Family Medicine Commons^™

Compassionate Curiosity: Mitigating The Effects Of Biasthrough Motivational Interviewing, Paul J. Hershberger, Dean A. Bricker, Angie Castle, Timothy N. Crawford, Stacy R. Flowers, Alexandria L. Goff, Katharine Conway

Family Medicine Faculty Publications

There is strong evidence that the implicit biases of health care professionals affect the treatment of patients, and that minority and other marginalized patients are disproportionately harmed. Assumptions made about patient knowledge or lack thereof function as judgments that are prone to bias, which then affect the education and advice imposed upon patients. We review how the motivational interviewing (MI) approach to patient engagement includes components of evidence-based bias-mitigating strategies, such as understanding circumstances from the patient’s point of view, and therefore we propose that the MI approach can reduce the impact of bias in patient care.

Motivational Interviewing Skills Practice Enhanced With Artificial Intelligence, Paul J. Hershberger, Yong Pei, Dean A. Bricker, Timothy N. Crawford, Ashutosh Shivakumar, Angie Castle, Katharine Conway, Raveendra Medaramitta, Maria Rechtin, Josephine F. Wilson

Family Medicine Faculty Publications

Background: Finding time in the medical curriculum to focus on motivational interviewing (MI) training is a challenge in many medical schools. We developed a software-based training tool, “Real-time Assessment of Dialogue in Motivational Interviewing” (ReadMI), that aims to advance the skill acquisition of medical students as they learn the MI approach. This human-artificial intelligence teaming may help reduce the cognitive load on a training facilitator. Methods: During their Family Medicine clerkship, 125 third-year medical students were scheduled in pairs to participate in a 90-minute MI training session, with each student doing two role-plays as the physician. Intervention group students received …

Interface Between Motivational Interviewing And Burnout, Paul J. Hershberger, Stacy R. Flowers, Sharlo L. Bayless, Katharine Conway, Timothy N. Crawford

Family Medicine Faculty Publications

BACKGROUND: The contemporary challenges of improving patient engagement in chronic disease management and addressing the growing problem of physician burnout are commonly viewed as separate issues. However, there is extensive evidence that person-centered approaches to patient engagement, such as motivational interviewing (MI), are associated both with better outcomes for patients and improved well-being for clinicians.

METHODS: We conducted an exploratory survey study to ascertain whether resident physicians who perceive that they embrace and utilize the MI approach also report less burnout. A total of 318 residents in several specialties were invited via email to complete a 10-question survey about patient …

A Refined Teach-Back Observation Tool: Validity Evidence In A Pediatric Setting, Mary Ann Abrams, Kristin Garton Crichton, Edward J. Oberle, Stacy Flowers, Timothy N. Crawford, Michael F. Perry, John D. Mahan, Suzanne Reed

Family Medicine Faculty Publications

Background: Teach Back (TB) is recommended to assess and ensure patient understanding, thereby promoting safety, quality, and equity. There are many TB trainings, typically lacking assessment tools with validity evidence. We used a pediatric resident competency-based communication curriculum to develop initial validity evidence and refinement recommendations for a Teach-back Observation Tool (T-BOT).

Objective: This study aimed to develop initial validity evidence for a refined T-BOT and provide guidance for further enhancements to improve essential TB skills training among pediatric residents.

Methods: After an interactive health literacy (HL) training, residents participated in recorded standardized patient (SP) encounters. Raters developed T-BOT scoring …

Laboratory Markers Predictive Of Fulminant Clostridioides Difficile Infection Refractory To Fluid Resuscitation, Omar Ahmad, Timothy N. Crawford, Vaneet Arora, Mitu Karki Maskey

Family Medicine Faculty Publications

Background: Old age, leukocytosis, hypoalbuminemia, and elevated creatinine have been identified as risk factors for fulminant Clostridioides difficile infection (CDI). High ATLAS scores have also been linked to fatal disease. The affiliated studies, however, involved patients prescribed metronidazole - a regimen no longer standard of care. The variables were thus reassessed in patients prescribed optimal therapy.

Methods: Adults hospitalized with CDI at University of Kentucky Medical Center were retrospectively reviewed. Enrolled subjects were separated according to disease classification i.e. non-severe/severe versus fulminant CDI. Fulminant patients were further subdivided into hypotensive persons responsive to fluid resuscitation, and those with sequent shock, …

Predictive Factors For Early Breastmilk Discontinuation In Premature Infants: A Retrospective Study, Smiti Gupta, Darah Yuhas, Janet Wasylyshen-Valesco, Adrienne Stolfi

Medical Student Research Symposium Abstracts and Posters

The AAP recommends exclusive breastfeeding for 6 months, followed by continuation of breastfeeding with introduction of complimentary foods for at least 1 year (1). There has been considerable success initiating breastfeeding in birth hospitals. This can largely be attributed to many beneficial programs, including the WHO/UNICEF Baby-Friendly Hospital Initiative and “10 Steps to Successful Breastfeeding” (2, 3). Despite the success with increasing breastfeeding rates in birth hospitals, only 58.3% of US infants received breast milk at 6 months of age and only 25.6% of US infants were exclusively breastfed at 6 months in 2019 (4).This discrepancy is even greater for …

Global And Local Service Connection: Global Health Experiences And Local Community Engagement In Wright State University Boonshoft School Of Medicine Alumni, Katie Lomeo, Katharine A. Conway, Kelly Muterspaw, Kaitlyn Danner, Virginia Keim

Medical Student Research Symposium Abstracts and Posters

The Global Health Scholars Program (GHSP) at Wright State University Boonshoft School of Medicine (BSOM) has been in place for 18 years. The GHSP gives medical students an opportunity to serve in various medical settings around the world. There are many reasons why healthcare professionals seek global health experiences. One main reason for global health participation is altruism and the desire to improve community health abroad. However, global health participants are widely criticized for neglecting their home countries’ problems to solve those around the world. The goal of this study is to assess the relationship between global health experiences and …

Advancing Motivational Interviewing Training With Artificial Intelligence: Readmi, Paul J. Hershberger, Yong Pei, Dean A. Bricker, Timothy Crawford, Ashutosh Shivakumar, Miteshkumar Vasoya, Raveendra Medaramitta, Maria Rechtin, Aishwarya Bositty, Josephine F. Wilson

Family Medicine Faculty Publications

Background: Motivational interviewing (MI) is an evidence-based, brief interventional approach that has been demonstrated to be highly effective in triggering change in high-risk lifestyle behaviors. MI tends to be underutilized in clinical settings, in part because of limited and ineffective training. To implement MI more widely, there is a critical need to improve the MI training process in a manner that can provide prompt and efficient feedback. Our team has developed and tested a training tool, Real-time Assessment of Dialogue in Motivational Interviewing (ReadMI), that uses natural language processing (NLP) to provide immediate MI metrics and thereby address the need …

Impact Of The Affordable Care Act On Referral To Care For People Living With Hiv In Appalachia, Cameron A. Wade, Timothy N. Crawford, Nicole Leedy, Alice C. Thornton

Family Medicine Faculty Publications

Introduction: The Affordable Care Act (ACA) enacted on March 23, 2010 significantly impacted access to healthcare for people living with HIV (PLWH). Expansion of care was accomplished in three areas: eliminating exclusions for pre-existing conditions, elimination of lifetime caps on healthcare expenditures, and expansion of Medicaid eligibility.

Purpose: This study evaluated the impact of state implementation of the ACA Medicaid expansion on referral to HIV care at a Ryan White federally funded clinic in Kentucky (University of Kentucky Bluegrass Care Clinic [UK BCC]).

Methods: Retrospective chart review of all newly enrolled patients at the UK BCC between March 2010 and …