Samantha Cox, Jacob Givens, Titilola Labisi, Keyonna King, Tzeyu L. Michaud, Danielle Westmark, and Nada A. Fadul
Association of Health Literacy and Provider Education with Knowledge of Breast and Cervical Cancer Screening in an Underserved Female Population
Mallory Gandy, Karly A. Meyer, Jennifer Liu, and Jenenne Geske
Over the last four years, I have developed a research focus examining the intersections of race, place, and health. My M.D. Honors Thesis reflects a snapshot of these efforts. In this collection of brief research reports, I leverage area-based measures to investigate structural inequities in three contexts: the HIV epidemic in our hyperlocal community, the early stages of the COVID-19 pandemic, and clinical trials for novel COVID-19 therapeutics. I apply novel social epidemiologic tools to measure and explore disparate outcomes. And, in reflecting upon my findings, I discuss concrete implications for clinicians, researchers, and policymakers alike.
Chapter 1: Neighborhood-Level Deprivation and Racial Inequities in HIV Viral Suppression
Human immunodeficiency virus (HIV) is a treatable chronic disease. Yet, geographic and racial inequities across the HIV care continuum are persistent, even in the U.S. Midwest. Using the Area Deprivation Index, a novel measure of neighborhood-level disadvantage, I showed that Black-White disparities in HIV viral suppression among our clinic population are explained by neighborhood deprivation. Our findings highlighted how structural racism, through longstanding place-based disinvestment, directly contributes to disparate HIV outcomes.
Chapter 2: County-Level Social Vulnerability and COVID-19 Cases & Deaths
While it is now widely recognized that the COVID-19 pandemic has had an outsized impact on marginalized and minoritized communities, the pandemic’s inequitable trajectory was not as obvious during the early stages. Leveraging publicly available data as of mid-April 2020 and the validated CDC/ATSDR Social Vulnerability Index, I showed how greater prevalence of population-level characteristics like racial/ethnic minority status, limited English proficiency, poverty, unemployment, crowded housing, and poor transportation access are directly associated with disease incidence and death. Our findings informed risk prioritization efforts across the country and offer an evidence-based framework for allocation of scarce resources.
Chapter 3: Census Tract-Level Inequities in Access to COVID-19 Therapeutic Trials
Geography is a key determinant of access to health care yet is often unexplored as a determinant of clinical trial enrollment. Using publicly available data from ClinicalTrials.gov, I geocoded the locations of 2,095 COVID-19 biomedical trial sites and calculated the driving distance from each U.S. Census tract center of population to the nearest site. I identified that nearly one-third of the overall US population, over one-half of the Native American population, and over three-fourths of the rural population lived more than an hour away from the nearest trial site. Of further concern, Black and Hispanic populations lived closer to trial sites than other populations, yet several studies highlighted the underrepresentation of these populations in major COVID-19 trials. Our findings demonstrated that geographic accessibility alone may not improve representative trial enrollment in the absence of additional structural interventions.
If interested in citing this work, please consider referencing one or more of the following peer-reviewed publications relevant to the content herein. The manuscripts published which directly represent the content of this honors thesis include references 1-4, whereas, the subsequent citations include related works which were cited but not directly discussed in this thesis.
1. Khazanchi R, Sayles H, Bares SH, Swindells S, Marcelin JR. Neighborhood Deprivation and Racial/Ethnic Disparities in HIV Viral Suppression: A Single-Center Cross-Sectional Study in the U.S. Midwest. Clin Infect Dis. 2020;72(10):e642-e645. doi:10.1093/cid/ciaa1254
2. Khazanchi R, Beiter ER, Gondi S, Beckman AL, Bilinski A, Ganguli I. County-Level Association of Social Vulnerability with COVID-19 Cases and Deaths in the USA. J Gen Intern Med. 2020;35(9):2784-2787. doi:10.1007/s11606-020-05882-3
3. Khazanchi R, Beiter ER, Ganguli I. Methodological Considerations for Modeling Social Vulnerability and COVID-19 Risk—Response to Nayak et al. J Gen Intern Med. 2021;36(4):1115-1116. doi:10.1007/s11606-021-06601-2
4. Khazanchi R, Powers SD, Rogawski McQuade ET, McManus KA. Inequities in the Geographic Accessibility of COVID-19 Biomedical Therapeutic Trials in the United States. J Gen Intern Med. 2021;36(11):3650-3653. doi:10.1007/s11606-021-07081-0
5. Chen J, Khazanchi R, Bearman G, Marcelin JR. Racial/Ethnic Inequities in Healthcare-associated Infections Under the Shadow of Structural Racism: Narrative Review and Call to Action. Curr Infect Dis Rep. 2021;23(10):17. doi:10.1007/s11908-021-00758-x
6. Khazanchi R, Evans CT, Marcelin JR. Racism, Not Race, Drives Inequity Across the COVID-19 Continuum. JAMA Network Open. 2020;3(9):e2019933. doi:10.1001/jamanetworkopen.2020.19933
7. Khazanchi R, Winkelman TNA, Pandita D, Jelinek R, Shearer RD, Bodurtha PJ. Patient Characteristics and Subsequent Health Care Use by Location of SARS-CoV-2 Testing Initiation in a Safety-Net Health System. JAMA Netw Open. 2021;4(6):e2112857. doi:10.1001/jamanetworkopen.2021.12857
8. Khazanchi R, Crittenden F, Heffron AS, Cleveland Manchanda EC, Sivashanker K, Maybank A. Beyond Declarative Advocacy: Moving Organized Medicine And Policy Makers From Position Statements To Anti-Racist Praxis. Health Affairs Forefront. Published February 25, 2021. Accessed February 26, 2021. https://www.healthaffairs.org/do/10.1377/hblog20210219.107221/full/
9. Tsai J, Cerdeña JP, Khazanchi R, et al. There is no “African American physiology”: The fallacy of racial essentialism. Journal of Internal Medicine. 2020;288(3):368-370. doi:10.1111/joim.13153
10. Khazanchi R. On Student Advocacy, Syndemics, & Structural Racism. The Advocate: Nebraska Medical Association’s Magazine. 2020;20(3):14-15, 22-23.
11. Thakore N, Khazanchi R, Orav EJ, Ganguli I. Association of social vulnerability, COVID-19 vaccine site density, and vaccination rates in the United States. Healthcare. 2021;9(4):100583. doi:10.1016/j.hjdsi.2021.100583
12. Khazanchi R, Marcelin J, Abdul-Mutakkabir J, Essien U. Race, Racism, Civil Rights Law, And The Equitable Allocation Of Scarce COVID-19 Treatments. Health Affairs Forefront. Published February 10, 2022. Accessed February 26, 2022. https://www.healthaffairs.org/do/10.1377/forefront.20220208.453850
Taylor J. Kratochvil MS; Kaeli K. Samson MA, MPH; Kari L. Nelson PhD; and Travis L. McCumber PhD
Introduction: It is critical to evaluate student experience with any newly integrated educational resource. In 2018, a Distal Upper Limb (DUL) Anatomy eModule was developed for first-year medical students at the University of Nebraska Medical Center, who have historically identified the DUL as a region of difficulty. This mixed methods study sought to (1) evaluate learner perception of the eModule relative to other resources, and (2) identify eModule content and features that students found valuable.
Methods: The DUL eModule was made available to first-year medical students in 2019 (n= 132), 2020 (n=131), and 2021 (n=131) as a voluntary, supplemental resource. In 2019-2021, all eModule users were prompted to complete a post-eModule, pre-exam survey. In 2021, users were also asked to complete a post-eModule, post-exam survey. Both surveys included a combination of Likert-type and free-response questions.
Results: In the post-eModule, pre-exam survey, a majority of students from all three years agreed or strongly agreed that the eModule was convenient, preferred compared to a textbook or didactic lecture, and applicable to the gross anatomy lab, though opinions were more split when comparing the eModule to studying from a gross specimen. In the post-eModule, post-exam survey, greater than 75% of students agreed or strongly agreed that the eModule prepared them to answer DUL exam questions, and was a useful adjunct to learning DUL anatomy. In the survey’s free response section, students cited support for the eModule’s cadaveric images, its ability to consolidate/organize information, and its two modes of use, though users reported a need for a figure legend to orient the user, and a desire for a learning evaluation integrated within the eModule.
Discussion: While gross anatomy has historically been taught through in-person dissection, student demand for digital, remote learning resources is certain to grow. The findings of this mixed methods analysis will serve to guide anatomy faculty in developing effective digital resources for future novice anatomists.
Amber McMahon and Brian Boerner
Reducing "Treble" with Performance Focused Music Programs in Medical School: A Student Driven Needs Assessment to Clarify Participation Barriers Amongst Undergraduate Medical Students
Alexander Tu, Tiffany Truong, Kristy J. Carlson PhD, Matthew J. Brooks DMA, and Jayme R. Dowdall MD
Integration of the arts into medical education has numerous benefits, including reducing burnout and producing empathetic physicians. Investment in arts-related activities has expanded considerably. However, funding remains a common limitation for further integration of arts into medical education. Clarifying student preferences and barriers to music programs can optimize such limited resources to best suit medical student needs.
Climbing the Anki Mountain, One (Review) Step at a Time: A Written and Video-Based Guide on Using Anki in Medical School to Enhance Knowledge Acquisition and Retention
Alexander Tu, Tiffany Truong, and Avi Prajapati
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