Dataset Information

Are you really doing 'codesign'? Critical reflections when working with vulnerable populations.

ABSTRACT: 'Codesign' and associated terms such as 'coproduction' or 'patient engagement', are increasingly common in the health research literature, due to an increased emphasis on the importance of ensuring that research related to service/systems development is meaningful to end-users.  However, there continues to be a lack of clarity regarding the key principles and practices of codesign, and wide variation in the extent to which service users are meaningfully engaged in the process. These issues are particularly acute when end-users include populations who have significant health and healthcare disparities that are linked to a range of intersecting vulnerabilities (eg, poverty, language barriers, age, disability, minority status, stigmatised conditions).  The purpose of this paper is to prompt critical reflection on the nature of codesign research with vulnerable populations, including key issues to consider in the initial planning phases, the implementation process, and final outputs.  Risks and tensions will be identified in each phase of the process, followed by a tool to foster reflexivity in codesign processes to address these issues.

SUBMITTER: Moll S

PROVIDER: S-EPMC7640510 | biostudies-literature | 2020 Nov

REPOSITORIES: biostudies-literature

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Are you really doing 'codesign'? Critical reflections when working with vulnerable populations.

Moll Sandra S Wyndham-West Michelle M Mulvale Gillian G Park Sean S Buettgen Alexis A Phoenix Michelle M Fleisig Robert R Bruce Emma E

BMJ open 20201103 11

'Codesign' and associated terms such as 'coproduction' or 'patient engagement', are increasingly common in the health research literature, due to an increased emphasis on the importance of ensuring that research related to service/systems development is meaningful to end-users.  However, there continues to be a lack of clarity regarding the key principles and practices of codesign, and wide variation in the extent to which service users are meaningfully engaged in the process. These issues are p ...[more]

PMID: 33148733

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Project description:AudienceThis content is intended for emergency medicine faculty.IntroductionFaculty at our institution noted that it can be easy to identify and address the knowledge gaps of junior learners. However, they often find different skills are needed when precepting senior residents, a sentiment shared by faculty at other institutions.1 To foster the skills needed for lifelong learning and deliberate practice, it is crucial that educators find methods to effectively assess the skills of senior residents and provide them with continued feedback.2 The goal of this faculty development session is to outline methods educators can use with senior residents to support their autonomy and independence while exploring their clinical reasoning, pushing them outside of their comfort zone, and promoting reflective and deliberate practice.2-9.Educational objectivesBy the end of the lecture, all faculty will be able to 1) describe how to use the Aunt Minnie method of precepting for senior residents, 2) list examples of ways in which they can probe the clinical reasoning of senior residents, 3) explain how to use reflective feedback techniques with senior residents, and 4) report use of the techniques discussed during this session when precepting senior residents in the emergency department.Educational methodsThis content is presented as a PowerPoint lecture with subsequent discussion.Research methodsA post-session survey was distributed to allow participants to evaluate the session. This survey was sent four months after the session to gauge how often participants were using the covered techniques on their clinical shifts in the interim.ResultsThe majority of survey respondents reported that they initially felt that precepting senior learners was "somewhat difficult" and that they found this session "valuable" in helping them address this challenge. Faculty reported using all of the techniques discussed in this session during their clinical shifts, but were more likely to use methods to promote clinical reasoning or reflective feedback than the Aunt Minnie method of precepting. Overall, respondents reported learning new skills during this exercise and appreciated the format which allowed them to share their own experiences of working with the senior residents and brainstorm techniques that might be useful beyond those discussed by the instructors.DiscussionThis faculty development session successfully introduced emergency medicine faculty to techniques that can be used to improve feedback and assessment of senior residents. The lecture format allowed for efficient transmission of material, while several group discussions and a role-play activity allowed for integration of material and sharing of experiences. Overall this exercise was a success with faculty reporting use of several of the techniques discussed. In future iterations, it may be beneficial to integrate more role-play activities to allow participants to practice more of the skills learned in a simulated environment prior to implementing on shifts with learners.TopicsFeedback, deliberate practice, clinical reasoning, precepting.

Project description:ObjectiveNational data suggest drivers who are younger, older, and have lower socioeconomic status (SES) have heightened crash-related injury rates. Ensuring vulnerable drivers are in the safest vehicles they can afford is a promising approach to reducing crash injuries in these groups. However, we do not know the extent to which these drivers are disproportionately driving less safe vehicles. Our objective was to obtain population-based estimates of the prevalence of important vehicle safety criteria among a statewide population of drivers.MethodsWe analyzed data from the NJ Safety and Health Outcomes warehouse, which includes all licensing and crash data from 2010-2017. We borrowed the quasi-induced exposure method's fundamental assumption-that non-responsible drivers in clean (i.e., only one responsible driver) multi-vehicle crashes are reasonably representative of drivers on the road-to estimate statewide prevalence of drivers' vehicle characteristics across four driver age groups (17-20; 21-24; 25-64, and ≥65) and quintiles of census tract median household income (n = 983,372). We used NHTSA's Product Information Catalog and Vehicle Listing platform (vPIC) to decode the VIN of each crash-involved vehicle to obtain model year, presence of electronic stability control (ESC), vehicle type, engine horsepower, and presence of front, side, and curtain air bags.ResultsThe youngest and oldest drivers were more likely than middle-aged drivers to drive vehicles that were older, did not have ESC, and were not equipped with side airbags. Additionally, across all age groups drivers of higher SES were in newer and safer vehicles compared with those of lower SES. For example, young drivers living in lowest-income census tracts drove vehicles that were on average almost twice as old as young drivers living in highest-income tracts (median [IQR]: 11 years [6-14] vs. 6 years [3-11]).ConclusionsVehicle safety is an important component of seminal road safety philosophies that aim to reduce crash fatalities. However, driver groups that are overrepresented in fatal crashes-young drivers, older drivers, and those of lower SES-are also driving the less safe vehicles. Ensuring drivers are in the safest car they can afford should be further explored as an approach to reduce crash-related injuries among vulnerable populations.

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Are you really doing 'codesign'? Critical reflections when working with vulnerable populations.

Publications

Are you really doing 'codesign'? Critical reflections when working with vulnerable populations.

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