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Articles 61 - 90 of 144
Full-Text Articles in Interprofessional Education
Meet An Ipe Student Champion From Thomas Jefferson University, Krista Garrison
Meet An Ipe Student Champion From Thomas Jefferson University, Krista Garrison
Collaborative Healthcare: Interprofessional Practice, Education and Evaluation (JCIPE)
From Fall 2019 - January 2021, I had the opportunity to be a graduate assistant (GA) for JCIPE. This experience gave me the opportunity to be involved in a variety of programs. My main projects included working with Team Care Planning, the TeamSAFE program and mainly Hotspotting. My work with Team Care Planning involved analyzing and preparing data from previous sessions.
The Clarion Case Competition, Jordan Mak, Cat-Trinh Phan, Francesca Girone, Mary Lloyd
The Clarion Case Competition, Jordan Mak, Cat-Trinh Phan, Francesca Girone, Mary Lloyd
Collaborative Healthcare: Interprofessional Practice, Education and Evaluation (JCIPE)
Hosted by the Center for Health Interprofessional Programs, University of Minnesota, the CLARION National Interprofessional Case Competition is designed to give healthcare students an interprofessional teamwork experience. In 2021, JCIPE sent a strong team consisting of two pharmacy students, Jordan Mak & Cat-Trinh Phan, and two nursing students, Francesca Girone & Mary Lloyd, to represent Jefferson. Our team successfully developed an innovative solution proposal to build a better healthcare system by conducting a root-cause analysis of a fictionalized event. Over the course of the project, our team formed a strong relationship, which culminated in a presentation and a …
Jcipe Update
Collaborative Healthcare: Interprofessional Practice, Education and Evaluation (JCIPE)
JCIPE Update
From The Editors
Collaborative Healthcare: Interprofessional Practice, Education and Evaluation (JCIPE)
When last we wrote, we were just beginning to reflect on the global upheaval encapsulated in the COVID-19 pandemic and the new urgency to confront systemic racism. Some areas of the world have emerged from COVID-19 lockdowns while others are battling new variants with catastrophic consequences. The disparities in vaccine distribution continue to be an urgent problem, along with vaccine hesitancy, building trust between patients and the healthcare system, and establishing access to healthcare for underserved populations. So, while we may be nearing the end of the COVID-19 pandemic, there is much work to be done to tackle the complexities …
Collaborative Healthcare: Interprofessional Practice, Education And Evaluation (Jcipe), Volume 12, Number 1, Spring/Summer 2021
Collaborative Healthcare: Interprofessional Practice, Education and Evaluation (JCIPE)
In this Issue
1 - Letter from the Editors
2 - JCIPE Update
3 - How Structural Competency Can Help Dismantle Structural Racism
5 - The Clarion Case Competition
6 - Meet an IPE Student Champion from Thomas Jefferson University
7 - Teamwork (Really Does) Make the Dream Work! Lessons Learned from Implementing Citywide Infrastructure with Interdisciplinary Teams
8 - Meet an IPE Faculty Champion from Thomas Jefferson University
8 - Accelerating Interprofessional Trailblazing
8 - Meet an IPE Student Champion from Thomas Jefferson University
11 - 2021 James B. Erdmann Award Recipients
2021 James Erdmann Award Recipients
2021 James Erdmann Award Recipients
Collaborative Healthcare: Interprofessional Practice, Education and Evaluation (JCIPE)
Jefferson Center for Interprofessional Practice and Education (JCIPE) congratulates this year's interprofessional education (IPE) and collaborative (CP) award winners and thanks them for all their efforts to support and advance this work on campus and beyond. Their contributions are immeasurable!
Examining Predictors Of Attitudes And Knowledge Of Registered Nurses And Nursing Students In Tennessee Toward Pregnant And Perinatal Women With A Substance Use Disorder, Jessica Patrylo
Electronic Theses and Dissertations
Substance use disorders (SUDs) among pregnant and perinatal women continue to be a national public health crisis. Furthermore, nursing students and perinatal nurses have historically negative and punitive attitudes toward this vulnerable population of women. As nurses are primary care providers for pregnant and perinatal women, this is troublesome as perinatal patients express feeling stigmatized by nurses whom they should be able to trust. This contributes to the reluctance of women to seek needed medical and prenatal care. Tennessee was the first state to criminalize drug use in pregnancy and has higher neonatal abstinence syndrome (NAS) rates, which were more …
Utilizing Structured Worksheets To Strengthen Resident Teaching On The Ob/Gyn Clerkship, Matthew R Carroll, Charlie C Kilpatrick, Grace Johnson, Neelima Sukhavasi, Bani M Ratan
Utilizing Structured Worksheets To Strengthen Resident Teaching On The Ob/Gyn Clerkship, Matthew R Carroll, Charlie C Kilpatrick, Grace Johnson, Neelima Sukhavasi, Bani M Ratan
Faculty, Staff and Students Publications
OBJECTIVE: To determine if structured worksheets can aid resident teaching on the obstetrics and gynecology (OB/GYN) clerkship.
DESIGN: We developed structured worksheets to aid residents in teaching medical students. In this pilot study, we measured the impact of the material by conducting end of clerkship focus groups between October 2017 to June 2018 and administering surveys to medical students who had recently completed the clerkship. We performed analyses of the focus group transcriptions for positive and negative themes and analyzed questionnaire data utilizing unpaired t-test and chi-square test to determine whether resident use of structured worksheets influenced student perception of …
From Opportunity To Necessity: Development Of An Asynchronous Online Interprofessional Learning Experience, Kristen Mchenry, S. Alicia Williams, Florence M. Weierbach, Kate E. Beatty, Brian Cross
From Opportunity To Necessity: Development Of An Asynchronous Online Interprofessional Learning Experience, Kristen Mchenry, S. Alicia Williams, Florence M. Weierbach, Kate E. Beatty, Brian Cross
International Journal of Health Sciences Education
Incorporating interprofessional collaboration competencies into both undergraduate pre-licensure and graduate health science students poses challenges for academic health science centers. Certain student groups may have less opportunity to participate in interprofessional learning experiences due to demands of individual programs of study and conflicts in scheduling time with other disciplines. A group of interprofessional higher education faculty members created an innovative online asynchronous interprofessional experience with the primary goals of meeting accreditation standards for specific programs and providing interprofessional education (IPE) to students who were unable to participate in traditional face-to-face IPE experiences already established at the institution. This guide will …
Medical Schools Ignore The Nature Of Consciousness At Great Cost, Anoop Kumar
Medical Schools Ignore The Nature Of Consciousness At Great Cost, Anoop Kumar
Journal of Wellness
The essential question of the relationship between consciousness and matter is ignored in medical school curricula, leading to a machine-like view of the human being that contributes to physician burnout and intellectual dissatisfaction. The evidence suggesting that the brain may not be the seat of consciousness is generally ignored to preserve the worldview of the primacy of matter. By investigating new frameworks detailing the nature of consciousness at different levels of hierarchy, we can bring intellectual rigor to a once opaque subject that supports a fundamental reality about our experience: We are human beings, not only human bodies.
Intimate Partner Violence Education For High School Students, Morgan Foster
Intimate Partner Violence Education For High School Students, Morgan Foster
Dissertations
Problem Adolescents are at risk for experiencing intimate partner violence (IPV). As early as seventh grade, over half of adolescents have reported being in a romantic relationship. Adolescent screening for and education of IPV is minimal, and only the Healthy Relationships Quiz developed by the U.S. Department of Health and Human Services [HHS] screens young adolescents across all aspects of IPV, including psychological and sexual violence. The purpose of this project was to develop an IPV education plan for high school students in a health course.
Methods An educational lesson plan for IPV was created for high school teachers.
Results …
Utilizing Virtual Reality To Introduce Hospice And End-Of-Life Approaches, Sydney P. Springer, George P. Allen
Utilizing Virtual Reality To Introduce Hospice And End-Of-Life Approaches, Sydney P. Springer, George P. Allen
Pharmacy Practice Faculty Posters
Research poster describing the following:
The objective of this study was to assess changes in students’ comfort with talking about and caring for patients at EOL. A gap in the degree of instruction regarding palliative care in pharmacy curricula has been identified. The use of a virtual reality experience (VRE) has been shown to increase students’ understanding of and empathy for older adults with age-related conditions. We created a two-part palliative care series embedded into the 3rd professional year curriculum. Part one discussed perceptions of death and deprescribing at end-of-life (EOL). Part two used the Embodied Labs® VRE to follow …
The Assessment Of Clinical Reasoning In Preceptors Across The Athletic Training Profession, Gary Wayne Cohen Jr.
The Assessment Of Clinical Reasoning In Preceptors Across The Athletic Training Profession, Gary Wayne Cohen Jr.
Health Services Research Dissertations
Clinical reasoning (CR) is defined as a complex multi-factorial metacognitive process for diagnosis formulation. Clinical reasoning begins as a student and develops over a career. Students are typically taught an analytical approach defined as hypothetico-deductive reasoning (HDR). Expert clinicians use a non-analytical approach defined as the Knowledge Based Model (KBM) of CR. It is accepted that clinicians use the KBM with cases that they have more experience to streamline the evaluation process. Unfortunately, because of the nuance of CR there have been limited investigations within athletic training to evaluate CR outside of the student population.
The overarching purpose of this …
What The Pandemic Experience Taught Us About Stem Higher Education-School Partnerships, Nancy P Moreno, Dolores V Garay, Katherine A Harris, Alana D Newell, Beatriz Perez-Sweeney, Elizabeth Camacho-Lopez, Bernice A Shargey
What The Pandemic Experience Taught Us About Stem Higher Education-School Partnerships, Nancy P Moreno, Dolores V Garay, Katherine A Harris, Alana D Newell, Beatriz Perez-Sweeney, Elizabeth Camacho-Lopez, Bernice A Shargey
Faculty, Staff and Students Publications
The move to virtual schooling and other measures to reduce the spread of SARS-CoV-2 infection dramatically changed the educational experience for grades K-12 populations during the years 2020 and 2021. STEM teaching and learning, and community partnerships focused on STEM education, were not exempt from the changes. Universities and other community partners had to adapt their STEM partnership programming to address new needs and assist students, teachers, families, and schools throughout periods of at-home learning and the re-reintroduction of in-person classes. Some of the changes included developing new programs, providing health-related guidance to school leaders, and converting student-focused programs to …
Clinical Teaching And Learning In The Covid-19 Era And Beyond: The Emergent And Emerging Scenarios, Shashikala K. Bhat, Veena Manja, Vinutha Shankar, Shashikiran Umakanth
Clinical Teaching And Learning In The Covid-19 Era And Beyond: The Emergent And Emerging Scenarios, Shashikala K. Bhat, Veena Manja, Vinutha Shankar, Shashikiran Umakanth
Manipal Journal of Medical Sciences
The need for social distancing due to the COVID-19 pandemic has compromised traditional medical education. Educators and students in low-resource settings face diverse challenges in clinical teaching, learning, and assessment. The pandemic has necessitated a rapid transition from traditional pedagogical strategies to virtual platforms. Challenges in low resource settings include knowledge and training in technology, limited resource allocation for faculty development in virtual teaching methods, and financial constraints limiting the use of available technologies. There is also a lack of constructive alignment between outcomes, instructional strategies, and assessment of curriculum delivery in virtual platforms as the earlier curriculum design was …
Required Longitudinal Service-Learning And Its Effects On Medical Students’ Attitudes Toward The Underserved, Monica Rose Arebalos, Faun Lee Botor, Edward Simanton, Jennifer Young
Required Longitudinal Service-Learning And Its Effects On Medical Students’ Attitudes Toward The Underserved, Monica Rose Arebalos, Faun Lee Botor, Edward Simanton, Jennifer Young
School of Medicine Faculty Research
Although medical students enter medicine with altruistic motives and seek to serve indigent populations, studies show that medical students’ attitudes towards the undeserved tend to worsen significantly as they go through their medical education. This finding emphasizes the need for medical educators to implement activities such as service-learning that may help mitigate this negative trend. All students at the University of Nevada Las Vegas (UNLV) School of Medicine are required to participate in longitudinal service-learning throughout medical school, and a majority of students interact with the underserved at their service-learning sites. Using the previously validated Medical Student Attitudes Towards the …
Development And Validation Of Machine Learning-Based Race-Specific Models To Predict 10-Year Risk Of Heart Failure: A Multicohort Analysis, Matthew W Segar, Byron C Jaeger, Kershaw V Patel, Vijay Nambi, Chiadi E Ndumele, Adolfo Correa, Javed Butler, Alvin Chandra, Colby Ayers, Shreya Rao, Alana A Lewis, Laura M Raffield, Carlos J Rodriguez, Erin D Michos, Christie M Ballantyne, Michael E Hall, Robert J Mentz, James A De Lemos, Ambarish Pandey
Development And Validation Of Machine Learning-Based Race-Specific Models To Predict 10-Year Risk Of Heart Failure: A Multicohort Analysis, Matthew W Segar, Byron C Jaeger, Kershaw V Patel, Vijay Nambi, Chiadi E Ndumele, Adolfo Correa, Javed Butler, Alvin Chandra, Colby Ayers, Shreya Rao, Alana A Lewis, Laura M Raffield, Carlos J Rodriguez, Erin D Michos, Christie M Ballantyne, Michael E Hall, Robert J Mentz, James A De Lemos, Ambarish Pandey
Faculty, Staff and Students Publications
BACKGROUND: Heart failure (HF) risk and the underlying risk factors vary by race. Traditional models for HF risk prediction treat race as a covariate in risk prediction and do not account for significant parameters such as cardiac biomarkers. Machine learning (ML) may offer advantages over traditional modeling techniques to develop race-specific HF risk prediction models and to elucidate important contributors of HF development across races.
METHODS: We performed a retrospective analysis of 4 large, community cohort studies (ARIC [Atherosclerosis Risk in Communities], DHS [Dallas Heart Study], JHS [Jackson Heart Study], and MESA [Multi-Ethnic Study of Atherosclerosis]) with adjudicated HF events. …
Longitudinal Curricular Assessment Of Knowledge And Awareness Of Intimate Partner Violence Among First-Year Dental Students, Charles Buchanan, Karl Kingsley, Rhonda J. Everett
Longitudinal Curricular Assessment Of Knowledge And Awareness Of Intimate Partner Violence Among First-Year Dental Students, Charles Buchanan, Karl Kingsley, Rhonda J. Everett
Dental Medicine Faculty Research
Background: Intimate partner violence (IPV) has previously been recognized as a major public health issue. Oral healthcare providers, such as dentists, are crucial to the screening and identifying of individuals experiencing IPV, since most injuries occur in the head and neck region. A lack of knowledge and awareness regarding teaching and learning about IPV in dental school curricula has been identified. Based upon the overall lack of knowledge, the objective of this study was to conduct a longitudinal assessment of knowledge, awareness, and beliefs regarding IPV among dental students in their first year of education. Methods: All students (n = …
James Davidson Fawcett (1933–2020): Imbibing With The Kiwi, Louis A. Somma
James Davidson Fawcett (1933–2020): Imbibing With The Kiwi, Louis A. Somma
Papers in Herpetology
An obituary and summary of the life of James D. Fawcett (1933-2020), herpetologist and instructor and professor of Biology at University of Nebraska at Omaha, 1972-2015. Includes bibliography of his works, list of master's theses chaired, and recollections of former students.
Understanding The "Social" In "Social Media" An Analysis Of Twitter Engagement Of Pulmonary And Critical Care Fellowship Programs, Sheetal Gandotra, Nancy H Stewart, Dina Khateeb, Puneet Garcha, W Graham Carlos, Christopher L Carroll, Viren Kaul
Understanding The "Social" In "Social Media" An Analysis Of Twitter Engagement Of Pulmonary And Critical Care Fellowship Programs, Sheetal Gandotra, Nancy H Stewart, Dina Khateeb, Puneet Garcha, W Graham Carlos, Christopher L Carroll, Viren Kaul
Faculty, Staff and Students Publications
Background: Social media is ubiquitous as a tool for collaboration, networking, and dissemination. However, little is known about use of social media platforms by pulmonary and critical care medicine fellowship programs.
Objective: We identify and characterize pulmonary and critical care fellowship programs using Twitter and Instagram, as well as the posting behaviors of their social media accounts.
Methods: We identified all adult and pediatric pulmonary, critical care medicine (CCM), and combined pulmonary and critical care medicine (PCCM) programs in the United States using the Electronic Residency Application Service. We searched for Twitter profiles for each program between January 1, 2018, …
The Impact Of Educational Resources And Perceived Preparedness On Medical Education Performance, Justin Bauzon, Amalie Alver, Vishvaas Ravikumar, Adrian Devera, Tatiana Mikhael, Rafae Nauman, Edward Simanton
The Impact Of Educational Resources And Perceived Preparedness On Medical Education Performance, Justin Bauzon, Amalie Alver, Vishvaas Ravikumar, Adrian Devera, Tatiana Mikhael, Rafae Nauman, Edward Simanton
School of Medicine Faculty Research
Introduction: Undergraduate medical education has evolved necessarily with the increasing utilization of technology and the availability of ancillary resources developed for medical students. However, medical educational resources are expensive and there have been few studies validating these resources for their ability to significantly modify student exam performance. Methods: A post-exam survey was devised to evaluate medical students for resource usage, student-perceived preparedness, and exam performance. Results: Students who felt more prepared for exams performed better than students who felt less prepared (p =.017). Students who watched didactic lectures online and those who utilized peer-to-peer tutoring outperformed students who did not …
Treatment Anxiety Education For Pediatric Cardiac Neurodevelopmental Patients, An Evidence Based Project, Mary Nagel
Treatment Anxiety Education For Pediatric Cardiac Neurodevelopmental Patients, An Evidence Based Project, Mary Nagel
Doctor of Nursing Practice Final Manuscripts
Abstract
Background
Congenital heart disease (CHD) is the most common birth defect and affects almost 1% of all live births. Treatment anxiety is common among children with CHD who undergo multiple procedures early in their lifetime. Dramatically increased life spans for this cardiac population has led to a shift from focusing on survival to their long-term health outcomes.
Methods:
Administration of the Peds QL Cardiac Module 3.0 assesses health related quality of life (HRQOL) during annual visits to a Cardiac Neurodevelopmental (ND) Clinic by evaluating the level of Treatment Anxiety a patient experiences during healthcare appointments. The questionnaire scores are …
Get America Talking: Implementing Advanced Care Planning In Primary Care, Sasha Recht
Get America Talking: Implementing Advanced Care Planning In Primary Care, Sasha Recht
Doctor of Nursing Practice Final Manuscripts
Advanced Care Planning (ACP) is an essential part of providing adequate care in the primary care setting. Discussing end of life with patients can be a tedious and uncomfortable conversation for many providers, however, its continued avoidance contributes to the stigma of end of life care and may also result in significant healthcare cost expenditure with the use of unwanted invasive treatments. All providers should engage in consistent advanced care planning in order to improve patient and provider communication, improve patient satisfaction, increase advanced directives on file, reduce the stigma of the topic, and improve quality of life.
Achieving Advance Care Planning In Diverse Populations Via Teleconferencing With Skilled Nursing Facility Residents, Tania Huezo
Achieving Advance Care Planning In Diverse Populations Via Teleconferencing With Skilled Nursing Facility Residents, Tania Huezo
Doctor of Nursing Practice Final Manuscripts
Background: Advance care planning (ACP) has always been a priority in healthcare, and even more crucial during the COVID-19 pandemic. It has been extremely challenging for ACP to occur in the skilled nursing facility (SNF) population once social distancing restrictions were put in place to protect residents and staff.
Purpose: The purpose of this evidence-based project was to assess the effectiveness of ACP via teleconferencing with skilled nursing facility (SNF) residents in the hope of increasing completion of high-quality Physician’s Orders for Life-Sustaining Treatment (POLST) forms.
Methods: The San Diego Coalition for Compassionate Care developed an ACP community outreach program …
Improving Identification Of Seniors At Risk Tool Adherence To Identify Emergency Department Readmissions In Older Adults, Joy Gao
Doctor of Nursing Practice Final Manuscripts
The purpose of this evidence-based project (EBP) is to improve the emergency department (E.D.) staff adherence in completing the Identifying Seniors at Risk (ISAR) screening tool. The specific aim is to improve electronic health record (EHR) data collection to enhance the identification of older adults that are frequent utilizers of the E.D. at a local community hospital in Southern California. Based upon the most recent National Hospital Ambulatory Medical Care Survey, patients ages 65 and older make up 32% of all E.D. admissions. These patients also represent 50% of the moderate to severely ill patients seen in the E.D. …
A Guide To Vaccine Policy Change At A National Level, Janelle Bird
A Guide To Vaccine Policy Change At A National Level, Janelle Bird
Doctor of Nursing Practice Final Manuscripts
Abstract
Health policy is in a near constant state of improvement. In order to solidify those improvements, health policy requires assistance from the upcoming generations of healthcare workers to push for those changes. Due to the outdated vaccination policy in the American Nurses Association (ANA), many states continued to issue exemptions based upon unsupported religious preferences. This helped to worsen the outbreak of measles in 2018-2019. The Previous ANA Policy on Vaccinations as of July 21, 2015 stated the ANA supports immunization exemptions only for the following reasons: Medical contraindications and Religious beliefs. Educate and train future health care professionals …
Providing High Reliability Care For Picu Patients With Pulmonary Hypertension: A Quality Improvement Project, Anjali Subbaswamy, Nicholas Tan, Iric Guthrie, Kelsey Fath, Cole Linzmeyer, Elizabeth Yakes Jimenez
Providing High Reliability Care For Picu Patients With Pulmonary Hypertension: A Quality Improvement Project, Anjali Subbaswamy, Nicholas Tan, Iric Guthrie, Kelsey Fath, Cole Linzmeyer, Elizabeth Yakes Jimenez
Quality Improvement/Patient Safety Symposium
Providing High Reliability Care for PICU Patients with Pulmonary Hypertension: A Quality Improvement Project
Anjali Subbaswamy, MD; Nicholas Tan, DO; Iric Guthrie, MD; Kelsey Fath, MD; Cole Linzmeyer, DO; Elizabeth Yakes Jimenez, PhD, RDN, LD
Purpose: Pediatric patients with pulmonary hypertension (PHTN) are a high acuity, low frequency population, and are often admitted to the pediatric intensive care unit (PICU). To mitigate the risk of precipitating a potentially life-threatening pulmonary hypertensive crisis, health care staff need to take specific precautions. This quality improvement (QI) project aims to increase the number of inpatient PHTN patients for whom PHTN precautions are applied …
Online Echocardiography Modules For Pediatric Cardiology Fellows, Sarah Studyvin, Doaa Aly, Tyler Johnson, Laura Kuzava, Alison Samrany, Nitin Madan, Sanket Shah
Online Echocardiography Modules For Pediatric Cardiology Fellows, Sarah Studyvin, Doaa Aly, Tyler Johnson, Laura Kuzava, Alison Samrany, Nitin Madan, Sanket Shah
Research Days
Background: Adequate echocardiographic (echo) education is integral to successful cardiology training. Online education is proven to be effective in other specialties, but pediatric echo training data are lacking.
Objectives/Goal: Our aim was to design and assess the role of a novel online module-based curriculum to enhance pediatric cardiology fellows’ echo education.
Methods/Design: Four interactive modules, focused on principles and interpretation of a normal echo, were delivered to fellows. Content included high quality 2D and 3D echo clips as well as interactive quizzes and could be accessed from a phone, tablet, or computer. All fellows completed pre- and post-tests, validated by …
Efficacy Of Pediatric Surgery Mobile Application For General Surgery Residents, James Fraser
Efficacy Of Pediatric Surgery Mobile Application For General Surgery Residents, James Fraser
Research Days
Background/Objectives/Goal: Integration of pediatric surgery content into the general surgery curriculum poses unique challenges as the patient population, pathophysiology, and management of surgical disease is distinctive from other subspecialties. Pediatric surgery represents approximately 2% of content on the in-training exam for residents (ABSITE) and is often underemphasized in didactic material, contributing to difficulty with preparation for these clinical rotations. We hypothesize that implementation of a mobile-based application with pertinent clinical algorithms and resources for pediatric surgical education will improve resident performance and enhance learning experiences in the management of pediatric surgery patients.
Methods/Design: Seventeen residents rotating on the pediatric surgery …
Impactful Interactions With Medical Interpretation, Alyssa L. Reinschmidt
Impactful Interactions With Medical Interpretation, Alyssa L. Reinschmidt
Honors Thesis
The purpose of this paper is to examine the quality of healthcare that one can receive when the language barrier is a factor, looking specifically at the collaboration of interpreters and physicians in the delivery of care. To carry out this study, I have analyzed the presence of the language barrier in South Dakota, the current methods of interpretation in clinical settings, and how physicians and interpreters work together to provide care to Limited English Proficiency (LEP) patients. Data has been collected from scholarly articles, journals, presentations, and videos.
Ultimately, with my committee’s help, I have created a physician-interpreter training …