Browsing by Author "Brown, Lucy"

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    Acknowledging Racial and Ethnic Health Disparities in Mass Incarceration
    (Indiana State Medical Association, 2022-06-06) Brown, Lucy; Clark, Sydney; Nunge, Rebecca A; Fazle, Trilliah; Cooper, Siena; Robinson, Peyton; Darroca, Roberto
    Whereas, the United States incarcerates more people per capita than any country in the world, where the U.S. comprises only 4% of the world’s population, yet is home to nearly 16% of all incarcerated people in the world; and Whereas, in Indiana, the total jail population increased by 526% between 1970 and 2015, while rates of pretrial detainees have increased by 72% in the state’s 48 rural counties, 43% in the state’s 21 small/medium counties, 40% in the state’s 22 suburban counties, and 268% in Marion County alone since 2000; and Whereas, in 2015 in Indiana, when including jail, prison, immigration detention, and juvenile facilities, the incarceration rate was 765 per 100,000 people, well above the rate of the United States as a whole, which was 665 per 100,000 people; and Whereas, Black residents make up 10% of Indiana’s population, but represent 24% of people in jail and 34% of people in prison; additionally, pretrial populations, disproportionately Black and Hispanic, more than doubled from 2002 to 2017; and Whereas, in 2019, Native people made up 2.1% of all federally incarcerated people, larger than their share of the total U.S. population, which was less than one percent; additionally, Native women are particularly overrepresented in the incarcerated population, making up 2.5% of women in prisons and jails and only 0.7% of the total U.S. female population; and Whereas, populations of color are more impacted by the use of money bail, where Black defendants often receive higher bail amounts, even when controlling for legal factors such as offense severity; and Whereas, Black and brown defendants are 10-25% more likely to be detained pretrial or to receive financial conditions of release; and Whereas, significant racial and ethnic disparities exist among policing, arrests, and incarceration rates, which further exacerbate disparate health outcomes for Black communities, including, but not limited to, Black individuals disproportionately being stopped by the police, experiencing use of force and repeated arrests, serving sentences of life and life without parole, being sent to solitary confinement, and receiving convictions that place them on death row; and Whereas, nearly one in three Black men will ever be imprisoned, and nearly half of Black women currently have a family member or extended family member who is in prison; and Whereas, ISMA (RESOLUTION 15-31) advocates for improved health care of incarcerated individuals; however, ISMA has no policy acknowledging the inequitable burden of incarceration and policing on minoritized individuals and communities of color; and Whereas, the AMA (H-65.954) recognizes police brutality as a manifestation of structural racism which disproportionately impacts Black, Indigenous, and other people of color; therefore, be it RESOLVED, that ISMA recognize that unjust and disproportionate racial and ethnic disparities exist in policing, sentencing, and mass incarceration among Black, indigenous, and other people of color (BIPOC) and have devastating impacts on BIPOC communities; and be it further, RESOLVED, that ISMA refer to the Committee on Diversity, Equity and Inclusion for study on what policies would be germane for ISMA to act on regarding racial and ethnic disparities in mass incarceration.
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    Adherence Barriers to Breast Cancer Treatment: Fragmentation of Care, Mood Disorders, and Substance Use Disorder
    (2021-03) Wells, Lindsey; Brown, Lucy; Heitz, Adaline; Newton, Erin
    Case: The patient is a premenopausal, recently divorced 40-year-old female with a history of alcohol use disorder, anxiety, and depression. She presented with a 3-month history of a palpable right sided breast mass and was found to have Stage IIB/IIIA ER+ PR+ invasive ductal carcinoma of her right breast. She successfully completed preoperative therapy followed by a right mastectomy. She subsequently had a relapse in her alcohol use disorder and since then has had inconsistent and incomplete radiation treatment. Her substance use led to the loss of her job, custody of her children, and social support. Conclusions: We identified four primary barriers to adherence to cancer treatment: fragmentation of care, major depressive disorder, generalized anxiety disorder, and substance use disorder. As a result of these mental health and systemic communication challenges, her treatment was discontinued and her care team lost her in follow-up. Clinical Significance: As many as 28% of breast cancer patients do not complete their recommended treatment, which increases risk for recurrent breast cancers. Discontinuation of and non-adherence to therapy for breast cancers are associated with increased mortality. Among breast cancer patients who have difficulty adhering to chemotherapy treatment, a common barrier is fragmentation of care. Studies have also indicated that anxiety and depression may play explanatory roles in non-adherence to breast cancer treatment. Prevalence of depression is as high as 24% among breast cancer patients. Furthermore, rates of co-occurrence of substance use disorders in cancer patients can reach up to 35%. Substance use disorders, including alcoholism, have been associated with increased rates of non-adherence and discontinuation of hormonal treatment in individuals with ER+ breast cancer diagnoses. Interventions addressing the occurrence of mental illness and fragmented cancer care are important steps in increasing adherence among these patients.
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    The Case of the Vanishing Yoni Pearl
    (2022-03) Brown, Lucy; Heitz, Adaline; Cox, Natalie; Hulsman, Luci; Christman, Megan
    Case: A 41-year-old female presented to the Emergency Department (ED) with a retained vaginal foreign body (VFB). She reported inserting a detoxifying “yoni” pearl 36 hours prior. She was unable to remove it herself. She denied fever, vaginal pain, discharge, or dysuria. A gynecologist was consulted, and the VFB was removed manually without complications. Conclusions: The authors reviewed 29 case studies and series. Overall, tampons, condoms, menstrual cups, items used for sexual gratification, and unconventional items used for barrier contraception (e.g., aerosol caps) are among the most common VFBs in premenopausal adult women. Among postmenopausal adult women, medical devices such as pessaries can be neglected in the vagina leading to retained VFB. While most cases had no contributing risk factors, associated medical and social determinants include mental health disorders, history of sexual assault, and uninsured status. This is the first documented case of a detoxifying vaginal pearl VFB. Clinical Significance: VFB is a common presentation in the United States; from 2010 to 2014, 89,160 female patients presented to the ED with a vulvar/vaginal foreign body, many requiring gynecologic or urologic consultations and invasive procedures. Although this case was without complications, VFBs can have significant morbidity. Depending on the consistency of the foreign body, VFBs can serve as a nidus for infection with subsequent sepsis, most notably toxic shock syndrome. Other serious complications of VFBs are compression of tissue, which can lead to compromise of blood flow to that region, necrosis, perforation, and fistulas (i.e., rectovaginal or vesicovaginal). Fistula formation has also been reported as a direct result of the surgical trauma from removal of the VFB. Prevention efforts should be aimed at education about what can safely be placed in the vagina, and providers should focus on dispelling misinformation surrounding vaginal detoxification and cleanliness.
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    Case-Based Options Counseling Panel to Supplement an Indiana Medical School’s Pre-Clinical Family Planning and Abortion Education Curriculum
    (2022-04-16) McKinzie, Alexandra; Brown, Lucy; Swiezy, Sarah; Komanapalli, Sarah; Bernard, Caitlin
    Background: While 25% of US women will seek an abortion before age 45, targeted laws have led to a decline in abortion clinics, subsequently leaving 96% of Indiana counties and the 70% Hoosier women residing in these counties without access to services they desperately need.1,2 Despite the need for a physician workforce that is educated and able to provide full-spectrum reproductive health care, few medical institutions have a standardized family planning and abortion pre-clinical curriculum. Methods: A Qualtrics survey was disseminated to students from Indiana University School of Medicine (IUSM) to evaluate (1) student interest in curriculum reform, (2) self-assessed preparedness to counsel on contraceptive and pregnancy options, and (3) preferred modality of instruction for family planning and abortion topics. Based on the pre-panel survey feedback, a case-based pregnancy options counseling panel will be implemented in the students’ pre-clinical, didactic course Endocrine, Reproductive, Musculoskeletal, Dermatologic Systems (ERMD) in February 2022. A Qualtrics post-panel survey will be disseminated to evaluate students’ perceived efficacy and quality of the panel, as well as their self-assessed preparedness to counsel on pregnancy options. Results: Participants in the pre-panel survey (n=303) were primarily female (61.72%) and White (74.43%). Across all class levels, many (60.80%) students expected to learn about family planning and abortion in their pre-clinical education. While most (84-88%) participants felt prepared to counsel about common, non-controversial pharmacotherapies (e.g. beta-blockers and diuretics), only 20% of students felt prepared to counsel on abortion options. Overall, 85.67% of students believed that IUSM should enhance its reproductive health coverage in pre-clinical, didactic courses. Traditional lectures, panels, and direct clinical exposure were the most popular instructional modalities. Expected Results: The authors predict that following the panel, students will indicate improved confidence in providing pregnancy options counseling. Additionally, students will provide constructive feedback on the structure and content of the panel for incorporation into future years’ curriculum. Conclusions: IUSM students overwhelmingly expressed interest in expanding their pre-clinical curriculum’s coverage of family planning and abortion topics. To specifically improve students’ self-assessed preparedness to provide pregnancy options counseling and address students’ self-cited learning gaps, a case-based provider panel session will be implemented in response to students’ preferred modality feedback.
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    Change in Medical Students’ Attitudes Towards Family Planning after a Pregnancy Options Counseling Panel
    (2024-04-26) Peipert, Leah J.; Brown, Lucy; King, Carli; Bhamidipalli, Surya Sruthi; Stout, Julianne; Peipert, Jeffrey F.; Caldwell, Amy
    INTRODUCTION: Abortion is one of the most commonly performed procedures in the U.S., but abortion education is lacking in medical curricula. Previous studies have shown that clinical exposure to abortion care in medical school can change students’ attitudes about abortion, yet few medical schools incorporate abortion education during students’ preclinical years. STUDY OBJECTIVE: This study evaluates changes in medical students’ attitudes after a virtual pregnancy counseling panel intervention during pre-clinical medical education at Indiana University School of Medicine. We hypothesized that students would feel more comfortable counseling and treating patients for unplanned pregnancy after attending the virtual panel. METHODS: Students participated in a “Pregnancy Options Panel” during their second-year course covering reproductive health. The panel consisted of OBGYNs, a pediatrician, and a social worker. Using a case study format, panelists guided discussion of appropriate care for a patient diagnosed with an unintended pregnancy. Two identical 19-item surveys consisting of multiple-choice and open-ended questions were electronically disseminated before and after the panel to assess students’ comfort and beliefs about family planning counseling and treatment. Statistical analyses were performed using non-parametric statistics (Wilcoxon signed rank and McNemar’s test) to compare before and after responses of participants. The study was IRB exempt. RESULTS: The second-year medical school class enrolled in the reproductive health course at Indiana University was composed of 366 students with 189 students (51.6%) identifying as female. Of the 366 students, 171 students (46.7%) completed surveys before and after the panel. Demographics were as follows: 60.6% female, 37.6% male, 64.9% white, 2.9% black, 84.6% non-Hispanic, and 10.7% Hispanic. After the pregnancy panel, students reported increased comfort when contemplating referral to an abortion provider, prescribing a medication abortion, and performing a surgical abortion compared to prior to the panel (p<0.01, all comparisons). Students were more likely to withhold disclosing their personal beliefs about abortion when counseling a pregnant patient (64.6% vs 42.3%, p<0.01), felt more capable of approaching the conversation about pregnancy options in a genuinely neutral manner (86.4% vs 71.6%, p<0.01), and had a significant increase in preparedness to counsel on continuing pregnancy, abortion, and adoption (p<0.01). CONCLUSIONS: Our pregnancy options counseling panel effectively guided students through a common reproductive health scenario counseling a patient with unintended pregnancy. Second year preclinical medical students felt more prepared to counsel patients neutrally and without influence of their own beliefs after attending the educational event. Students additionally felt more comfortable referring to an abortion provider, prescribing a medical abortion, and performing a surgical abortion after the panel, emphasizing how exposure to family planning scenarios can influence future physicians’ comfort providing non-judgmental counseling and abortion care. Expert panels comprised of health professionals with diverse clinical and social perspectives on pregnancy options can serve as an instructional model for preparing medical students for their obstetric and gynecological clinical clerkship and improving pre-clinical medical curriculum on the often-neglected topic of abortion.
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    Curriculum Integration of Pregnancy Termination and Family Planning in Didactic Medical Education
    (2021-04) Brown, Lucy; Swiezy, Sarah; Komanapalli, Sarah; McKinzie, Alexandra; Bernard, Caitlin
    Background: Given that one in four women will seek an abortion before age 45, there is an urgent need to demystify abortion-related topics and expand providers’ foundational knowledge about pregnancy termination and family planning. An effective way of addressing gaps in women’s reproductive healthcare is integration of the public health importance, legal factors, and counseling surrounding family planning and pregnancy termination into medical school curricula in accordance with Association of Professors of Gynecology and Obstetrics (APGO) guidelines. Objective: Determine whether Indiana University School of Medicine’s (IUSM’s) current pregnancy termination and family planning curricula follow proposed APGO educational guidelines. Evaluate medical student preparedness and interest surrounding family planning and pregnancy termination. Methods: To assess the alignment between IUSM and APGO educational guidelines, session learning objectives (SLOs) from the didactic course Endocrine, Reproductive, Musculoskeletal, Dermatologic Systems (ERMD) syllabus were compared to the relevant APGO objectives. Data was collected through a survey via Qualtrics disseminated to all IUSM students which was intended to assess students’ feelings of preparedness providing accurate medical information regarding reproductive health topics, including contraception, abortion, ethical and legal implications of pregnancy termination, personal values clarification, and others, as well as interest in integrating those topics into IUSM curriculum. Results: Participants (n=303) were primarily female (61.72%) and White (74.43%) and included students who had completed the Reproductive Block of the Endocrine, Reproductive, Musculoskeletal, and Dermatologic Systems (ERMD) Course and the OB/GYN Clerkship (35.64%), only the ERMD Course (25.08%), or neither (39.27%). Across all levels of undergraduate medical education, the majority (60.80%) of students expected to learn about family planning and contraception in preclinical or clinical years of medical school. Overall, 85.67% of students believed that IUSM should enhance its reproductive and sexual health coverage in the current curriculum, including expanding family planning and contraception didactic training.
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    Development and Implementation of Pregnancy Options Counseling Curriculum in Preclinical Medical Education
    (2022-04-28) Komanapalli, Sarah; Brown, Lucy; Swiezy, Sarah; McKinzie, Alexandra; Stout, Julianne
    INTRODUCTION: Pre-clinical education during medical school is an opportunity to lay a strong foundation for clinical skill development. Options counseling for pregnancy is one such topic that is essential for students to learn early in their education. The most recent estimates from the CDC report that 102.1 per 1,000 women aged 15–44 will be pregnant. Teaching medical students the skills for pregnancy options counseling centers patient goals and prevents significant adverse outcomes, particularly those that come from being denied appropriate abortion counseling. In a previous assessment of student preparedness and interest, we found that Indiana University School of Medicine (IUSM) adequately covers family planning topics, but has gaps in abortion counseling during preclinical education. Our survey definitively showed that IUSM medical students are interested in learning about options counseling and feel unprepared to counsel about abortion; additionally, abortion counseling preparedness did not improve in our sample even after completing the OBGYN clerkship. Based on these findings, we sought to implement curriculum change in the form of a panel-based discussion that would improve student education and comfort with this crucial healthcare topic. STUDY OBJECTIVE: 1) Introduce options counseling education into IUSM preclinical reproductive education and 2) evaluate changes in student preparedness and 3) satisfaction with the panel discussion METHODS: We used data from prior surveys that demonstrated high student interest and poor preparedness regarding complete options counseling to approach faculty regarding adding options counseling to preclinical curriculum. We subsequently collaborated with pre clinical education course faculty to design and implement a panel discussion about options counseling for the preclinical reproductive coure. We then developed a survey in Qualtrics to distribute to students following the panel. The survey has 17 questions including 3 free response prompts. The survey evaluates whether students feel prepared to provide options counseling after the panel, how well topics were covered, and satisfaction overall. RESULTS: The panel will take place on February 7, 2022 and the survey will be open for weeks after the panel, at which point we will analyze student responses. We expect that our post-panel survey will demonstrate increased preparedness to counsel patients about options during pregnancy. CONCLUSIONS/IMPLICATIONS: Future panels and additional course development will fill gaps in preclinical education regarding options counseling, while expanding the skills of medical students. In addition, being prepared to offer patient centered care could better prepare students for clerkships and clinical experiences. This is a promising start to enhance preclinical education regarding women’s health.
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    Evaluation of family planning and abortion education in preclinical curriculum at a large midwestern medical school
    (Elsevier, 2022) Brown, Lucy; Swiezy, Sarah; McKinzie, Alexandra; Komanapalli, Sarah; Bernard, Caitlin
    OBJECTIVE: Evaluate a Midwestern medical school's current pregnancy termination and family planning undergraduate medical curriculum (UMC) in accordance with Association of Professors of Gynecology and Obstetrics (APGO) guidelines. Assess 1) student interest 2) preparedness to counsel patients, and 3) preferred modality of instruction. STUDY DESIGN: A survey assessed students about UMC. Course syllabus learning objectives and APGO educational guidelines were compared. RESULTS: There were 309 responses total; six did not complete all survey questions and were excluded. Participants (n = 303) were primarily female (62%) and White (74%). Across all class levels, many (61%) students expected to learn about family planning and contraception in UMC. While most (84-88%) participants who completed the preclinical course with or without the clerkship felt prepared to counsel about common, non-controversial pharmacotherapies, only 20% of students felt prepared to counsel on abortion options, and 75% of students who had completed both the preclinical and OBGYN clerkship felt unprepared for abortion counseling Overall, 86% of all students surveyed believed that the medical school should enhance its reproductive health coverage in UMC. Traditional lectures, panels, and direct clinical exposure were the most popular instructional modalities. CONCLUSION: We identified potential gaps in UMC where students expressed high level of interest with low level of preparedness regarding abortion options counseling, even among senior students. Considering the high percentage of students expecting to learn about pregnancy termination and family planning in their UMC, this expectation is not being met. Students were open to a variety of modalities of instruction, indicating that several possible options exist for curricular integration. IMPLICATIONS: Despite evidence of need for training in family planning and abortion, few medical institutions have a standardized curriculum. Little available literature exists on curricula covering pregnancy options and contraception counseling, signifying a gap of knowledge and an opportunity to study how to integrate these important topics into UMC.
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    Fostering Leadership in a Student-Run Free Clinic Medical Executive Board and Across Interdisciplinary Partners.
    (2022-03-30) Haddad, Aida; Khan, Maria; Gensel, Annie; Barber, Mckenzie; Aksu, Eric; Klipsch, Eric; Class, Jon; Brown, Lucy; Kabir, Jason; Etling, Mary Ann
    Background: Being a member of a healthcare executive board requires a unique sense of resolve and passion for service. Not only are these leaders operating a student-run free clinic, but they are also full-time professional students while balancing extracurricular activities to discern their healthcare vocation. Board members feel pulled in many directions, resulting in imposter syndrome and possibly untapped leadership potential. Leadership succumbing to this pressure in 2021 might have resulted in the permanent closure or dysfunction of a clinic after COVID-19 required closure for one year. This study will discuss the interventions employed by the clinic’s Chair, Vice-Chair, Women’s Health co-chairs, and Operations chair to overcome the burden felt when faced with reopening a large, interdisciplinary, free clinic serving approximately 34 patients per weekly clinic day. Though fostering interpersonal relationships best encompasses the theme with which the above leaders encouraged hope during a time of global suffering, relationships were encouraged through multiple discrete interventions forming camaraderie and trust within and between interdisciplinary executive boards. Interventions: Medical Executive Board: In anticipation of the added pressures of reopening the clinic amid COVID-19, the Chair took special care to create a culture of collegiality and mutual vulnerability by facilitating various ways to ‘check-in’ with her board. She hosted preterm and midterm check-ins with each leader to discuss their vision for their role on the board. The Chair and Chair-elect also hosted the clinic’s first annual leadership retreat to support each member in finding their leadership style, and in turn, becoming familiar with their colleagues’ leadership styles. The Chair and Chair-elect will also perform exit interviews with all graduating board members. Partners: Reopening during the pandemic meant reorganizing the entire clinic flow and limiting the number of volunteers present. As a result, many interdisciplinary partners could not participate in the initial reopening and had to be brought in slowly throughout the year. Partner participation was encouraged by monthly meetings with all partners (regardless of clinical presence), and an active group chat with leaders. The Vice-Chair also emphasized alternate means of participation. Some partners organized winter clothes and food drives, while others fundraised for the clinic. All partners were encouraged to develop telehealth plans. The fall partners’ retreat fostered community, during which all partners brainstormed 2022 goals. Results/Conclusion: Medical Executive Board: As a result of the above interventions, clinic leadership not only reopened the free clinic but fulfilled many years-long goals, which include rolling out a weekday telehealth protocol, serving record numbers of patients during a time of immense need, publishing the inaugural clinic-wide monthly newsletter, and formulating the clinic’s first-ever mistreatment policy. The leadership retreat inspired our Women’s Health Coalition to host a retreat; a check-in with the Women’s Health chair led to a midterm co-chair election to sustain the coalition long-term. Finally, the Operations chair spearheaded changes to clinic flow to avoid COVID-19 outbreaks–in doing so, she inspired a record turnout for this position at the 2022 elections. Partners: By the end of 2021, all interdisciplinary partners had resumed in-person care. However, the regular monthly meetings, alternate projects, and retreats fostered community and interest in the clinics even when all could not physically participate.
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    Implementing Scheduled Women’s Health Clinics at Free Student Outreach Clinic
    (2022-03-30) Gensel, Annie; Brown, Lucy; Asdell, Stephanie
    Introduction/Problem: Since 2009, Indiana University Student Outreach Clinic (IU-SOC) has served the underinsured and uninsured members of the Indianapolis community. Many barriers to care exist within this community, from low income to lack of documented immigration status. One of the most concerning vulnerable populations observed was pregnant patients. Five years ago, the IU-SOC addressed this via creation of Women’s Health days on Saturdays every other month and in 2020 by creating an as needed prenatal clinic. However, the need still existed for general, non-prenatal women’s health concerns, which led to the expansion to a twice monthly general women’s clinic staffed by a board-certified obstetrician-gynecologist (OB/GYN). Methods/Interventions: In April 2021, twice monthly scheduled clinics were implemented for two hours on Wednesday evenings staffed by OB/GYNs or obstetrics-trained family medicine physicians. Additionally, the team available on Wednesday clinics expanded to include a women’s health specific clinic manager, women’s health patient navigator to facilitate referrals, and women’s health education specialist to address low health literacy. Results: In 2021, 15 women’s health clinic days have been hosted since April,expanding beyond prenatal patients and resulting in increased volume of this clinic. There were a total of 36 patient encounters from 31 different patients including eight pregnant patients. Other chief concerns addressed at the clinic included: infertility/preconception counseling, abnormal uterine bleeding, pelvic pain/mass, vaginal itching, dyspareunia, and preventive women’s health visit. Six patients received pap smears and sexually transmitted infection (STI) screening. Low pap smear and STI screening rates at the women’s health clinic are attributed to the presence of women’s health fourth year student representatives at general clinic days ensuring most patients receive pap smears and STI screenings prior to referral. Conclusion: We implemented a twice-monthly, referral-based women’s health clinic in 2021 that has successfully provided care for 31 different patients including eight pregnant patients for a variety of chief concerns and preventive care encounters. The presence of a certified OB/GYN has ensured appropriate management of prenatal and primary care women’s health issues. Consistent provision of women’s health care services helps to mitigate the many barriers to women’s health care in our Indianapolis community.