Browsing by Author "Umoren, Rachel A."

Now showing 1 - 7 of 7
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    A targeted systematic review of cost analyses for implementation of simulation-based education in healthcare
    (Sage, 2020-03-19) Hippe, Daniel S.; Umoren, Rachel A.; McGee, Alex; Bucher, Sherri L.; Bresnahan, Brian W.; Pediatrics, School of Medicine
    Over the past two decades, there has been an increase in the use of simulation-based education for training healthcare providers in technical and non-technical skills. Simulation education and research programs have mostly focused on the impact on clinical knowledge and improvement of technical skills rather than on cost. To study and characterize existing evidence to inform multi-stakeholder investment decisions, we performed a systematic review of the literature on costs in simulation-based education in medicine in general and in neonatal resuscitation as a particular focus. We conducted a systematic literature search of the PubMed database using two targeted queries. The first searched for cost analyses of healthcare simulation-based education more broadly, and the second was more narrowly focused on cost analyses of neonatal resuscitation training. The more general query identified 47 qualified articles. The most common specialties for education interventions were surgery (51%); obstetrics, gynecology, or pediatrics (11%); medicine, nursing, or medical school (11%); and urology (9%), accounting for over 80% of articles. The neonatal resuscitation query identified five qualified articles. The two queries identified seven large-scale training implementation studies, one in the United States and six in low-income countries. There were two articles each from Tanzania and India and one article each from Zambia and Ghana. Methods, definitions, and reported estimates varied across articles, implying interpretation, comparison, and generalization of program effects are challenging. More work is needed to understand the costs, processes, and outcomes likely to make simulation-based education programs cost-effective and scalable. To optimize return on investments in training, assessing resource requirements, associated costs, and subsequent outcomes can inform stakeholders about the potential sustainability of SBE programs. Healthcare stakeholders and decision makers will benefit from more transparent, consistent, rigorous, and explicit assessments of simulation-based education program development and implementation costs in low- and high-income countries.
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    Care Experiences of Women Who Used Opioids and Experienced Fetal or Infant Loss
    (Elsevier, 2017-11) Scott, Lisa F.; Shieh, Carol; Umoren, Rachel A.; Conard, Teri; School of Nursing
    Objective To explore care experiences of women who used prescription or illicit opioids and experienced fetal or infant loss. Design A qualitative, descriptive design with secondary data analysis. Setting The Fetal and Infant Mortality Review program in an urban Midwestern county in the United States. Participants Eleven women with histories of prescription or illicit opioid use who experienced fetal or infant loss participated in the semistructured telephone or in-person interview portion of the mortality case review. Methods We used thematic analysis to analyze interview data. Results Five themes were identified related to the care experiences of participants throughout pregnancy and fetal/infant loss: Frustration and anger related to not being heard, feeling minimalized; Being overwhelmed with attempts to process and understand medical complications and outcomes; Profound sense of grief and coping with loss; Need to understand why and make difficult decisions; and Placing blame and guilt over death. Conclusion Our findings suggest that women who use opioids and experience fetal or infant loss have complex care, educational, and emotional needs. In the development of interventions for these women, it is important to address their unique and complex circumstances.
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    Career choices and global health engagement: 24-year follow-up of U.S. participants in the Indiana University-Moi University elective
    (Elsevier, 2015-12) Umoren, Rachel A.; Gardner, Adrian; Stone, Geren S.; Helphinstine, Jill; Machogu, Emily P.; Huskins, Jordan C.; Johnson, Cynthia S.; Ayuo, Paul O.; Mining, Simeon; Litzelman, Debra K.; Department of Medicine, IU School of Medicine
    Background Global health experiences evoke a profound awareness of cultural differences, inspire learners to prioritize professional values, and provide a lens for addressing global health care challenges. This study compares the long-term career and practice choices of participants in a 2-month Indiana University-Moi University, Kenya elective from 1989–2013 with those of a control group. Methods Global health elective (GHE) participants and a random sample of alumni without GHE experience were surveyed on their clinical practice, public health and global health activities. Results Responses from 176 former participants were compared with a control group of 177 alumni. GHE participants were more likely than similar controls to provide care to underserved U.S. populations (p=0.037), spend time in global health, public health, and public policy activities (p=0.005) and be involved in global health advocacy (p=0.001). Using multivariable analysis, GHE participants were more likely to be generalists (p<0.05), report that healthcare costs influenced medical decision-making (p<0.05), and provide healthcare outside the U.S. for ≥1 week/year (p<0.001). Conclusions Many years out of training, GHE participants were more likely to be generalists working with underserved populations, to be cost-conscious in their healthcare decision-making, and to be involved in global health, public health or public policy. Implications With the primary care provider shortage and need for greater awareness among providers of healthcare costs, our study shows that that global health experiences may yield broader benefits to the U.S. medical system.
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    Correction: [On Becoming a Global Citizen: Transformative Learning Through Global Health Experiences]
    (Ubiquity Press, 2021-03-16) Litzelman, Debra K.; Gardner, Adrian; Einterz, Robert M.; Owiti, Philip; Wambui, Charity; Huskins, Jordan C.; Schmitt-Wendholt, Kathleen M.; Stone, Geren S.; Ayuo, Paul O.; Inui, Thomas S.; Cottingham, Ann H.; Umoren, Rachel A.; Medicine, School of Medicine
    [This corrects the article DOI: 10.1016/j.aogh.2017.07.005.].
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    Experience of Maternal Narcotics Users with Fetal and Infant Loss throughout the Infant Life Cycle
    (Office of the Vice Chancellor for Research, 2016-04-08) Scott, Lisa Fath; Shieh, Carol; Umoren, Rachel A.; Conard, Teri
    Objective: Fetal or infant loss is a painful and traumatic experience for all mothers. Literature, however, has been limited in describing maternal experience from pregnancy to the time when a baby dies. This study explored the experience of mothers using prescribed or illicit opioids and encountering fetal or infant loss. Design: A qualitative approach using a reflexive iteration process was used to identify maternal experience across an infant’s life cycle. Participants: Eleven mothers (mostly white, single, less than a high school education) with a history of using prescribed or illicit opioids participated in the semi-structured telephone or in person maternal interview portion of the Fetal and Infant Mortality Review in a Midwest county. Methods: Interview transcripts were first coded. Codes with similar meaning were grouped into categories. Categories sharing similar features were collapsed into common themes. Each phase of analysis was performed and checked by three investigators. Results: Four common themes were identified throughout the entire life cycle of the infant: not being heard, dealing with medical complications, reproductive health, and grief, guilt and bereavement. Mothers perceived that their needs and concerns were not carefully attended to by care providers. They were overwhelmed by medical information about pregnancy and infant complications. Participants did not plan for the pregnancy or use contraception prior to the pregnancy but did use contraception in the post-partum period. Many mothers struggled with grief and loss. Additional themes included care needs for substance use and mental health and taking action and making decisions for the baby’s life. Conclusions: The findings suggest women experiencing opioid use have education and care needs when dealing with fetal/infant loss. When developing interventions for these women, clear communication about medical complications, emotional and bereavement support, and services to help these women prevent unplanned pregnancy are needed.
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    Fostering reciprocity in global health partnerships through a structured, hands-on experience for visiting postgraduate medical trainees
    (Accreditation Council for Graduate Medical Education, 2014-06) Umoren, Rachel A.; Einterz, Robert M.; Litzelman, Debra K.; Pettigrew, Ronald K.; Ayaya, Samuel O.; Liechty, Edward A.; Department of Medicine, IU School of Medicine
    BACKGROUND: Global health programs that allow international experiences for US learners should also enable reciprocal learning experiences for international learners, particularly if that is a need identified by the partner institution. METHODS: A partnership between Indiana University and Moi University, Kenya, has successfully hosted 41 visiting Kenyan internal medicine and pediatrics registrars at Indiana University since 2006. The program's logistics, curriculum, and evaluation are described. RESULTS: The registrars rotated through nephrology, cardiology, hematology and oncology, infectious diseases, and intensive care, as well as related ambulatory experiences, functioning on a level comparable to fourth-year medical students. They showed significant improvement in pretest and posttest scores on a standardized National Board of Medical Examiners examination (P  =  .048). International learners experienced culture shock, yet they felt the Indiana University elective was helpful and would recommend it to future participants. CONCLUSIONS: Global health programs can reciprocate the benefits derived for US students and residents by offering learning experiences to international learners if that is an expressed need from the international partner. Barriers to those experiences can be overcome, and the hands-on, elective experience has the potential to positively affect the knowledge and attitudes of participants as well as the home nation.
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    On Becoming a Global Citizen: Transformative Learning Through Global Health Experiences
    (Ubiquity, 2017-05) Litzelman, Debra K.; Gardner, Adrian; Einterz, Robert M.; Owiti, Philip; Wambui, Charity; Huskins, Jordan C.; Schmitt-Wendholt, Kathleen M.; Stone, Geren S.; Ayuo, Paul O.; Inui, Thomas S.; Umoren, Rachel A.; Medicine, School of Medicine
    BACKGROUND: Globalization has increased the demand for international experiences in medical education. International experiences improve medical knowledge, clinical skills, and self-development; influence career objectives; and provide insights on ethical and societal issues. However, global health rotations can end up being no more than tourism if not structured to foster personal transformation and global citizenship. OBJECTIVE: We conducted a qualitative assessment of trainee-reported critical incidents to more deeply understand the impact of our global health experience on trainees. METHODS: A cross-sectional survey was administered to trainees who had participated in a 2-month elective in Kenya from January 1989 to May 2013. We report the results of a qualitative assessment of the critical incident reflections participants (n = 137) entered in response to the prompt, "Write about one of your most memorable experiences and explain why you chose to describe this particular one." Qualitative analyses were conducted using thematic analysis and crystallization immersion analytic methods based on the principles of grounded theory, employing a constructivists' research paradigm. FINDINGS: Four major themes emerged. These themes were Opening Oneself to a Broader World View; Impact of Suffering and Death; Life-Changing Experiences; and Commitment to Care for the Medically Underserved. CONCLUSIONS: Circumstances that learners encounter in the resource-scarce environment in Kenya are eye-opening and life-changing. When exposed to these frame-shifting circumstances, students elaborate on or transform existing points of view. These emotionally disruptive experiences in an international health setting allowed students to enter a transformational learning process with a global mind. Students can see the world as an interdependent society and develop the capacity to advance both their enlightened self-interest and the interest of people elsewhere in the world as they mature as global citizens. Medical schools are encouraged to foster these experiences by finding ways to integrate them into curriculum.