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Aaron D Baugh,1 Allison A Vanderbilt,2 Reginald F Baugh3 1Pulmonary and Critical Care Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA; 2Department of Emergency Medicine, Fulton County Health Center, Wauseon, OH, USA; 3Department of Surgery, College of Medicine and Life Sciences, University of Toledo, Toledo, OH, USACorrespondence: Reginald F BaughDepartment of Surgery, College of Medicine and Life Sciences, University of Toledo, 2120 Dowling Hall MS 1905, 3000 Arlington Avenue, Toledo, OH 43623, USATel +1 419 383 6834Email reginald.baugh@utoledo.eduImproving the representation of trainees from low-income households in medicine is a global challenge. While there are broad commonalities in this effort, every country has hosted particular concerns shaped by their unique history, culture, and social structure. We were therefore gratified by the recent letter to the editor from Dr. von Widekind,1 who highlighted such concerns in the United Kingdom with the depth of our review2 that did not allow and without first-hand perspective available to our authors.We firmly believe these exchanges embolden us as educators, expanding our armamentarium. It is our sincere hope that others might likewise share their experiences from their own countries. For us, as much as our trainees, cross-cultural exposure to new perspectives enlightens and enriches our sense of the possible.This is in response to the Letter to the Editor

Aaron D Baugh,1 Allison A Vanderbilt,2 Reginald F Baugh31Pulmonary and Critical Care Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA; 2Emergency Medicine, Fulton County Health Center, Wauseon, OH, USA; 3Department of Surgery, College of Medicine and Life Sciences, University of Toledo, Toledo, OH, USACorrespondence: Reginald F BaughDepartment of Surgery, College of Medicine and Life Sciences, University of Toledo, 2120 Dowling Hall MS 1905, 3000 Arlington Avenue, Toledo, OH 43623, USATel +1 419 383 6834Email reginald.baugh@utoledo.eduAbstract: Approximately one-third of the US population lives at or near the poverty line; however, this group makes up less than 7% of the incoming medical students. In the United Kingdom, the ratio of those of the highest social stratum is 30 times greater than those of the lowest to receive admission to medical school. In an effort to address health disparities and improve patient care, the authors argue that significant barriers must be overcome for the children of the disadvantaged to gain admission to medical school. Poverty is intergenerational and multidimensional. Familial wealth affects opportunities and educational attainment, starting when children are young and compounding as they get older. In addition, structural and other barriers exist to these students pursuing higher education, such as the realities of financial aid and the shadow of debt. Yet the medical education community can take steps to better support the children of the disadvantaged throughout their education, so they are able to reach medical school. If educators value the viewpoints and life experiences of diverse students enriching the learning environment, they must acknowledge the unique contributions that the children of the disadvantaged bring and work to increase their representation in medical schools and the physician workforce. We describe who the disadvantaged are contrasted with the metrics used by m

Juli A Lambert,1 Allison A Vanderbilt,2 Thomas J Papadimos3 1College of Medicine and Life Sciences, University of Toledo, Toledo, OH, USA; 2Curriculum Evaluation and Innovation, Family Medicine College of Medicine and Life Sciences, University of Toledo, Toledo, OH, USA; 3Lloyd Jacobs Simulation Center, Department of Anesthesiology, College of Medicine and the Life Sciences, University of Toledo, Toledo, OH, USA Abstract: Emotional intelligence (EI) is the processing of emotional information. It reflects the ability to 1) monitor one’s own and others’ emotions, 2) discriminate among them, 3) and use this information to guide one’s thinking and actions. Higher EI contributes to the doctor–patient relationship, increased empathy, stress management, and leadership. Although EI has been shown to be beneficial in a hospital setting, little work has been done specifically on EI and its efficacy in the perioperative period. There are instances during perioperative care where rise and conflict occur, an environment where EI skills can play an important role. Instituting simulation-based training programs that cover critical skills related to EI early in anesthesiology residency may facilitate constructive interactions with interdisciplinary teams, leading to improved outcomes for patients during perioperative care. These programs in EI would also incorporate elements of the Accreditation Council for Graduate Medical Education (ACGME) core competencies, only adding to the benefit for these residents. Keywords: residency, interdisciplinary, Emotional Intelligence, GME, ACGME, simulation

Alexis Danielle Vick,1 Aaron Baugh,2 Julie Lambert,1 Allison A Vanderbilt,3 Evan Ingram,1 Richard Garcia,4 Reginald F Baugh5 1College of Medicine and Life Sciences, 2Department of Internal Medicine, 3Department of Family Medicine, College of Medicine and Life Science, University of Toledo, Toledo, OH, 4Consultant, The Ethnic Health Institute, Oakland, CA, 5Department of Surgery, College of Medicine and Life Sciences, University of Toledo, Toledo, OH, USA Abstract: A growing body of research illustrates the importance of aligning efforts across the operational continuum to achieve diversity goals. This alignment begins with the institutional mission and the message it conveys about the priorities of the institution to potential applicants, community, staff, and faculty. The traditional themes of education, research, and service dominate most medical school mission statements. The emerging themes of physician maldistribution, overall primary-care physician shortage, diversity, and cost control are cited less frequently. The importance and salience of having administrative leaders with an explicit commitment to workforce and student diversity is a prominent and pivotal factor in the medical literature on the subject. Organizational leadership shapes the general work climate and expectations concerning diversity, recruitment, and retention. Following the Bakke decision, individual medical schools, supported by the Association of American Medical Colleges, worked to expand the frame of reference for evaluating applicants for medical school. These efforts have come together under the rubric of “holistic review”, permitted by the US Supreme Court in 2003. A large diverse-applicant pool is needed to ensure the appropriate candidates can be chosen for the incoming medical school class. Understanding the optimal rationale and components for a successful recruitment program is important. Benchmarking with other schools regionally and nationally will identif

Paige M Anderson, Allison A Vanderbilt College of Medicine and Life Sciences, University of Toledo, Toledo, OH, USA Abstract: Cultural competence (CC) training has become a required part of medical education to create future physicians dedicated to decreasing health disparities. However, current training seems to be inadequate as research has demonstrated gaps between CC training and clinical behaviors of students. One aspect that is potentially contributing to this gap is the lack of physician education of CC. Without it being something not only taught in the classroom, but also modeled and taught in the clinical setting, CC will continue to be a theoretical concept instead of a skill set that changes the way that future physicians interact with patients and make decisions about patient care. To change this, we propose the implementation of a Train the Trainer model in which the preclinical professor in charge of CC education trains Clerkship and Residency Directors who then can train and supervise the physicians and residents in their departments on CC to better implement it into the formal and informal curriculum of clerkships. Keywords: cultural competence, Train the Trainer, physician education, undergraduate medical education, health disparities, clerkship curriculum A Letter to the Editor has been received and published for this article.&nbsp

Allison A Vanderbilt,1 Sara Q Perkins,2 Moriah K Muscaro,2 Thomas J Papadimos,3 Reginald F Baugh4 1Department of Family Medicine, 2College of Medicine and Life Sciences, University of Toledo, 3Department of Anesthesiology, 4Department of Surgery, College of Medicine and Life Sciences, University of Toledo, Toledo, OH, USA Abstract: Medical education has been under a constant state of revision for the past several years. The overarching theme of the curriculum revisions for medical schools across the USA has been creating better physicians for the 21st century, with the same end result: graduating medical students at the optimal performance level when entering residency. We propose a robust, thorough assessment process that will address the needs of clerkships, residents, students, and, most importantly, medical schools to best measure and improve clinical reasoning skills that are required for the learning outcomes of our future physicians. The Accreditation Council for Graduate Medical Education (ACGME) evaluates and accredits medical school graduates based on competency-based outcomes and the assessment of specialty-specific milestones; however, there is some evidence that medical school graduates do not consistently meet the Level 1 milestones prior to entering/beginning residency, thus starting their internship year underprepared and overwhelmed. Medical schools should take on the responsibility to provide competency-based assessments for their students during the clinical years. These assessments should be geared toward preparing them with the cognitive competencies and skills needed to successfully transition to residency. Then, medical schools can produce students who will ultimately be prepared for transition to their residency programs to provide quality care. Keywords: ACGME Core Competencies, milestones, clerkships, medical education, evaluation&nbsp

Allison A Vanderbilt,1 Scott M Pappada,2 Howard Stein,3 David Harper,4 Thomas J Papadimos5 1Department of Family Medicine, 2Department of Anesthesiology, College of Medicine and Life Sciences, University of Toledo, 3Department of Pediatrics, ProMedica Toledo Children’s Hospital, 4Department of Obstetrics and Gynecology, ProMedica Toledo Hospital, 5Department of Anesthesiology, College of Medicine and the Life Sciences, University of Toledo, Toledo, OH, USA Abstract: Hospitals have struggled for years regarding the handoff process of communicating patient information from one health care professional to another. Ineffective handoff communication is recognized as a serious patient safety risk within the health care community. It is essential to take communication into consideration when examining the safety of neonates who require immediate medical attention after birth; effective communication is vital for positive patient outcomes, especially with neonates in a delivery room setting. Teamwork and effective communication across the health care continuum are essential for providing efficient, quality care that leads to favorable patient outcomes. Interprofessional simulation and team training can benefit health care professionals by improving interprofessional competence, defined as one’s knowledge of other professionals including an understanding of their training and skillsets, and role clarity. Interprofessional teams that include members with specialization in obstetrics, gynecology, and neonatology have the potential to considerably benefit from training effective handoff and communication practices that would ensure the safety of the neonate upon birth. We must strive to provide the most comprehensive systematic, standardized, interprofessional handoff communication training sessions for such teams, through Graduate Medical Education and Continuing Medical Education that will meet the needs across the educational continuum. Keywords: interpro

Sallie D Mayer,1 Erika Peterfy,2 Steven H Crossman,3 Lisa Burroughs Phipps,4 Allison A Vanderbilt5 1Bon Secours Virginia Health System, Bon Secours Medical Group, Midlothian, VA, 2School of Pharmacy, Virginia Commonwealth University, Charlotte, NC, 3Department of Family Medicine and Population Health, College of Medicine, 4Department of Pharmacotherapy and Outcomes Science, School of Pharmacy, Virginia Commonwealth University, Richmond, VA, 5Department of Family Medicine, College of Medicine and Life Sciences, University of Toledo, Toledo, OH, USA Abstract: Utilizing the Consultation and Relational Empathy survey, this project examined the perceptions of care team empathy and patient-centeredness between English- and Spanish-speaking patients. From fall through spring semesters, patient surveys from a primary care, interprofessional student-led teaching clinic were collected and analyzed. Overall, mean scores for both English- and Spanish-speaking patients were above the reported normative average for general practitioners. While, overall, patients expressed satisfaction with the student-led teaching clinic in terms of empathy and patient-centeredness, English-speaking patients had higher median scores than Spanish-speaking patients. Analyzed individually, questions related to communication and provider attitudes were scored lower by Spanish-speaking patients. These results demonstrate that student-led clinics can deliver patient-centered care and highlight the continuing need to investigate and address disparities between English- and Spanish-speaking patients with regard to feelings of empathy and patient-centeredness. Keywords: patient-centeredness, interprofessional care, uninsured patients, free clinics, student teams

Allison A Vanderbilt,1,2 Michael D Dail,3 Parham Jaberi4 1Center on Health Disparities, 2School of Medicine, Virginia Commonwealth University, Richmond, VA, USA; 3Family Health Clinic, McDonald Army Health Center, Fort Eustis, VA, USA; 4Virginia Department of Health, Chesterfield Health District, Chesterfield, VA, USA Abstract: Health disparities can negatively impact subsets of the population who have systematically experienced greater socioeconomic obstacles to health. Health disparities are pervasive across the United States and no single health care profession can tackle this national crisis alone. It is essential that all health care providers work collaboratively toward the overarching goal of systematically closing the health disparities gap. Interprofessional collaboration is the foundation needed for health care providers to support patient needs and reduce health disparities in public health. Let us reach across the silos we work within and collaborate with our colleagues. Stand up and begin thinking about our communities, our patients, and the future overall health status of the population for the United States. Keywords: health disparities, underserved communities, public health, interprofessional collaboration, community health, health care providers

Lynn M VanderWielen,1 Allison A Vanderbilt,2 Erika K Dumke,3 Elizabeth K Do,4 Kim T Isringhausen,5 Marcie S Wright,2 Alexander S Enurah,6 Sallie D Mayer,7 Melissa Bradner81School of Allied Health Professions, Department of Health Administration, 2Center of Health Disparities, School of Medicine, 3Division for Health Sciences Diversity, 4Virginia Institute for Psychiatric and Behavioral Genetics, 5Department of Oral Health Promotion and Community Outreach, School of Dentistry, 6School of Medicine, 7Department of Pharmacotherapy and Outcomes Science, School of Pharmacy, 8Family Medicine and Population Health, School of Medicine, Virginia Commonwealth University, Richmond, VA, USAAbstract: In the US, health care professionals are trained predominantly in uniprofessional settings independent of interprofessional education and collaboration. Yet, these professionals are tasked to work collaboratively as part of an interprofessional team in the practice environment to provide comprehensive care to complex patient populations. Although many advantages of interprofessional education have been cited in the literature, interprofessional education and collaboration present unique barriers that have challenged educators and practitioners for years. In spite of these impediments, one student-led organization has successfully implemented interprofessional education and cross-disciplinary collaboration. The purpose of this paper is to provide a conceptual framework for successful implementation of interprofessional education and collaboration for other student organizations, as well as for faculty and administrators. Each member of the interprofessional team brings discipline-specific expertise, allowing for a diverse team to attend to the multidimensional health needs of individual patients. The interprofessional team must organize around a common goal and work collaboratively to optimize patient outcomes. Successful interdisciplinary endeavors must address issues related to role

Allison A Vanderbilt,1 Julie Mayglothling,1 Nicholas J Pastis,2 Douglas Franzen31School of Medicine, Virginia Commonwealth University, Richmond, VA, 2Division of Pulmonary and Critical Care, Medical University of South Carolina, SC, 3School of Medicine, University of Washington, WA, USAIntroduction: A review of the literature was conducted to analyze the impact of simulation-based training for direct and video laryngoscopy (VL) skills for health care professionals and health care students.Methods: This review focused on the published literature that used randomized controlled trials to examine the effectiveness of simulation-based training to develop airway management skills and identify pertinent literature by searching PubMed from inception of the database up to July 2013. This current review addresses the question of whether airway management simulation-based training improves the acquisition of resuscitation skills for health care profession learners.Results: A total of eleven articles qualified for this systematic review based on the inclusion and exclusion criteria. These studies were analyzed and the specific simulators, participants, assessments, and details related to: time of intubation; Cormack and Lehane classification; success and failure rate; and number of attempts.Conclusion: This review suggests that simulation-based training is one effective way to teach VL skills. VL allows for a higher success rate, faster response time, and a decrease in the number of attempts by health care students and health care professionals under the conditions based on the eleven studies reviewed.Keywords: laryngoscopy, video laryngoscopy, simulation, systematic review, health care professionals, health care students

Allison A Vanderbilt,1 Kim T Isringhausen,2 Patricia Brown Bonwell2,3 1Center on Health Disparities and School of Medicine, 2Department of Oral Health Promotion and Community Outreach, School of Dentistry, 3Dental Hygiene Program, School of Dentistry, Virginia Commonwealth University, Richmond, VA, USA Abstract: There is a lack of access to oral health care in the United States for rural, underserved, uninsured, and low-income populations. There are widely recognized problems with the US health care system, including rapidly increasing costs and access to oral health. During the last decade, there has been a huge influx and push toward interprofessional education programs; however, these programs conveniently leave out dental hygiene. Interprofessional education can bring forth the collaboration, communication, and teamwork necessary to provide a comprehensive health care plan to treat oral health care needs in patients. As the advanced practice for dental hygiene emerges, it is imperative that the educational qualifications of dental hygienists are sufficient to enable them to safely provide the scope of services and care encompassed in these new expanded roles and to effectively participate as an interprofessional team member. Keywords: interprofessional education, dental hygiene programs, dental hygiene education, oral health education