Browsing by Author "Dolan, Kathryn J."
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Item Assessing Accessibility to Domestic Violence Resources within Tarrant County: A Community-Based Study of Prevalence, Barriers, and Proposed Solutions(2021) Das, Siddharth; Siddiqui, Umar; Nguyen, Jacqueline; Bhachawat, Neal; Katamaneni, Varun; Dolan, Kathryn J.Purpose: Intimate partner violence is a common issue affecting 1 in 4 women and 1 in 10 men in the U.S. Tarrant county has a higher incidence rate of 1 in 3 women. It is important to understand the impact of abuse on individuals and evaluate the accessibility of resources available. In this study, we aim to perform a systematic review of the resources available to people at a national, state, and local level. Methods: Our study determined which resources at the national, state, and local levels were most likely sought out by domestic violence victims from Tarrant county. From database searches, we selected and interviewed various resources about those who sought their services and the barriers that victims typically face. Results: Locally, victims are able to access the following: National Domestic Violence Hotline, National Resource Center on Domestic Violence, Texas Family Violence Program, Texas Council on Family Violence, Freedom House, and SafeHaven. The interplay of national, state, and local programs depends on local entities providing a strong structure for support and referral. For example, SafeHaven is often overwhelmed by those seeking temporary housing, who are then discouraged to seek out further programs or services. Conclusion: Despite the various resources offered to victims, there are many barriers such as distance, finances, social, and cultural factors that can hinder a victim's accessibility to these resources. The significance of these barriers is ultimately the social and health ramifications on victims: increased possibility of emotional distress and disease.Item Current Endeavors to Support the Homeless Population of Fort Worth(2017-03-14) Alavi, Michael; Burgess, Lauren; Dolan, Kathryn J.; Phillips, KaitlinPurpose: The aim of this research was to identify and explore current solutions in supporting the homeless population in Fort Worth, Texas, particularly through the services provided by local non-profit organizations. Methods: We identified the terms of eligibility, services provided, service access, and barriers to effective outreach provided by five local non-profit organizations, including John Peter Smith Health Network, Tarrant County Samaritan Housing, Arlington Life Shelter, Salvation Army DFW, and Union Gospel Mission of Tarrant County. Results/Conclusions: Frequent terms of eligibility include valid U.S. identification and proof of low-income or homeless status, and common service access methods include hospital referrals, word of mouth, and flyers in well-populated public areas. Services provided included shelter, aid in employment search, navigation to health services, and a variety of supportive services to integrate those who have been recently homeless into society. These organizations have encountered multiple barriers to effective outreach, such as client mental illness, client lack of appropriate paperwork, shortage of affordable housing, and transportation difficulties. Non-profit organizations in Fort Worth provide varying degrees of support for the homeless population and have identified areas for improvement that that citizens, volunteers, local government, and the organizations themselves can consider in broadening their outreach.Item JPS Community Clinics(2017-03-14) Corjay, Ryan; Gnasigamany, Jason; Griffin, Brandon; Luu, Stephanie; Dolan, Kathryn J.; Vandermause, MatthewObjective: Approximately 41 million Americans are thought to be living in poverty which includes 21% of all children and 12% of adults and translates into 291,534 individuals in Tarrant County. Low-income individuals often lack access to the most basic primary health care services, including women’s health, pediatric services, and basic dental care. This project was undertaken to identify the safety net of community-based healthcare for people living in poverty in Tarrant County. Materials and Methods: The following JPS community clinic resources were identified using TarrantCares.org, Tarrant County 211 websites, the JPS website, and visits to the JPS main hospital and Viola Pitts/Como Community Health Center. Results: This led us to identify the most significant nonprofit primary health care resources provided by the Tarrant County Hospital District, JPS Health Network, which includes comprehensive community health clinics as well as school-based clinics. Careful consideration of the community clinic capacities, eligibility requirements, and overall barriers to care experienced by individuals suggests the JPS community clinics are providing a much-needed healthcare service in Tarrant County. JPS continuously adapts to the changing needs of the underserved community by delivering culturally competent care to very diverse patient populations and by implementing the community needs assessment and improvement plan. Additionally, JPS trains its workforce to deliver patient education for self-management of chronic conditions such as hypertension and diabetes. Conclusions: JPS Health Network provides broad medical coverage for persons in poverty and for persons without adequate access to health care in Tarrant County through the JPS community clinics. Room for improvement in health coverage was identified as the need for increased access to care for persons with behavioral health issues, the need for expansion of school-based clinics, new and improved modalities for patient education, and further reduction of preventable ED visits.Item Medical Students' Practice of EPAs in Service Learning(2018-03-14) Huang, Yuhan; Dolan, Kathryn J.Purpose Community service learning activities meet a wide range of learning objectives: exercising clinical skills which includes taking vitals, histories and physicals, preventive health screenings and health education, injury prevention and first aid, collaborating with other members of the health care team as well as providing care under supervision for the most underserved and vulnerable populations, and addressing population health. Many of the direct service experiences enable students to work with patient records, dispense donated medicines, practice forming clinical questions, collecting patient data and interacting directly with real patients practicing interviewing skills, patient centered care and empathy. Many of the health education and safety service experiences enable students to recognize factors affecting population health and opportunities to develop strategies to improve the overall health of our communities. Methods Self-report data from osteopathic medical students’ required service is required for each activity or event and since Fall 2015 is collected electronically. Data includes the type of service, and Likert scale ratings of students overall satisfaction with the experience, and the extent to which each activity meets certain learning objectives. Specific service activities exercise specific EPAs, and students ratings can indicate whether the learning objectives for those EPAs have been met. Results Data from 920 students with a total of 7,490 service evaluation reports are available for analysis. The most common types of service are assisting at indigent clinics, health fairs, sporting events, health education and safety for children and direct health services including OMM. The majority of students strongly agreed or agreed the overall experience of a specific event was good for of them. The majority strongly agreed clinical skills, health education and collaboration learning objectives were met during homeless services events and for mission trips. Conclusions Service learning is designed to provide opportunities for students to engage in experiential learning which is task and problem specific, improves clinical skills, and experience the benefits of altruistic behavior. The model of learning applied here originated with John Dewey (1938) and developed by Kolb (1984), and Boyatzis (2000) to address professional competencies. This is a step in understanding on the impact of service learning in meeting specific learning objectives in medical education.Item Pre-Clinical Medical Student Attitudes Toward Interprofessional Practice(2015-03) Dolan, Kathryn J.; Nejtek, Vicki A.Hypothesis: (1) Brief exposure to Interprofessional Practice (IP) curriculum will improve student attitudes about working within a medical team model of care. Objectives: The IP curriculum was created to capitalize on the expertise from multiple healthcare professionals working together to enhance patients’ quality of care, resolve safety issues, and improve prognostic outcomes [1]. The integrated model of care is especially relevant to the osteopathic philosophy of holistic medical practice. Thus, students who are exposed to IP curriculum should have a better understanding about the importance of providing patient care within an interdisciplinary team of healthcare professionals. First, a longitudinal, paired comparison study of pre-clinical medical students who matriculated in July, 2012 and had received at least one formal course of IP education was designed to measure pre- and post-course attitudes about interprofessional healthcare. A larger cross-sectional study was conducted to examine potential relationships among attitude response items from pre-clinical medical students who matriculated in 2010 - 2014. Materials and Methods: Pre- and post-course attitudes were measured with the Attitudes Toward Health Care Teams (ATHCT) Scale, a 21-item validated tool [2]. Comparisons were analyzed using a one-way ANOVA with semester entered as a grouping variable. A correlation matrix was used to examine attitude response item relationships in the cross-sectional analyses. A 95% confidence interval and a probability of >0.05 was considered statistically significant. Results: 190 students completed the ATHCT in both the pre- and post-course conditions. Out of 21 response items, 10 showed no significant improvement in attitudes such as team care results in more complications (item #1, p = 0.29), team care results in holistic patient care (item #5, p = 0.44), increased satisfaction (item #8, p = 0.28), or patient needs are better met (item #20, p = 0.15). Conclusions: Although pre-clinical medical students were exposed to various interprofessional team experiences (community service, preceptorship) and at least one formal IP class session, these data show some resistance and misunderstanding about the importance of the team model of care. More IP coursework exposure and clinical faculty teaching by example in the clinic may help strengthen the team model of care.Item PREPARING MEDICAL STUDENTS FOR INTERPROFESSIONAL PRACTICE ‘OUTSIDE THE FOUR WALLS’(2014-03) Dolan, Kathryn J.Purpose (a): The Medical Home Model as implemented within the guidelines of the Affordable Care Act, requires physicians to utilize community resources provided by many diverse allied health professions and organizations, including social, vocational and rehabilitation service providers which are typically “outside of the four walls” of the medical home. This research addresses approaches to enriching the curriculum to introduce students to the competencies required for community and/or systems based practice, many addressed in the NBOME Domain 7 Competency—Systems Based Practice. In the rapidly changing practice environment, osteopathic medical students need to be prepared for interprofessional practice during their clinic training. Methods (b): Educational objectives for IPE outside the four walls are identified. Varying instructional strategies to meet these objectives are identified and evaluated taking into account their costs, benefits and challenges. Many professionals from diverse allied health professions and organizations are keenly aware of the barriers their clientele face in accessing the care they need and communicating those needs to physicians. Comparison are made between two basic approaches to systematically expose medical students to other members of the extended health care team, a large classroom format where all students are exposed to the same material, and individual or small group visits to specific agencies chosen by the students. Results (c): Student evaluations, performance on quizzes and focus group feedback reveal strengths and weaknesses of these approaches. Large group presentations by community professionals is by far the most efficient delivery method, however is most effective when case studies are used to illustrate the needs and barriers accessing services their clients face. Student focus group feedback led to developing a format that can be applied to diverse agencies and client populations. Individual and small group visits with community agencies are typically rated very favorably by students, however do not offer consistent experiences that meet all learning objectives. Conclusions (d): Recommendations are made for best practices and further development. Medically vulnerable and underserved individuals present with health problems that are deeply embedded in social, economic, community and psychological conditions which must be addressed for successful treatment outcomes. In Accountable Care Organizations (ACO), there will be a need for all practitioners to be able to respond appropriately to a broad array of these common situations and the challenges they pose. Medical students entering training in ACO practice environments will be well served to know how to recognize the needs of medically underserved and vulnerable patients, identify their problems, barriers they experience, and locate appropriate community services “outside of the four walls” of the medical home.Item Role of Service Learning in Medical Students’ Acquisition of EPAs(2019-03-05) Dolan, Kathryn J.PURPOSE Service learning is designed to provide opportunities to engage in experiential learning which is task and problem specific, improves clinical skills, and facilitates experiencing the benefits of altruistic behavior. Students self reported ratings of various service activities shed light on the activities value in learning clinical skills and professionalism, as reflected in EPAs 1, 6, 7, and 9. The model of learning that is applied here has its origin in the work of John Dewey (1938) and more recent elaboration by Kolb and Boyatzis (2000) who addresses issues of emotional intelligence in professional competencies. METHODS Osteopathic medical students perform service during the first two years as one of the required elements of their ‘doctoring’ course. Service learning meets various learning objectives, including exercising clinical skills for EPAs 1, 6, 7, and 9. Students’ self-report data from their service learning activities is captured electronically. Learning objectives for each service activity are rated by student using a Likert scale. Each semester, approximately 1425 service learning reports are available for preliminary analysis and pilot testing. A total of 7 semesters of data will be available for analysis. For significant differences among the various types of services exercising EPAs 1, 6, 7 and 9, two-sided t-tests using z scores and the Bonferroni correction are applied. RESULTS Initial results show students overall agreement that homeless services and school and sports physicals meet the learning objectives associated with EPA1, again homeless services for EPA6, indigent clinics and sporting events for EPA7, health and safety education and health fairs and screening the highest for EPA9, CONCLUSIONS Despite skewedness in the self-reported data, discernable differences exist between types of activities meeting various learning objectives and furthermore ratings ran in expected directions. Students’ comments offer insights into their professional values and empathy.Item Role of Service Learning in Medical Students’ Clinical and Professionalism Competencies (2016)(2016-03-23) Dolan, Kathryn J.The role of service learning in students’ acquisition of knowledge, skills and professional attitudes is poorly understood. Osteopathic medical students perform service during the first two years as one of the required elements of their ‘doctoring’ course. The availability of this data provides the first opportunity to more systematically examine the role of service learning in students’ acquisition of clinical skills and professional attitudes. Self-report data from osteopathic medical students’ required service is required for each activity or event and is now collected electronically. Starting in Fall 2015 semester, this data is now collected electronically. Data includes the type of service, and Likert scale ratings of students overall satisfaction with the experience, and the extent to which each activity meets certain learning objectives and promotes professional values such as service, integrity, respect and collaboration. Data from 458 students with a total of 1569 service learning evaluation reports are available for preliminary analysis. The most common type of service is assisting at indigent clinics, n=498 events, followed by health fairs n= 310, sporting events=203, health education and safety for children n=154 and direct health services including OMM n=120. 65.0% of students strongly agreed and 31.8% agreed the overall experience of a specific event was good for of them. 89.7% strongly agreed health career promotions was an overall good experience, followed by 88.7% for homeless services and 83.3% for school and sports physicals. 94.3% strongly agreed clinical skills objectives were met during homeless services events and 81.3% for school and sports physicals. Basic descriptive statistics facilitate understanding of students’ attitudes toward various types of service activities and generate additional hypotheses regarding satisfaction, learning objectives and professional values. Service learning is designed to provide opportunities to engage in experiential learning which is task and problem specific, improve clinical skills, and experience the benefits of altruistic behavior. The model of learning applied here originated with John Dewey (1938) and more recent elaborations by Kolb (1984) and Boyatzis (2000) who addresses issues of emotional intelligence in professional competencies. This is a step in understanding on the impact of service learning in meeting specific l objectives in medical education.Item Role of Service Learning in Medical Students’ Clinical and Professionalism Competencies (2017)(2017-03-14) Yang, Mei; Dolan, Kathryn J.Background: The role of service learning in students’ acquisition of knowledge, skills and professional attitudes is poorly understood. Osteopathic medical students perform service during the first two years as one of the required elements of their ‘doctoring’ course. The availability of this data provides opportunities to more systematically examine the role of service learning in students’ acquisition of clinical skills and professional attitudes. Methods: Self-report data from osteopathic medical students’ required service is required for each activity or event and is now collected electronically. Starting in Fall 2015 semester, this data is now collected electronically. Data includes the type of service, and Likert scale ratings of students overall satisfaction with the experience, and the extent to which each activity meets certain learning objectives and promotes professional values such as service, integrity, respect and collaboration. Results: Data from 690 students with a total of 4,700 service learning evaluation reports are available for analysis. The most common types of service are assisting at indigent clinics, health fairs, sporting events, health education and safety for children and direct health services including OMM. The majority of students strongly agreed or agreed the overall experience of a specific event was good for of them. The majority strongly agreed clinical skills objectives were met during homeless services events and for school and sports physicals. Students ratings of the extent to which various service activities promoted UNTHSC values vary. Basic descriptive statistics facilitate understanding of students’ attitudes toward various types of service activities and generate additional hypotheses regarding satisfaction, learning objectives and professional values. Conclusions: Service learning is designed to provide opportunities for students to engage in experiential learning which is task and problem specific, improve their clinical skills, and experience the benefits of altruistic behavior. The model of learning applied here originated with John Dewey (1938) and further developed by Kolb (1984), and Boyatzis (2000) who addresses issues of emotional intelligence in professional competencies. This is a step in understanding on the impact of service learning in meeting specific objectives in medical education.Item Tarrant County Breast, Cervical, and Ovarian Cancer Resources(2019-03-05) Philip, Sarah; DeVille, Heather; Mickle, Rebecca; Sankar, Aparna; Dolan, Kathryn J.; Hutton, SarahPurpose Breast, cervical and ovarian cancer are significant sources of morbidity and mortality in women in the United States, Texas and Tarrant County. One of the best ways to combat these cancers is taking appropriate preventative measures as needed as well as understanding one’s individual risk . Often survivors of breast, cervical, and/or ovarian cancer require significant community resources to help them navigate and recover from their cancers. This poster describes risk factors and demographics and identifies local support in Tarrant County for these groups. Methods The primary method of gathering the information and data shown here was research on governmental and non-governmental sources regarding statistics and demographics. Tarrant County community resources for these groups were identified using tarrant211.org and the Tarrant Cares website. Results Our research showed that that breast, ovarian, and cervical cancers are most commonly diagnosed in women aged 62 and older, 50-60 years old, and 35-44 years old respectively. Risk factors for each of these three cancers are identified, as well as resources for preventative screening and support for those who have had one of these diseases. Resources identified include the local chapter of the Susan B. Komen foundation, local chapters of the National Cervical and Ovarian Cancer Coalitions, the Tarrant County Indigent Health Care Program, and JPS Connection at John Peter Smith Hospital. Conclusions In Tarrant County, there are many different resources available for those who have breast, ovarian and cervical cancer, including local and national organizations that provide financial, medical and transportation services. Lack of both awareness and access to appropriate screening tools and information about these diseases are some of the biggest obstacles women in Tarrant county face.