much longer to complete than anticipated. This was mainly because we did not have the right team assembled from the beginning. Specifically, we were missing a team member with evaluation expertise, and therefore we did not devise a systematic process for evaluation and assessment. Without periodic checks or timely assessments built into our curriculum design, we received feedback from students after it was too late to implement changes. We realized that our initial research design had some methodological flaws, which we later rectified.We encountered additional technical challenges during the curriculum implementation. We struggled with various online learning platforms. Through this, we learned the importance of being knowledgeable upfront about the features of learning platforms and adaptable to changing educational technologies. We also learned our curriculum could and should evolve to meet the needs of our learners and faculty. Moving forward, we realize the benefit of applying a quality improvement process to our curriculum development and implementation, which will help us to continuously transform medical education for future health care needs.

IntroductionMedical providers' attitudes about caring for vulnerable populations have significant implications for persistent health disparities. Therefore, assessing medical students' self-perceived knowledge about community-based medicine and care for underserved populations can provide insights for improving health care delivery to achieve health equity. We evaluated third-year medical students' perceptions of their knowledge and attitudes about community medicine, and addressing health care needs of vulnerable populations.MethodsFrom October 2, 2017 to July 12, 2019, third-year medical students at a private, urban medical school were asked to complete an assessment survey during their family medicine clerkship orientation. The anonymous survey assessed students' self-perceived knowledge and attitudes regarding community medicine and care of vulnerable populations. We examined differences in survey responses by student demographics.ResultsA total of 401 students participated in the survey; 50.5% of respondents agreed that they had knowledge to assess health literacy of the patient, while only 22.2% of students agreed that they had knowledge about how to identify a community and conduct a community health needs assessment. Additionally, students agreed with being most comfortable providing care to adolescents (73.0%) and the elderly (69.5%), and that they were least comfortable caring for incarcerated individuals (31.7%) and immigrants/refugees (44.1%).ConclusionAssessment of learners' self-perceived knowledge can help highlight areas for educational interventions. Our findings suggest the need for improving medical student knowledge in areas of community health and health care for specific vulnerable populations.

Introduction: Although menstruation is a natural biological process, many people feel embarrassed of their menses and struggle to discuss it. To mitigate menstrual communication stigma, it is necessary to first elucidate communication experiences and perceptions. Thus, we qualitatively explore menstrual communication among cisgender women who menstruate and their family, friends, healthcare providers, and community. Methodology: In partnership with No More Secrets (NMS), a Philadelphia menstrual health non‐profit, we conducted a community‐based participatory research (CBPR) project in Fall 2020. Cisgender, menstruating individuals ages 18–45 recruited from NMS' catchment in Philadelphia participated in semi‐structured interviews about their menstrual experiences and communication (N = 20). A deductive, theory‐driven approached based on the social‐ecological model was used to analyze the data. Results: Varying emotional responses arose across social‐ecological levels: communication was awkward and simplistic with family; positive and supportive with friends and community members; and uncomfortable and frustrating with healthcare providers. Participants echoed the importance of menstrual communication as a means of sharing information, feeling less alone, and decreasing menstrual stigma. Discussion: Findings can inform future CBPR workshops that address stigma in familial, healthcare, and community‐based discussions to improve menstrual health and experiences for cisgender girls and women, transgender men, and gender non‐binary individuals who menstruate. [ABSTRACT FROM AUTHOR]

One-third of U.S. adults have prediabetes, but only 11% are aware of their condition. Many do not receive education or treatment. The purpose of this study is to understand family medicine providers' and patients' attitudes, knowledge, and behaviors regarding prediabetes and its management, to guide future management interventions. Cross-sectional surveys of providers (n = 54, 57% response rate) and patients with prediabetes (n = 148, 16.5% response rate) were administered at a large urban academic family medicine practice. Nearly all providers agree prediabetes screening is important, but over half were unaware of the national Diabetes Prevention Program (DPP) and most do not prescribe metformin to eligible patients. Over half of patients reported being told they have prediabetes but <5% had been referred to DPP and over half were unaware of medication options. In open-ended responses, providers suggested nutrition counseling resources and an improved DPP referral process to improve prediabetes care. Patients requested clear diagnosis, education on treatment options, and nutritional counseling. This study indicates that notable gaps continue to exist in provider and patient understanding and management of prediabetes, suggesting that interventions to improve prediabetes care should include more effective counseling on diagnosis and treatment and expanding access to nutrition and educational resources. [ABSTRACT FROM AUTHOR]

Introduction: The COVID-19 pandemic has led to widespread mental health distress. Few COVID-19 employee wellness initiatives have been evaluated and have primarily focused on frontline health care workers. This study described the feasibility and utilization of, and participant satisfaction for virtual COVID-19 employee wellness sessions at a large university and health system. Method: Thomas Jefferson University behavioral health consultants (BHCs) and behavioral health leaders developed and offered JeffBeWell (JBW) wellness sessions over 17 weeks during March 2020 through July 2020. Sessions were advertised via mass emails and an employee intranet. Multiple live thirty-minute sessions were offered weekly; facilitators provided psychoeducation and offered coping tools. Topics included working remotely, parenting, sleep, nutrition, grief, anxiety, and yoga and relaxation. Attendance was tracked and participants were asked to complete satisfaction surveys; survey data was analyzed using descriptive statistics. Results: A total of 388 sessions were offered with 1,324 participants. Attendance rose in weeks 1-5, followed by a decline and then a second increase in Weeks 15 through 17, 213 participants (16%) responded to the survey. The largest portion of respondents were in academic administrative roles (46%), followed by clinical providers and staff (34%) and faculty and students (9%). Of respondents, 91% of respondents felt that the sessions met their expectations, 92% felt the session helped them, and 92% planned to attend future sessions. Discussion: JBW sessions were feasible to implement, attended by diverse participants and well received by survey respondents, although attendance has fluctuated during the pandemic. BHCs have refined sessions based on participant feedback and are tailoring more sessions to specific audiences. Keywords: behavioral health consultants, COVID-19, stress management, wellness, well-being, The COVID-19 pandemic has presented widespread mental health stressors. Frondine workers face a lack of personal protective equipment and caring for critically ill patients (Spoorthy et al., 2020). Beyond the [...]

Context: One-third of American adults have prediabetes. However, only 11% are aware of their condition, and they often do not receive prediabetes education or management. Prior studies have indicated knowledge gaps among primary care providers and patients on prediabetes management. Objective: To understand family medicine providers' and patients' attitudes, knowledge, and behaviors regarding prediabetes and its management to inform a prediabetes management intervention. Study Design: Cross-sectional surveys. Setting: A large academic family medicine practice in downtown Philadelphia with 30,000 patients making 80,000 visits annually. Population studied: Family medicine providers (attending physicians, nurse practitioners, residents) and adult patients seen within the last year, with HbA1c in the last 6 months between 5.7-6.4% (excluding pregnant, diabetes diagnosis). Instruments: Provider survey asking demographics, knowledge, attitudes, management, DPP awareness, barriers to prediabetes treatment, and open-ended question on how the practice could improve prediabetes management. Patient survey asking demographics, awareness of diagnosis and risk, knowledge, attitudes, experiences with DPP, prediabetes experiences with PCP, and same open-ended question as provider survey. Provider survey distributed via email; patient survey via Epic MyChart patient portal. Outcome Measures: Descriptive statistics for all quantitative survey items; thematic analysis of open-ended responses. Results: Fifty-four providers and 148 patients completed the surveys (57% and 16.5% response rates, respectively). Nearly all providers (96%) felt that prediabetes screening and management is important but most (74%) prescribe metformin to ≤ 25% of eligible patients. Over half (56%) were unaware of DPP, and 52% of those aware of DPP did not know how to refer a patient. Over half (59%) of patients reported having been told they have prediabetes and 84% thought diet and lifestyle changes were effective treatment, but 65% were unaware of medication options and only 5% had been referred to DPP. In open-ended responses, providers requested more nutrition counseling and an improved DPP referral process; patients also requested nutrition counseling and classes. Conclusions: Providers and patients saw prediabetes as important but reported knowledge and management gaps, particularly for metformin and DPP, and requested additional practice resources., Competing Interests: Authors report none., (© 2021 Annals of Family Medicine, Inc.)