Master of Arts in Medical Ethics and Humanities, Northeast Ohio Medical University, 2021, College of Graduate Studies

Despite 20% of its population living with a disability, the United States continues to produce physicians who are inadequately trained in delivering equitable healthcare to disabled patients (United States Census Bureau, 2012; Wen, 2014). With patients and healthcare providers alike acknowledging this discrepancy, the medical education system ought to integrate the lived disability experience into existing medical curricula and establish standardized training requirements and competencies for trainees (Santoro et al, 2017). As a solution, I propose a disability-focused medical curriculum. Centered around the theory of care ethics, this longitudinal curriculum redefines “care” as a mutual exchange amongst team members, with the patient as the expert of his or her body, experiences, and community (Kittay, 2011). Both medical students and residents are exposed to didactics and practical experience- based learning that provide a strong understanding of (1) this theory of care ethics, (2) the combination of the positive elements of the medical and social models of disability, and (3) intersectionality. Upon successful implementation of this curriculum, trainees will acknowledge and affirm the patient's lived experience, heal patients in accordance with their personal values, desires, and goals, and work towards the alleviation of any extra burdens endured by patients who exist at multiple intersections of marginalization (Reynolds, 2018). As medical students and residents master these competencies, they will build a medical community that humanizes their patients rather than reinforcing the cycle of misconceptions fashioned by their predecessors.

PhD, University of Cincinnati, 2023, Arts and Sciences: Sociology

In recent years, nearly all medical schools in the United States have made major investments in recruiting students with minoritized identities. Despite this, the students who match into the most competitive and prestigious medical specialties are predominantly straight, white, cisgender men, while students with minoritized identities disproportionately match into less competitive specialties. Building on sociological literature that frames medical institutions as racialized organizations where disparities in social, cultural, and economic capital are amplified throughout the course of medical training, I used grounded theory methodology to analyze in-depth interviews with 49 medical students in their final year of allopathic medical school. Participants' racial and ethnic identities were: 55% Black, 26% white, 13% Asian, 4% multiracial, and 2% Latinx. Participants' gender identities were: 68% cisgender female, 26% cisgender male, and 7% transgender/non-binary; 33% of participants identified as LGBTQ+. I present my findings in three journal article-length papers demonstrating that: 1) medical students with minoritized identities experience tension between medicine's professionalism standards and expression of their own identities which they must navigate, often at a detriment to their mental health and academic performance; 2) medical students with minoritized identities desire mentors who can provide emotional support, career advice and advocacy, and help with navigating medical culture; however, there are racial, gender, and sexual orientation-based disparities in who can access high quality mentorship; and 3) medical students with minoritized identities are deterred from pursuing careers in surgery through their perceptions of surgical culture. While stratification in specialization is often attributed to explicit discrimination and active discouragement from pursuing competitive specialties, this dissertation furthers our understanding of the str (open full item for complete abstract)

Ph.D., Antioch University, 2016, Leadership and Change

Patient-centered care requires robust physician leadership in all aspects of healthcare in order to lead organizations to this ideal. Programs in Graduate Medical Education provide inconsistent and limited exposure to formal leadership development experiences for physicians in their final year of residency training. Literature addressing leadership training for residents focuses on the scarcity of effective programs that deliver adequate training and provide measurable outcomes. The purpose of this study was to explore how chief medical and surgical residents develop leadership awareness and experience training in leadership and engage chief residents, faculty mentors, and program administrators in a collaborative process, developing a leadership training model within an independent (non-academic) residency training program. To understand the residents' and the institutional experience in this realm, focused interviews were conducted with chief residents from Family Medicine and Surgery, faculty mentors, program administrators, and regional subject matter experts. Professional identity development of the residents was investigated and related to their experiences. Action research was the framework for this study due to the iterative and participative nature of the methods. Subsequent to the interviews, outgoing and incoming chief residents engaged in collaborative sessions during which peak leadership experiences were discussed. The outcomes of the sessions and analysis of the interviews were discussed with the program directors for future consideration of curriculum change. The findings indicated a change in leadership awareness among chief residents demonstrating that stimulus and subsequent reflection prompted the residents to review their roles as leaders, seeking opportunities to apply leadership awareness to their daily work. In order to teach and role model leadership, training has to be implemented that interposes the same rigor as in clinical training. Expe (open full item for complete abstract)

Master of Arts, The Ohio State University, 2021, Educational Studies

The provision of graded supervision affording progressive autonomy is fundamental to the progression of a medical learner towards competency for independent practice; the decision of how much supervision versus trust and autonomy to provide a trainee in the execution of clinical care constitutes an entrustment decision. Despite entrustment decision making occurring both daily in practice and summatively at points of matriculation through stages of medical training, the factors influencing entrustment decisions remain poorly understood across clinical contexts. This study was designed to explore the central research question of: How are entrustment decisions made in the medical intensive care unit? This qualitative case study utilized semi-structured interviews with attending pulmonary and critical care physicians in the medical intensive care unit at a major midwestern medical center to explore the entrustment decision making process as it was enacted in the clinical environment. Five major themes emerged from the data: (1) Task, circumstance, and trainee factors contribute to entrustment decision making, (2) Ad hoc entrustment decisions are enacted by supervisors with a consideration of the care team as a unit, not only an individual, (3) Autonomy does not arise only out of entrustment, but outcomes of prior autonomy inform ongoing intention to entrust, (4) Entrustment decision making includes a social process of back-and-forth akin to negotiation, and (5) Entrustment decision making is a learned skill. The process of entrustment decision making in the ICU is more complex than prior frameworks have captured; a model with more complete incorporation of the factors that influence entrustment in the ICU is presented. Lastly, recommendations for the application of our model of entrustment to improve the quality of entrustment decisions in order to better inform the use of entrustment decisions for assessment are discussed.

Doctor of Philosophy, The Ohio State University, 2018, Educational Studies

With the rapid increase in medical knowledge, the ability to use “point of care” information, and the expectation of transparency in working with patients, practitioners are increasingly compelled to use electronic continuing medical education (eCME). However, despite being less effective, pre-digital practitioners often prefer direct contact with faculty lecturers and taking notes on handouts for formal continuing medical education (CME). As the use of technology for learning inevitably evolves, understanding the process of how professionals adopt it for learning will remain meaningful. The research addressed this issue: How have pre-digital physician assistants continued their professional learning in a digital world? Using a lens of the technology acceptance model and its later iterations as theoretical grounding, qualitative interviews were conducted with a bounded group of nineteen physician assistants who graduated from the same training program from 1979 to 1984 using voice over Internet protocol. The understanding of how pre-digital professionals continue their learning in a digital world can be broken into three themes: (a) individuals who demonstrate a willingness to change adapt their learning practices as technology evolves, (b) motivated learners gravitate toward environments that are rich in devices, programs, and people who encourage their continued use of digitally mediated education, and (c) external requirements from medical professional, governmental, and commercial organizations have rendered the use of technology as mandatory to retrieve authoritative information. The implications of this study were to help individual practitioners and employers more effectively integrate technology into professional learning practices and potentially to influence policy decisions regarding continuing education requirements – both for testing and training and to improve patient care.

Doctor of Philosophy, University of Toledo, 2016, Health Education

Purpose: The purpose of this study was to survey the directors of internal medicine residency programs in the United States to determine the current status of end-of-life care education for internal medicine residents. Methods: The study featured a cross-sectional design with total population sampling. All 403 internal medicine residency directors in the United States were surveyed using a 4-wave data collection method to ensure an optimum return rate. The response rate was 52.4% (211/403). Results: Residency directors reported very high outcome expectations regarding the potential positive outcomes of providing residents with formal training in end-of-life skills. More than 90% of directors believed that the quality of care for patients at the end-of-life phase would increase if their residents were taught specific knowledge and skills related to end-of-life care. Although directors believed in the potential benefits of providing end-of-life training to their residents, nearly 1 in 4 programs (24%) reported not having a formal end-of-life curriculum in place. Another 39% had recently decided to implement an end-of-life curriculum or had implemented a curriculum in the last 3 years. Thus, 63% of residency programs either did not have a formal end-of-life curriculum in place or just recently implemented one. Only 36% of programs reported having formal end-of-life curriculum in place for more than three years. Most programs reported spending nine or less hours of instructional time during residency on multiple end-of-life topical areas such as socio-cultural issues (71%), patient care (56%), professionalism (54%), ethical issues (50%), and communication (46%). The majority of residency directors reported that their programs do not formally evaluate residents' competence in end-of-life topical areas such as socio-cultural issues (77%), patient care (60%), and ethical issues (55%). The most common method used to evaluate residents' skill competence in ca (open full item for complete abstract)

Doctor of Philosophy, The Ohio State University, 2011, Public Health

Background: Tobacco use is the leading cause of preventable death worldwide and is projected to cause nearly 450 million deaths worldwide during the next 50 year. Health professionals can play a critical role in reducing tobacco use. However, data on the competence of physicians from the Middle East and North Africa to offer tobacco cessation counseling are very scarce. The goal of this research is to determine how well prepared students in the Middle East and North Africa are with respect to providing cigarette and waterpipe smoking cessation advice, and to determine the prevalence of smoking and waterpipe use among Lebanese medical students. Methods: We surveyed the administrators who are familiar with the content of the curriculum in accredited medical schools from the Middle East and North African regions. We also surveyed third year medical students from Lebanon. The questionnaires included items about specific curricular content related to tobacco dependence and treatment. Descriptive statistics were reported by country and region and among the medical students in Lebanon. Results: There may be major gaps in medical training pertaining to tobacco related issues in medical school‘s curriculum in the Middle East and North Africa. The prevalence of tobacco use is high among Lebanese medical students. Discussion: Targeting the medical curriculum for improvement in tobacco use and cessation in countries of the Middle East and North Africa will not only help this region, but it will also serve as an international effort to contain a global phenomenon.

Doctor of Philosophy, The Ohio State University, 2004, Educational Policy and Leadership

From 1971 to 2000, 2,500 medical students at The Ohio State University College of Medicine and Public Health participated in a clinical internship program. Of these interns 231 worked in international settings and the rest participated in domestic internships. In 2002, a survey focusing on the participants' perceptions of their intercultural sensitivity development and other aspects of the experience was mailed to all alumni of the international internship program and a stratified sample of domestic interns, yielding a return rate of 81% of the international interns and 55% of the domestic interns. Survey data was quantitative and qualitative in nature and demonstrated that international interns were significantly more likely to say that they developed intercultural sensitivity as a result of the internships than domestic interns. International interns were also more likely to demonstrate intercultural competency in medical practice in terms of their career and volunteer choices as well as their intercultural skills in working with patients from different cultural backgrounds. The study findings that international interns were more likely to demonstrate intercultural competence in medical practice may indicate that medical students who participate in an internship abroad are better suited to work with a diverse patient population in the U.S. than their peers who have less intercultural experience. The focus on intercultural sensitivity and intercultural competence in medical practice sets the current study apart from the more broadly conceptualized literature about international internships in medical education. Bringing theoretical perspectives from within and outside of medical education to bear on the study further establishes its place in this literature, which does not draw as extensively upon theory. The literature about medical education for intercultural sensitivity and intercultural competence in medical practice does not consider intercultural internships. (open full item for complete abstract)

Specialist in Education (Ed.S.), University of Dayton, 2023, School Psychology

Traumatic Brain Injuries (TBI) can have a devastating impact on victims and their families. Families living in rural communities experience unique barriers to receiving care for complex medical needs. While little research exists surrounding TBI specifically, medical staff, school staff, and caregivers for children with complex medical conditions report a range of barriers and facilitators to coordinating care for their child. The current study explored the experiences of rural caregivers for children with TBI, gaining the insights of caregivers, school staff, and medical professionals who cared for a child with a TBI who transitioned to public school after the injury. Themes included the need to navigate complex situations, support from small communities, isolation and loneliness, differences in experience based on severity of injury, and feelings of hope. Barriers to quality care coordination included navigating complex situations, access to transportation, and lack of communication or education from agencies. Facilitators included support from small communities and interagency communication. Based on information from the interviews, more comprehensive coordination between agencies is recommended, including care coordination that was not limited to that covered by insurance. Implications for practitioners include being cognizant of the difficulties caregivers face, providing flexibility due to transportation barriers, creating more comprehensive care for students with mild TBI, and providing more education.

Master of Science, The Ohio State University, 2023, Genetic Counseling

With the increasing knowledge of genetics and the expansion of targeted therapy options, genetic testing for conditions like Amyotrophic Lateral Sclerosis (ALS) is increasing in demand. Since relatively few ALS clinics are staffed by a genetic counselor, non-genetics neurology providers will need to play key roles in genetic test result interpretation, communication, and implementation into patient care. However, physicians across various fields of practice have communicated a lack of confidence in interpreting and communicating uncertain genetic results, a common result for patients with ALS who undergo genetic testing. This questionnaire-based randomized controlled study was conducted to assess whether a genetics educational module could increase non-genetics neurology providers' understanding of and comfort with uncertain genetic testing results in ALS-associated genes. This anonymous online study-questionnaire assessed each participant's baseline genetics knowledge and comfort with interpreting and communicating genetic testing results. Following this, participants were randomly assigned to either the intervention or control arm. The intervention arm received a comprehensive genetic testing educational module, while the control arm received a condensed version that only covered inheritance patterns. The study questionnaire then re-evaluated each participant's genetics knowledge. The questionnaire also assessed their clinical interpretation and comfort level when presented with a hypothetical case vignette featuring an uncertain genetic testing result in an ALS-associated gene. While the results did not reach statistical significance due to a low number of respondents, certain trends were observed. As compared to control arm participants, intervention arm participants had a greater increase in knowledge after receiving the educational module and were more likely to include certain key implications of the case vignette uncertain result in their written interpret (open full item for complete abstract)

Master of Arts, The Ohio State University, 2021, Educational Studies

Introduction: The benign hematology consult service is a high-volume, high-acuity service that creates a challenge in finding time to teach during the rotation. There is a need to develop novel education approaches to meet the needs of this service and here we present a novel audio-only podcast pilot study. Methods: A series of short audio-only podcasts were developed covering some of the commonly encountered topics on the benign hematology consult service. The learners eligible to participate were all learners rotating on the service during academic year 2020-2021. IRB approval was obtained and participants were sent email invitations to participate that included a pre and post questionnaire and the audio podcast files. Results: There were 7 responses in the pre-questionnaire and 2 responses in the post-questionnaire out of a total of 26 eligible participants. The 2 post questionnaire respondents were extremely satisfied with the podcasts. Additional informal verbal feedback was spontaneously received from learners who liked the succinctness and clarity of the podcasts. Discussion: The study supports further exploration of podcasts in this setting given these preliminary findings. The feedback received will guide further development of educational resources for this service.

Doctor of Philosophy (PhD), Ohio University, 2020, Translational Biomedical Sciences

More than 47,000 people died in 2017 due to opioid-involved overdoses. In addition, fatal overdoses from non-methadone synthetic opioids like fentanyl have risen dramatically over the past 7 years. The heavy flow of opioid-related overdoses in hospitals have pressured healthcare professionals to adapt to new treatment modalities while following state and federally mandated prescribing guidelines. However, even when evidence-based practices are followed, patients may be negatively affected by opioid and opioid use disorder (OUD) stigma. The importance of addressing opioid-related stigma among healthcare providers has emerged during this time as a way to decrease barriers faced by patients in need of treatment for substance use disorders (SUDs) and improve general patient outcomes. Health professional students will, one day, be on the front line of the opioid epidemic, and thus, multidisciplinary opioid-focused education is needed. Developing education to address opioid-related stigma early in training may be valuable, though limited research has focused on this approach. The research detailed in this dissertation aimed to address the opioid epidemic by leveraging health professional students' opioid-related knowledge, perceptions, beliefs, and experiences toward the development of an educational intervention to reduce opioid and OUD stigma. The first study provided a quantitative analysis of health professional students' opioid-related beliefs, experiences, and postgraduate intentions. In general, nurse practitioner (NP) students perceived the epidemic as more severe compared to other health professional students. NP students had more clinical experiences than their physician assistant (PA) and doctor of osteopathy (DO) student counterparts, and these experiences were associated with increased confidence in caring for patients with OUD. The second study aimed to explore health professional students' perceived impact of the opioid epidemic on their future profes (open full item for complete abstract)

Master of Science, The Ohio State University, 2019, Dentistry

Objective: In the event of a medical emergency in the dental office, the supervising dentist must be able to effectively lead the office team in a concerted effort to stabilize the patient and transfer them to higher-level medical care. This study investigates the impact of a simulation-based medical emergency training curriculum on the ability of general practice residents to effectively manage medical emergencies in a dental environment. Methods: An interventional and pre-post educational trial of 16 general practice residency participants was carried out at The Ohio State University College of Dentistry. Eight participants completed a standard training curriculum as the control group and eight completed a modified training curriculum as the intervention group. The intervention consisted of a simulation-based education curriculum designed for dentists called Medical Emergency Management in the Dental Office (MEMDO). Near the completion of residency, each participant experienced a summative performance-based assessment using an Objective Structured Clinical Examination (OSCE), which was later reviewed and scored by a customized 128-point scoring grid. Additionally, the intervention group completed a baseline performance assessment at the beginning of their residency. Four calibrated faculty reviewers scored each OSCE independently. These data were subsequently analyzed using nonparametric statistical tests with alpha set to 0.05. Reviewer consistency was assessed by calculating an intraclasscorrelation coefficient. All participants completed a survey of demographic information and 11 Likert-type questions. Results: The intervention group performed significantly better than the control group (p=0.0009). This group improved their post-intervention score by an average of 36.9 points out of 128. The intraclass correlation coefficient was found to be 0.9795. Surveys found all participants in agreement with the importance of medical emergency preparedness of all de (open full item for complete abstract)

Doctor of Philosophy, The Ohio State University, 1977, Graduate School

Doctor of Philosophy, The Ohio State University, 1976, Graduate School

Doctor of Philosophy, The Ohio State University, 1972, Graduate School

Doctor of Philosophy, The Ohio State University, 2015, Anatomy

There continues to be a decrease in contact hours for anatomy sub-discipline instruction to medical students. Along with the change in contact hours, medical schools are transitioning from individual discipline-based courses to integrated curricula. Medical educators have attempted to counteract the decrease in time spent with the students by creating numerous electronic learning (e-learning) and mobile learning (m-learning) resources. The powerful hardware and software within mobile devices like Apple's iPad allows developers to create intuitive, interactive and effective mobile applications (apps). Medical educators to this point have not taken advantage of the mobile technology available to create an integrated anatomy resource to supplement the integrated curricula of current medical schools. The goal of this study is to: 1) Assess the current state of mobile technology usage by medical students; 2) develop a novel integrated anatomy mobile app (i.e., 4natomy); 3) measure the acceptance and usage of the mobile app by medical students; 4) gather feedback to determine the future viability of the mobile resource. The outcomes from a group interview conducted with second year medical students within an integrated curriculum revealed that they use multiple devices while studying and are very comfortable with mobile technology. The students collectively downloaded forty-eight different mobile apps for studying purposes and gross anatomy was the discipline with the most commonly downloaded app. Students prefer anatomy apps with three-dimensional (3D) models, as well as detailed text descriptions and had a high response rate (98.3%) in regards to their interest in using an integrated anatomy app. The 4natomy mobile app of the spinal cord was developed through collaborations with computer science and digital design students to reflect responses from the focus group. The app was distributed during the neurological disorders learning block at The Ohio State Univers (open full item for complete abstract)

Master of Science, The Ohio State University, 2014, Allied Medical Professions

Despite the research that supports interprofessional education as a component to delivering optimal medical care, many education programs still provide minimal exposure and interaction during student training. This study used a pre/post-test design using a validated questionnaire and post-simulation student reflections to describe the effect of an interprofessional simulation experience on dietetic student perceptions of teamwork and decision-making, understanding roles of healthcare professionals, and self- efficacy for providing patient care. Two-tailed paired-sample t-tests assessed questionnaire items and demonstrated that students felt that learning with other students will increase effectiveness of the health care team (p=0.032); that shared learning with other health professions will increase their ability to problem-solve (p=0.017); and that shared learning will help them become better clinicians (p=0.018). There was a significant increase in support of small group projects (p=0.027) and generic lectures, tutorials, or workshops (p=0.006) shared with other health sciences students. Students had significant increases in their understanding for the roles of nursing, nurse practitioner, occupational therapy, pharmacy, physical therapy (p<0.001), medical dietetics (p=0.012), and medicine (p=0.004). Students indicated a statistically significant increase in the item “I feel confident in providing care for a ventilated patient” (p<0.001). This quantitative data is supported by previous Autumn 2012/Spring 2013 non-validated questionnaire data as well as qualitative reflections. This study demonstrates that interprofessional simulation is an effective method to increase dietetic student understanding of professional roles, increase dietetic student self-efficacy for clinical care, and provide a learning experience that may impact future patient care.

Doctor of Philosophy, The Ohio State University, 2012, EDU Policy and Leadership

The effectiveness of teams comprised of physicians, nurses, pharmacists, and allied health care providers is critical to the safe and effective delivery of health care. Teamwork is necessary in the current health care environment because patient problems and health care needs have become so complex that no single practitioner can be expected to manage them effectively alone. A number of reports, government agencies, and private organizations have been remarking on the association between team effectiveness and patient safety for more than 20 years. The first of the Institute of Medicine reports on this topic, To Err is Human: Building a Safer Health System, is credited with bringing the issue of patient safety to the forefront, and included the figures most often cited in discussions of health care safety issues. Recommendations to reduce the incidence of medical error and improve the outlook have considered the many causative elements related to health care safety and effectiveness. A number of these recommendations focus on collaboration as a way to improve team effectiveness. Much of the focus has concentrated on physicians and nurses, who form the core dyad on health care teams. The body of literature on interprofessional education to improve team effectiveness is expansive, however health care systems and academic health centers continue to struggle to implement successful methods to enhance collaborative teamwork. Health professions educational programs share the academic health center setting, but students continue to be educated in discrete and separate programs. There is usually little opportunity for learning together that provides for the makings of common ground and cross-profession understanding. The body of literature on interprofessional education is growing, however much of the literature continues to focus on practicing professionals rather than students. In addition, while faculty are the group of experts charged with educating students, they co (open full item for complete abstract)

Master of Science, The Ohio State University, 2009, Allied Medicine

Student learning is an important consideration in the development of course designs. By recognizing and holding a better understanding of student learning styles, educators are able to build a better framework for more efficient and desirable teaching methods. This study aimed to find a relationship between allied health students' classroom and clinical learning styles. Two Kolb Learning Style Inventories were administered to a total of 82 seniors in The School of Allied Health at The Ohio State University. This sample included students in the Athletic Training, Medical Dietetics, Radiological Sciences, and Respiratory Therapy programs. The students were asked to fill out the first questionnaire in regards to their didactic classroom learning. The second survey was administered at least one week after the first and the students were asked to fill out this questionnaire in regards to their current clinical experience. The data collected from the questionnaires was then entered into the Statistical Package of the Social Sciences for analyses. Overall, in the didactic classroom setting, 24.2% (n=16) of the students were Divergers, 28.8% (n=19) were Accommodators, 19.7% (n=13) were Convergers and 27.3% (n=18) were Assimilators. In the clinical settings 27.8% (n=20) of the students were Divergers, 36.1% (n=26) were Accommodators, 23.6% (n=9) were Convergers and only 12.5% (n=9) were Assimilators. Learning style did not change for 66.7% (n=10) of Athletic Training Majors. Over half of the Medical Dietetics (53.8%,n=7), Radiological Sciences (72.7%, n=8) and Respiratory Therapy (52.9%, n=9) students' Learning Style did change with the switch of the setting from classroom to clinical. It was found in Cross tabulation that the Accommodating learner was least likely to change style with setting (75%, n=12) with the Diverger style next at 69.2%. The change of style that was least likely to occur was between the Converger and Diverger (n=2) and the Assimilator and Accommodator (open full item for complete abstract)