Patients and families with limited English proficiency (LEP) face barriers to health care service access, experience lower quality care, and suffer worse health outcomes. LEP is an independent driver of health disparities and exacerbates other social determinants of health. Disparities due to language are particularly unjust because LEP is morally irrelevant and a source of unfair, unnecessary disadvantage. Clinicians and health care organizations have duties to intervene, which this article describes. To claim one AMA PRA Category 1 Credit TM for the CME activity associated with this article, you must do the following: (1) read this article in its entirety, (2) answer at least 80 percent of the quiz questions correctly, and (3) complete an evaluation. The quiz, evaluation, and form for claiming AMA PRA Category 1 Credit TM are available through the AMA Ed Hub TM. Case Dr J is a second-year emergency department (ED) resident physician who, during an unusually busy shift, sees MM, a 13-year-old girl, accompanied by her father; this is their third visit to the ED this week. MM, rubbing her belly, appears somewhat uncomfortable but in no apparent distress. After 15 minutes of fumbling with an interpreter via phone, Dr J realizes that MM and her father speak a language or dialect not available via the interpreter phone service. The 3 navigate a broken English dialogue that seems to reveal that, for 5 days, MM has had decreased appetite and abdominal pain, which was most severe yesterday and since then has improved. Dr J's physical examination of MM reveals mild, diffuse, nonspecific abdominal tenderness that seems most consistent with acute gastroenteritis. Dr J leaves MM's room and confers with Dr C about a treatment plan. Dr J returns to MM, suggesting she take acetaminophen for pain, and arranges for MM's discharge from the ED before moving on to another patient. Two days later, MM returns to the ED with an abdominal abscess from a ruptured appendix, in septic shock, and requiring urgent surgical intervention. Dr J wonders what she might have done differently.
investigation: Does allowing the use of electronic devices enhance or detract from the learning in PBL tutorials?We solicited 10 volunteer tutors (out of 36) within a 4-week GI system block in the second year of our medical school program, who would allow their students (8 per tutor) to bring an electronic device of their choice into their tutorial sessions. Up to this point, devices were disallowed and only a medical dictionary was used in the tutorial sessions. At the completion of the block, the participating students and tutors were invited to complete an electronic online survey including a Likert questionnaire as well as open-ended questions reflecting their experience during the interventions.Of the respondents, fifty-four different types of devices were reported being used in the tutorial sessions. Tablets (35%) and smart phones (46%) were the most popular type of device used by students and tutors with laptops making up a small percentage of use (16%). Five percent of them felt that the devices did not improve PBL, 39% were neutral, and 55% either agreed or strongly agreed that the devices improved PBL. Ten percent of the students and tutors felt that the devices did adversely affect group dynamics, 17% were neutral, and 74% felt that the devices did not interfere with group dynamics. Five percent of those responding felt it did not improve accuracy. Sixteen percent were neutral, and 80% felt that it did improve accuracy. Overall, 89% were in favor of recommending while 11% were not.In this pilot study, we found that PBL tutors and students overwhelmingly supported allowing the use of electronic devices into the PBL tutorials. This has led to a policy change, and devices are encouraged, but individual usage determined by group agreement only.
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