What’s New and In the Queue for Academic Medicine

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What’s New: A Preview of the March Issue
The March issue of Academic Medicine is now available! Read the entire issue online at academicmedicine.org or on your iPad using the Academic Medicine for iPad app. Highlights from the issue include:

Training Doctors for Person-Centered Care
English describes the ideal of “person-centered care,” which will require a change in the culture of health care. Medical schools’ vital role in this transformation is also described. 

Playing in the “Gutter”: Cultivating Creativity in Medical Education and Practice
Liou and colleagues found Integrated Clinical Arts workshops place students in “gutters” between medicine and arts-based disciplines to cultivate creativity and practice making connections among disparate ideas, values, and experiences.

Creating the Exceptional Patient Experience in One Academic Health System
Lee and colleagues describe how what began as a patient satisfaction project evolved into a seven-year initiative to change the culture of the University of Utah Health Care system to deliver a consistently exceptional patient experience.

Recovery of Sleep or Recovery of Self? A Grounded Theory Study of Residents’ Decision Making Regarding How to Spend Their Nonclinical Postcall Time
Taylor and colleagues found residents characterized their predominant approach to postcall decision making as one of making trade-offs; they exhibited two different trade-off orientations: being oriented toward maintaining a normal life or toward mitigating fatigue. A blog post to this article written by one of the authors is available.

How Can Academic Medical Centers and Teaching Hospitals Address the Social Determinants of Health?
In this AM Last Page, Fair and Arceneaux Mallery demonstrate how academic health centers are uniquely positioned to address the conditions in which people are born, grow up, live, work, and age to have a powerful impact on the health of communities.

What’s In the Queue: A Sneak Peek
Here’s a preview of an upcoming research report by Kenison and colleagues.

Through the Veil of Language: Addressing the Hidden Curriculum to Promote Quality, Safety, and Humanism in the Care of Patients With Limited English Proficiency

Tiffany C. Kenison, MD, MPH, MTS, Andrea Madu, Edward Krupat, PhD, Luis Ticona, MD, MPP, Iris M. Vargas, MS, and Alexander R. Green, MD, MPH

Abstract

Purpose
Patients with limited English proficiency (LEP) experience lower-quality health care and are at higher risk of medical errors than fluent English speakers. Despite some formal training for health professions students on caring for patients with LEP, the hidden curriculum may have a greater influence on learning and has not yet been studied. This study was designed to characterize the hidden curriculum that medical and nursing students experience regarding the care of patients with LEP.

Method
Sixteen students were invited from one medical school and one nursing school, who had completed an interprofessional pilot curriculum on caring for patients with LEP 6–10 months earlier, to participate in semistructured interviews about their clinical training experiences with LEP patients. Interview transcripts were independently coded and compared for agreement, and content analysis was used to identify major themes.

Results
Thirteen students (7 medical and 6 nursing students) participated. Four major themes emerged: (1) role modeling, (2) systems factors, (3) learning environment, and (4) organizational culture. All students described negative role modeling experiences and most described role models that the authors coded as “indifferent.” Students felt that the current system and learning environment did not support or emphasize high-quality care for patients with LEP.

Conclusions
The hidden curriculum that health professional students experience regarding the care of patients with LEP is influenced by systems limitations and a learning environment and organizational culture that value efficiency over effective communication. Role modeling seems strongly linked to these factors as supervisors struggle with these same challenges.

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