Patient-clinician Interaction Research Articles

Advance care planning in community: Evaluation of a two-session workshop.

14 Background: Engaging patients in advance care planning (ACP) is challenging. Group visits and multiple patient-clinician interactions appear to promote advance directive (AD) completion. We evaluated the effectiveness of a two-session ACP workshop. Methods: We conducted a nurse-led ACP workshop for patients and their family caregivers in a comprehensive cancer center. Patients were invited by their outpatient palliative care physician and an assistant helped coordinate attendance. Monthly sessions were 2 hours long and 2 weeks apart. The first session detailed the ACP process, featured the “Go Wish” card game, and introduced the “Five Wishes” AD. In the time between sessions, patients were encouraged to play Go Wish with family and to begin filling out their AD. The second session included questions and discussion, and helped patients complete, notarize, and scan their AD into the EMR. Workshop evaluation included the validated 4-question Sudore ACP Readiness Survey as well as semi-structured participant interviews. Results: Ten of 11 participants from 4 workshop offerings completed surveys. Median age was 48 years (range 41-72). Most patients (10/11, 90.9%) had breast cancer. Mean pre-workshop ACP readiness was 4.0 out of 5; post-workshop readiness increased nearly significantly to 4.325 (p = .057). Eight of the workshop participants (72.7%) had a new notarized AD scanned into the EMR. Participants most appreciated the chance to talk with other patients (“The most important thing was having a group there. I don’t think I ever would have read that packet if it had just been handed to me.”) and the chance to include their family caregivers (“My family and I had a rich and bonding talk, which was helpful for their own thinking about the AD for themselves as well.”). Two family caregivers completed their own AD. Patients who declined a workshop invitation most commonly reported they “did not have time” because of medical appointments. Conclusions: The ACP workshop was well received by participants and increased ACP readiness, discussion, and completion. The opportunities for group discussion and inclusion of family caregivers were important to participants. Barriers to attending workshops must be explored.

Patient-clinician relationship seems to affect adherence to analgesic use in cancer patients: a cross sectional study in a Taiwanese population.

Patient satisfaction can provide a measure of service quality and serve as a predictor of health-related behaviors. Little is known about how patients' satisfaction with clinician-patient interactions affects their adherence to taking analgesics. The purposes of this study were to (1) investigate the predictors of patients' satisfaction with clinicians, and (2) examine whether patients' satisfaction with their clinicians can improve adherence to analgesic use. A cross-sectional and descriptive design was used. Outpatient oncology clinic at a medical center in Taiwan. A convenience sample (N = 309) was recruited. The Medical Interview Satisfaction Scale 21 - Chinese Version, Short Version of the Barriers Questionnaire - Taiwan Form, Taiwanese version of the Morisky Medication Adherence Measure, and Interpersonal Physician Trust Scale - Chinese version, and Brief Pain Inventory Chinese Version. Variables that could significantly predict patients' satisfaction were patient age and trust in clinicians, which together accounted for 33% of the total variance. Patients' satisfaction with their clinicians significantly predicted patients' adherence to medication use (OR = 3.10, P < 0.05). There was an interactive effect (OR = 0.12, P < 0.05) between patients' satisfaction and barriers to analgesic use. Correlation coefficients between barriers to analgesic use and patients' adherence are -0.52 (P < 0.001) and -0.13 (P = 0.20) in the higher satisfaction and lower satisfaction patients, respectively. Patients' satisfaction with their clinicians can have a positive effect on changing analgesics adherence behaviors when patients hold incorrect beliefs about analgesics. Patients' satisfaction has an important role in enhancement of analgesics adherence behaviors.

How is adult patient adherence recorded in orthodontists' clinical notes? A mixed-method case-note study.

BackgroundPatient adherence in orthodontic treatment is extremely important as it is linked with better treatment outcomes. Despite its importance, however, there is no shared definition of the concept. This makes the recording of adherence-related behaviors in patient notes difficult. The current study explored how, and to what extent adherence is recorded in adult patients’ medical records by orthodontists working in a large National Health Service (NHS) London hospital.Materials and methodsA mixed-methods approach was used. A total of 17 clinicians with a mean age of 31 years (SD =4.87) provided N=20 case notes spanning N=324 appointments with patients they judged to be non-adherent. The notes were inspected for evidence of recording of patient adherence using adherence indicators identified in the literature.ResultsThe term “adherence” did not feature in any notes. The quantitative analysis showed that the three most frequent adherence-related behaviors recorded in notes were “oral hygiene,” “appointment attendance” and “breakages of appliances.” Qualitative analysis not only confirmed these factors but also showed that 1) the clinical aspects of treatment, 2) clinician–patient interaction factors and 3) patient attitudes also featured. This part of the analysis also highlighted inconsistencies across case notes in terms of the amount of information being recorded.ConclusionAdherence as a term does not feature in the clinical case notes of clinician-identified non-adherent adult patients, while predictors of adherence are recorded with varying degrees of consistency.

A systematic review of patient oncofertility support needs in reproductive cancer patients aged 14 to 45years of age.

Decline in fertility potential brought about by a cancer diagnosis or cancer treatment is one of the biggest impacts to cancer patients' long-term quality of life. As such, the current manuscript aimed to systematically review the literature on oncofertility support needs for cancer patients of a reproductive age (14-45years of age). A systematic review of the literature was conducted in May 2016 through the searching of electronic databases Medline, EMBASE, PSYCH Info, Web of Science and SCOPUS, alongside the screening of relevant reference lists. An initial search identified 351 potentially relevant studies. The papers were divided into 2 categories; papers on patient oncofertility support needs were reviewed for this systematic review, and papers on clinician provision of oncofertility support were reviewed for a separate systematic review. A total of 30 studies were included within the final review. Support needs were categorised as information, service, clinician-patient interactions, psychological, and family. A number of studies indicated that cancer patients place great important on their oncofertility care and have unmet support needs. Patients were satisfied and felt supported when additional care was taken to ensure fertility information and service needs were met. Patients desire for clinicians to support their concerns through the provision of adequate information, access to oncofertility services, taking time to discuss oncofertility treatment and concerns, specialised psychological support, and responsiveness to individual needs.

Fitness to drive in early dementia: A clinical ethics case

A 90-year-old man is diagnosed with early dementia. There are concerns about whether he is still fit to drive his car safely, but he is determined to continue driving. In this case, the clinician finds that this decision on fitness to drive is essentially evaluative and normative. Given the conflict of interests involved, how should the clinician attempt to manage this challenging ethical dilemma? This increasingly common clinical ethics scenario warrants further attention. After presenting the case, this analysis will consider the relevant issues in three dimensions: an ethical dilemma, a clinician–patient interaction, and a broader context. This analysis provides a potential framework for clinicians making decisions on fitness to drive in early dementia.

Dis-integration of communication in healthcare education: Workplace learning challenges and opportunities

The purpose of this paper, based on a 2016 Heidelberg International Conference on Communication in Healthcare (ICCH) plenary presentation, is to examine a key problem in communication skills training for health professional learners. Studies have pointed to a decline in medical students’ communication skills and attitudes as they proceed through their education, particularly during their clinical workplace training experiences. This paper explores some of the key factors in this disintegration, drawing on selected literature and highlighting some curriculum efforts and research conducted at the University of Iowa Carver College of Medicine as a case study of these issues. Five key factors contributing to the disintegration of communication skills and attitudes are presented including: 1) lack of formal communication skills training during clinical clerkships; 2) informal workplace teaching failing to explicitly address learner clinical communication skills; 3) emphasizing content over process in relation to clinician-patient interactions; 4) the relationship between ideal communication models and the realities of clinical practice; and 5) clinical teachers’ lack of knowledge and skills to effectively teach about communication in the clinical workplace. Within this discussion, potential practical responses by individual clinical teachers and broader curricular and faculty development efforts to address each of these factors are presented.

A Qualitative Case Study of Smartphone-Connected Hearing Aids: Influences on Patients, Clinicians, and Patient-Clinician Interactions.

Innovations in hearing aid technology influence clinicians and individuals who use hearing aids. Little research, to date, explains the innovation adoption experiences and perspectives of clinicians and patients, which matter to a field like audiology, wherein technology innovation is constant. By understanding clinician and patient experiences with such innovations, the field of audiology may develop technologies and ways of practicing in a manner more responsive to patients' needs, and attentive to society's influence. The authors aimed to understand how new innovations influence clinician and patient experiences, through a study focusing on connected hearing aids. "Connected" refers to the wireless functional connection of hearing aids with everyday technologies like mobile phones and tablets. The authors used a qualitative collective case study methodology, borrowing from constructivist grounded theory for data collection and analysis methods. Specifically, the authors designed a collective case study of a connected hearing aid and smartphone application, composed of two cases of experience with the innovation: the case of clinician experiences, and the case of patient experiences. The qualitative sampling methods employed were case sampling, purposive within-case sampling, and theoretical sampling, and culminated in a total collective case n = 19 (clinician case n = 8; patient case n = 11). These data were triangulated with a supplementary sample of ten documents: relevant news and popular media collected during the study time frame. The authors conducted interviews with the patients and clinicians, and analyzed the interview and document data using the constant comparative method. The authors compared their two cases by looking at trends within, between, and across cases. The clinician case highlighted clinicians' heuristic-based candidacy judgments in response to the adoption of the connected hearing aids into their practice. The patient case revealed patients' perceptions of themselves as technologically competent or incompetent, and descriptions of how they learned to use the new technology. Between cases, the study found a difference in the response to how the connected hearing aid changed the clinician-patient relationship. While clinicians valued the increased time they spent "getting to know" their patients, patients experienced some frustration specific to the additional troubleshooting related to Bluetooth connectivity. Across cases, there was a resounding theme of "normalization" of hearing aids via their integration with a "normal" technology (mobile phones) and general lack of concern about privacy in relation to the smartphone application and its tracking and geotagging features. Both audiologists and patients credited the connected hearing aids with increased opportunities to participate more fully in everyday life. The introduction of smartphone-connected hearing aids influenced the identities and candidate profiles of hearing aid users, and the nature of time spent in clinical interactions, in important and interesting ways. The influence of connected hearing aids on patient experience and audiology practice calls for continued research and clinical consideration, with implications for clinical decision-making regarding hearing aid candidacy. Further study should look critically at normalization and possible unintended stigmatizing effects of making hearing aids increasingly discreet.

Use and usefulness of the “know yourself” tool in outpatient cancer care.

e21558 Background: Patient-physician communication is important to cancer care. The National Coalition for Cancer Survivorship developed the Know Yourself Tool, a 2-page form, to improve patients’ understanding of goals of care and clinicians’ understanding of patients’ priorities/expectations. We assessed the Tool’s use and usefulness. Methods: This mixed-methods study at an academic cancer center recruited 1 medical, 1 radiation, and 1 surgical oncologist for each of 5 cancer types: breast, lung, gastrointestinal, genitourinary, head &amp; neck. For each clinician (n = 15), we recruited 2 control patients to observe usual care (n = 30) and then 4 intervention patients who were provided the Tool (n = 60); eligible patients were at a decision point in their care. Data were collected for the decision making visit via patient and physician post-visit surveys analyzed descriptively and visit recordings/transcripts to analyze: 1) option presentation 2) patient preference assessment 3) shared decision making elements 4) patient question asking opportunities. Results: Of 90 patients, 39 (43%) were female and 75 (83%) were white. Of the 60 intervention patients, 42 (70%) completed a post-visit survey: 15 (36% of respondents) reported using the Tool and 13 (31%) discussing the Tool. Nearly half (49%) reported the Tool helped them prepare for follow-up visits and know the importance of their perspective in decision making. Patients reported the Tool was easy to use (76%) and would recommend the Tool to others (52%). Clinicians reported on Tool use for 24 visits, finding it most helpful in identifying areas of concern (74%). Based on visit transcripts, physicians were more likely to describe certain options as more appropriate than others with intervention vs control patients. However, physicians were less likely to assess patient preference, engage in shared decision making behaviors, and provide opportunities for patients to ask questions with intervention vs control patients. Conclusions: Use and usefulness of the Know Yourself Tool was limited. Further work should identify barriers to Tool use, determine if there are specific subgroups for whom the Tool would be more useful, and further elucidate how the Tool affects patient-clinician interactions.

A Practical Framework for Understanding and Reducing Medical Overuse: Conceptualizing Overuse Through the Patient-Clinician Interaction.

Overuse of medical services is an increasingly recognized driver of poor-quality care and high cost. A practical framework is needed to guide clinical decisions and facilitate concrete actions that can reduce overuse and improve care. We used an iterative, expert-informed, evidence-based process to develop a framework for conceptualizing interventions to reduce medical overuse. Given the complexity of defining and identifying overused care in nuanced clinical situations and the need to define care appropriateness in the context of an individual patient, this framework conceptualizes the patient-clinician interaction as the nexus of decisions regarding inappropriate care. This interaction is influenced by other utilization drivers, including healthcare system factors, the practice environment, the culture of professional medicine, the culture of healthcare consumption, and individual patient and clinician factors. The variable strength of the evidence supporting these domains highlights important areas for further investigation. Journal of Hospital Medicine 2017;12:346-351.

Fading Away in Plain Sight.

The failure of health care professionals and providers to recognize and discuss end-of-life care continues to resonate across our heath care continuum. The value of the patient-clinician interaction is paramount in advocating for and establishing effective communication and care. A meaningful nurse-patient relationship is a key component to facilitate discussion of patient and family choices in how care can be managed throughout the dying process. This article describes how, using Virginia Henderson's nursing model of patientcentered care, a holistic and palliative approach to end-of-life care was successfully supported in the home.

Protocol of a Pilot Study of Technology-Enabled Coproduction in Pediatric Chronic Illness Care.

BackgroundPediatric chronic illness care models are traditionally organized around acute episodes of care and may not meet the needs of patients and their families. Interventions that extend the patient-clinician interaction beyond the health care visit, allow for asynchronous and bidirectional feedback loops that span visits and daily life, and facilitate seamless sharing of information are needed to support a care delivery system that is more collaborative, continuous, and data-driven. Orchestra is a mobile health technology platform and intervention designed to transform the management of chronic diseases by optimizing patient-clinician coproduction of care.ObjectiveThe aim of this study is to assess the feasibility, acceptability, and preliminary impact of the Orchestra technology and intervention in the context of pediatric chronic illness care.MethodsThis study will be conducted in the cystic fibrosis and inflammatory bowel disease clinics at Cincinnati Children’s Hospital Medical Center. We will enroll interested patients and their caregivers to work with clinicians to use the Orchestra technology platform and care model over a 6-month period. In parallel, we will use quality improvement methods to improve processes for integrating Orchestra into clinic workflows and patient/family lifestyles. We will use surveys, interviews, technology use data, and measures of clinical outcomes to assess the feasibility, acceptability, and preliminary impact of Orchestra. Outcome measures will include assessments of: (1) enrollment and dropout rates; (2) duration of engagement/sustained use; (3) symptom and patient-reported outcome tracker completion rates; (4) perceived impact on treatment plan, communication with the clinical team, visit preparation, and overall care; (5) changes in disease self-efficacy and engagement in care; and (6) clinical outcomes and health care utilization.ResultsParticipant recruitment began in mid-2015, with results expected in 2017.ConclusionsChronic disease management needs a dramatic transformation to support more collaborative, effective, and patient-centered care. This study is unique in that it is testing not only the impact of technology, but also the necessary processes that facilitate patient and clinician collaboration. This pilot study is designed to examine how technology-enabled coproduction can be implemented in real-life clinical contexts. Once the Orchestra technology and intervention are optimized to ensure feasibility and acceptability, future studies can test the effectiveness of this approach to improve patient outcomes and health care value.

The Chalice of Repose Project’s Music-Thanatology History and Praxis

Abstract The palliative medical modality of music-thanatology as developed by the author and pioneered at the Chalice of Repose Project is an evidence-based practice-vocation-profession, and maintains a singular focus and orientation: the physical and spiritual care of the dying with prescriptive music. Music-thanatology palliative care is delivered in every psychosocial setting and serves every patient constituency, pediatric to geriatric. The music-thanatology delivery of prescriptive music occurs live, at the bedside; is responsive to the patient’s unique, dynamic medical and interior conditions, and features quiet reception rather than clinician-patient interaction. This historical report provides a condensed overview of forty-four years of music-thanatology development, history and clinical practice. This includes a description of the historical and current curricula, excerpts from clinical field notes and an example of a spiritual practice that can sensitively orient musician-clinicians toward the existential patient experience. The bibliographical resources cited reflect the methodologies of a variety of scholarly disciplines in the biomedical and nursing arts and sciences and a full range of the humanities, all of which are integrated into music-thanatology education, formation and praxis. Recent population studies [1] report that there are currently over 46 million Americans aged 65 and older, and this number is expected to double by 2060. Life expectancy has generally increased and with it the need for excellent end-of-life palliative care programs. A full array of dedicated and competent practitioners skilled in a variety of end-of-life arts and sciences has never been so greatly needed in the USA. When interventional modalities have been exhausted, music-thanatology offers effective pain relief and meaningful, effective, cost-effective supportive care options during the final days and hours of life. Keywords: Music-thanatology, palliative care, prescriptive music, narrative medicine, spirituality, transitus, monastic medicine, contemplative practice, letting go.

Adolescent Suicidal Risk Assessment in Clinician-Patient Interaction

Youth suicide is a major public health problem. It is the third leading cause of death in the United States for ages 13 through 18. Many adolescents that face suicidal thoughts or make a suicide plan never seek professional care or help. Within this work, we evaluate both verbal and nonverbal responses to a five-item ubiquitous questionnaire to identify and assess suicidal risk of adolescents. We utilize a machine learning approach to identify suicidal from non-suicidal speech as well as characterize adolescents that repeatedly attempted suicide in the past. Our findings investigate both verbal and nonverbal behavior information of the face-to-face clinician-patient interaction. We investigate 60 audio-recorded dyadic clinician-patient interviews of 30 suicidal (13 repeaters and 17 non-repeaters) and 30 non-suicidal adolescents. The interaction between clinician and adolescents is statistically analyzed to reveal differences between suicidal versus non-suicidal adolescents and to investigate suicidal repeaters’ behaviors in comparison to suicidal non-repeaters. By using a hierarchical classifier we were able to show that the verbal responses to the ubiquitous questions sections of the interviews were useful to discriminate suicidal and non-suicidal patients. However, to additionally classify suicidal repeaters and suicidal non-repeaters more information especially nonverbal information is required.

Facial emotion recognition ability in psychiatrists, psychologist and psychological counselors

ObjectivesAlthough, emotional cues like facial emotion expressions seem to be important in social interaction, there is limited specific training about emotional cues for psychology professions.AimsHere, we aimed to evaluate psychologist’, psychological counselors’ and psychiatrists’ ability of facial emotion recognition and compare these groups.MethodsOne hundred and forty-one master degree students of clinical psychology and 105 psychiatrists who identified themselves as psychopharmacologists were asked to perform facial emotion recognition test after filling out socio-demographic questionnaire. The facial emotion recognition test was constructed by using a set of photographs (happy, sad, fearful, angry, surprised, disgusted, and neutral faces) from Ekman and Friesen's.ResultsPsychologists were significantly better in recognizing sad facial emotion than psychopharmacologists (6.23 ± 1.08 vs 5.80 ± 1.34 and P = 0.041). Psychological counselors were significantly better in recognizing sad facial emotion than psychopharmacologists (6.24 ± 1.01 vs 5.80 ± 1.34 and P = 0.054). Psychologists were significantly better in recognizing angry facial emotion than psychopharmacologists (6.54 ± 0.73 vs 6.08 ± 1.06 and P = 0.002). Psychological counselors were significantly better in recognizing angry facial emotion than psychopharmacologists (6.48 ± 0.73 vs 6.08 ± 1.06 and P = 0.14).ConclusionWe have revealed that the pyschologist and psychological counselors were more accurate in recognizing sad and angry facial emotions than psychopharmacologists. We considered that more accurate recognition of emotional cues may have important influences on patient doctor relationship. It would be valuable to investigate how these differences or training the ability of facial emotion recognition would affect the quality of patient–clinician interaction.

Hijacked evidence-based medicine: stay the course and throw the pirates overboard

The article discusses a number of criticisms that have been raised against evidence-based medicine, such as focusing on benefits and ignoring adverse events; being interested in averages and ignoring the wide variability in individual risks and responsiveness; ignoring clinician-patient interaction and clinical judgement; leading to some sort of reductionism; and falling prey to corruption from conflicts of interest. I argue that none of these deficiencies are necessarily inherent to evidence-based medicine. In fact, work in evidence-based medicine has contributed a lot towards minimizing these deficiencies in medical research and medical care. However, evidence-based medicine is paying the price of its success: having become more widely recognized, it is manipulated and misused to support subverted or perverted agendas that are hijacking its reputation value. Sometimes the conflicts behind these agendas are so strong that one worries about whether the hijacking of evidence-based medicine is reversible. Nevertheless, evidence-based medicine is a valuable conceptual toolkit and it is worth to try to remove the biases of the pirates who have hijacked its ship.

The importance of the clinician-patient interaction on outcomes in musculoskeletal pain: A systematic review

The importance of the clinician-patient interaction on outcomes in musculoskeletal pain: A systematic review

Implicit bias in healthcare professionals: a systematic review

BackgroundImplicit biases involve associations outside conscious awareness that lead to a negative evaluation of a person on the basis of irrelevant characteristics such as race or gender. This review examines the evidence that healthcare professionals display implicit biases towards patients.MethodsPubMed, PsychINFO, PsychARTICLE and CINAHL were searched for peer-reviewed articles published between 1st March 2003 and 31st March 2013. Two reviewers assessed the eligibility of the identified papers based on precise content and quality criteria. The references of eligible papers were examined to identify further eligible studies.ResultsForty two articles were identified as eligible. Seventeen used an implicit measure (Implicit Association Test in fifteen and subliminal priming in two), to test the biases of healthcare professionals. Twenty five articles employed a between-subjects design, using vignettes to examine the influence of patient characteristics on healthcare professionals’ attitudes, diagnoses, and treatment decisions. The second method was included although it does not isolate implicit attitudes because it is recognised by psychologists who specialise in implicit cognition as a way of detecting the possible presence of implicit bias. Twenty seven studies examined racial/ethnic biases; ten other biases were investigated, including gender, age and weight. Thirty five articles found evidence of implicit bias in healthcare professionals; all the studies that investigated correlations found a significant positive relationship between level of implicit bias and lower quality of care.DiscussionThe evidence indicates that healthcare professionals exhibit the same levels of implicit bias as the wider population. The interactions between multiple patient characteristics and between healthcare professional and patient characteristics reveal the complexity of the phenomenon of implicit bias and its influence on clinician-patient interaction. The most convincing studies from our review are those that combine the IAT and a method measuring the quality of treatment in the actual world. Correlational evidence indicates that biases are likely to influence diagnosis and treatment decisions and levels of care in some circumstances and need to be further investigated. Our review also indicates that there may sometimes be a gap between the norm of impartiality and the extent to which it is embraced by healthcare professionals for some of the tested characteristics.ConclusionsOur findings highlight the need for the healthcare profession to address the role of implicit biases in disparities in healthcare. More research in actual care settings and a greater homogeneity in methods employed to test implicit biases in healthcare is needed.

Effective patient–clinician interaction to improve treatment outcomes for patients with psychosis: a mixed-methods design

Effective patient–clinician interaction to improve treatment outcomes for patients with psychosis: a mixed-methods design

Examining the Quality of Medicines at Kenyan Healthcare Facilities: A Validation of an Alternative Post-Market Surveillance Model That Uses Standardized Patients.

BackgroundPromoting access to medicines requires concurrent efforts to strengthen quality assurance for sustained impact. Although problems of substandard and falsified medicines have been documented in low- and middle-income countries, reliable information on quality is rarely available.ObjectiveThe aim of this study was to validate an alternative post-market surveillance model to complement existing models.MethodsThe study used standardized patients or mystery clients (people recruited from the local community and trained to pose as real patients) to collect medicine samples after presenting a pre-specified condition. The patients presented four standardized conditions to 42 blinded facilities in Nairobi, Kenya, resulting in 166 patient–clinician interactions and dispensing of 300 medicines at facilities or nearby retail pharmacies. The medicine samples obtained thus resemble those that would be given to real patients.ResultsSixty samples were selected from the 300, and sent for analysis at the Kenya National Quality Control Laboratory. Of these, ten (17%) did not comply with monograph specifications (three ibuprofen, two cetirizine, two amoxicillin/clavulanic acid combinations, and one each for prednisone, salbutamol and zinc). Five of the ten samples that failed had been inappropriately prescribed to patients who had presented symptoms of unstable angina. There was no association between medicine quality and ownership, size or location of the facilities.ConclusionThe study shows that the standardized patient model can provide insights into multiple dimensions of care, thus helping to link primary care encounters with medicine quality. Furthermore, it makes it possible to obtain medicines from blinded sellers, thus minimizing the risk of obtaining biased samples.

Teaching Medical Students How to Ask Patients Questions About Identity, Intersectionality, and Resilience.

Medical education addressing people with sexual and gender minority (SGM) identities often focuses on sexual risk, is delivered in silos, and overlooks intersecting identities. SGM individuals-particularly those with coexisting stigmatized identities-experience a disproportionate burden of discrimination, which increases vulnerability to adverse health outcomes, especially when maladaptive coping behaviors are used to manage stress. Adaptive coping and resilience can develop in the context of identity affirmation and social support, for which sensitive clinician-patient interactions provide a crucial foundation. Guided by the AAMC publication Implementing Curricular and Institutional Climate Changes to Improve Health Care for Individuals Who Are LGBT, Gender Nonconforming, or Born With DSD: A Resource for Medical Educators, this session introduced first-year medical and dental students to the concepts of identity and intersectionality, providing an opportunity to practice apropos interviewing techniques. This 2-hour session includes prework, a didactic presentation, role-play scenarios, and a small-group session. Prior to the session, faculty facilitators had small-group leadership experience, and students had already mastered social history taking. Electronic student and faculty surveys provided qualitative assessment. Faculty and students reported that the session increased awareness of the health impact of identity and intersectionality and the clinician's role in establishing rapport. Suggestions included adding a prework video defining diversity terminology and a patient panel describing diverse identities and experiences. Addressing health issues related to SGM and other sociocultural identities is challenging yet crucial. This innovative session gave students an opportunity to explore their unconscious biases and practice novel interviewing techniques in a supportive environment.