Italo Milton Brown

All Publications

• The Glass Ceiling-Racial Disparities Among Emergency Medicine Chief Residents. JAMA network open Landry, A. M., Brown, I. 2024; 7 (9): e2432606

  View details for DOI 10.1001/jamanetworkopen.2024.32606

  View details for PubMedID 39316407

• A national pilot study on simulation-based upstander training for emergency medicine clinicians. AEM education and training Mundo, W., Vaughn, J., Odetunde, A., Donovan, T., Alvarez, A., Smith, K., Brown, C., Brown, I., Datta, S., Vora, S., Ward-Gaines, J. 2024; 8 (3): e10990

  Abstract

  Objective: This study assesses the effectiveness of clinical simulation-based training in boosting self-perceived confidence for using upstander communication skills to confront racism, discrimination, and microaggressions (RDM).Methods: We conducted an observational cohort study with emergency medicine professionals at the 2023 Scientific Assembly of the American Academy of Emergency Medicine in New Orleans, Louisiana. The study featured a clinical simulation-based training on upstander communications skills session followed by small- and large-group debriefs. Participants completed pre- and post-training questionnaires assessing demographics and confidence in health equity competencies. This survey was used in a previous study with emergency medicine residents. Data were analyzed using an independent Student's t-test, with a significance threshold of 0.05.Results: Thirty-two individuals participated in the simulation-based training, and 24 completed surveys, with a 75% response rate. Most participants were non-Hispanic (24, 85.7%) and women (18, 64%), with racial demographics mostly White (8, 28.6%), Black or African American (8, 28.6%), and Asian (6, 21.4%). After the workshop, there was a notable increase in self-perceived ability and confidence in identifying RDM (from 7±3.2 to 8.6±1.6, p<0.003), using upstander communication tools (from 6.1±3.5 to 8.5±1, p<0.0001), and the likelihood of intervening in RDM situations (from 7.1±3.3 to 8.8±1.1, p<0.0002).Conclusions: The clinical simulation-based training significantly improved participants' confidence and self-perceived ability to address RDM in simulated clinical environments. This training method is a promising tool for teaching health equity topics in clinical medicine.

  View details for DOI 10.1002/aet2.10990

  View details for PubMedID 38800608

• We outside: Modeling equity-centered, antiracist, community-driven partnerships in resident education. AEM education and training Lewis, J., Turner, A., James, T., Brown, I., Wilson, L. T. 2024; 8 (Suppl 1): S36-S42

  Abstract

  Background: Community engagement is increasingly recognized as a necessity in addressing intractable racial and ethnic health disparities in the United States. However, institutions have not adequately trained resident physicians in developing symbiotic community partnerships that preserve community autonomy and identity without exploitation. Our goals were to highlight the experiences of expert academic emergency physicians in creating innovative, community-driven, and anti-racist solutions to achieving measurable equity in health outcomes and to introduce a novel framework entitled the Social Change Method to take a community-embedded intervention from concept to creation.Methods: The methodology was based on the development of a didactic session at the 2023 SAEM Annual Meeting. The three novel initiatives discussed were Emergency Medicine Remix (EMR); Trust, Research, Access, and Prevention (TRAP) Medicine; and The Health Equity Accelerator (HEA). A team of multi-institutional experts convened to develop the session objectives through priority setting.Results: Our expert panel discussed successes and challenges encountered while using evidence-informed strategies to conduct their community-based programming. Participant questions were centered on fostering sustainability, emphasizing the importance of carefully crafted interventions in the face of uncertain legislative challenges and strategies to empower others.Conclusions: Emergency medicine residency education should incorporate training on methods to leverage community partnerships to improve individual and community health outcomes. The Social Change Method can be used as a conceptual framework to generate easily re-creatable and scalable partnerships that establish trust and forge relationships that honor identity and autonomy without exploiting community members.

  View details for DOI 10.1002/aet2.10984

  View details for PubMedID 38774826

• A Conference (Missingness in Action) to Address Missingness in Data and AI in Health Care: Qualitative Thematic Analysis. Journal of medical Internet research Rose, C., Barber, R., Preiksaitis, C., Kim, I., Mishra, N., Kayser, K., Brown, I., Gisondi, M. 2023; 25: e49314

  Abstract

  BACKGROUND: Missingness in health care data poses significant challenges in the development and implementation of artificial intelligence (AI) and machine learning solutions. Identifying and addressing these challenges is critical to ensuring the continued growth and accuracy of these models as well as their equitable and effective use in health care settings.OBJECTIVE: This study aims to explore the challenges, opportunities, and potential solutions related to missingness in health care data for AI applications through the conduct of a digital conference and thematic analysis of conference proceedings.METHODS: A digital conference was held in September 2022, attracting 861 registered participants, with 164 (19%) attending the live event. The conference featured presentations and panel discussions by experts in AI, machine learning, and health care. Transcripts of the event were analyzed using the stepwise framework of Braun and Clark to identify key themes related to missingness in health care data.RESULTS: Three principal themes-data quality and bias, human input in model development, and trust and privacy-emerged from the analysis. Topics included the accuracy of predictive models, lack of inclusion of underrepresented communities, partnership with physicians and other populations, challenges with sensitive health care data, and fostering trust with patients and the health care community.CONCLUSIONS: Addressing the challenges of data quality, human input, and trust is vital when devising and using machine learning algorithms in health care. Recommendations include expanding data collection efforts to reduce gaps and biases, involving medical professionals in the development and implementation of AI models, and developing clear ethical guidelines to safeguard patient privacy. Further research and ongoing discussions are needed to ensure these conclusions remain relevant as health care and AI continue to evolve.

  View details for DOI 10.2196/49314

  View details for PubMedID 37995113

• Diversity, Equity, Inclusion, Justice - Are we Accountable? Peter Rosen Memorial Lecture - 2022. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine Heron, S., Calderon, Y., Moll, J., Rotoli, J., Franks, N., Hassan, M., Ander, D., Brown, I., Lewis, J. 2022

  View details for DOI 10.1111/acem.14632

  View details for PubMedID 36420622

• Experiences of Discrimination, Institutional Responses to Seminal Race Events, and Depressive Symptoms in Black U.S. Medical Students. Academic medicine : journal of the Association of American Medical Colleges Milam, A. J., Brown, I., Edwards-Johnson, J., McDougle, L., Sousa, A., Furr-Holden, D. 2022; 97 (6): 876-883

  Abstract

  PURPOSE: To examine the relationship between experiences of discrimination, institutional responses to seminal race events, and depressive symptoms among Black medical students.METHOD: This study collected data from a convenience sample of Black U.S. medical students via an anonymous electronic questionnaire in August 2020 that was distributed through the Student National Medical Association and Organization of Student Representatives listservs and an author's social media accounts. It included questions on demographics, institutional responses to seminal race events, experiences of discrimination, and symptoms of depression. Path models were used to examine the relationship between experiences of discrimination, institutional responses to seminal race events, and depressive symptoms among Black medical students.RESULTS: Of the 750 students completing the survey, 733 (97.7%) were Black. Experiences of discrimination and a lack of institutional responses to seminal race events were associated with more depressive symptoms (b = 0.19, 95% CI: 0.11, 0.26; P < .001 and b = 0.12, 95% CI: 0.04, 0.20; P = .01). After controlling for gender and clinical diagnosis of depression or anxiety before medical school, there was a relationship between experiences of discrimination and institutional responses to seminal race events such that students who reported more experiences of discrimination were more likely to report that their institution did not respond to seminal race events (b = 0.41, 95% CI: 0.34, 0.48; P < .001). Experiences of discrimination moderated the relationship between institutional responses to seminal race events and depressive symptoms (i.e., the relationship between a lack of institutional responses to seminal race events and depressive symptoms was stronger among students who reported more frequent experiences of discrimination).CONCLUSIONS: Institutions dedicated to supporting Black medical student wellness must be diligent in cultivating a culture intolerant of discrimination and deft in their responses to seminal race events in the larger culture.

  View details for DOI 10.1097/ACM.0000000000004638

  View details for PubMedID 35703911

• Dear White People in Emergency Medicine. Annals of emergency medicine Brown, C., Brown, K., Brown, I., Daniel, R. 2021

  Abstract

  We, emergency physicians of color, are not okay. We are living and working through a pandemic that has disproportionately affected our communities and a year in which we cannot escape our lived experiences of police brutality. We see you, dear White people in emergency medicine, and are glad you want to support us. However, let us guide you in supporting our cause.

  View details for DOI 10.1016/j.annemergmed.2021.08.004

  View details for PubMedID 34598829

• Bias in recruitment: A focus on virtual interviews and holistic review to advance diversity AEM EDUCATION AND TRAINING Otugo, O., Alvarez, A., Brown, I., Landry, A. 2021; 5: S135-S139

  View details for DOI 10.1002/aet2.10661

  View details for Web of Science ID 000701048000023

  View details for PubMedID 34616988

  View details for PubMedCentralID PMC8480505

• COVID-19 Disparities and the Black Community: A Health Equity-Informed Rapid Response Is Needed. American journal of public health Brown, I. M., Khan, A., Slocum, J., Campbell, L. F., Lacey, J. R., Landry, A. M. 2020; 110 (9): 1350–51

  View details for DOI 10.2105/AJPH.2020.305804

  View details for PubMedID 32783709

• The Role of An Academic Emergency Department in Advancing Equity and Justice. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine Landry, A. M., Brown, I. n., Blomkalns, A. L., Wolfe, R. E. 2020

  Abstract

  In the midst of the coronavirus pandemic, the chronic issue of police brutality directed toward Black Americans reached a tipping in late May with the brutal murder of George Floyd. The social response raised equity and justice awareness, kickstarting one of the largest movements in U.S. history. A national dialogue on systemic racism as a public health concern has reemerged. Though traditionally viewed as taboo within academic medicine, the dialogue surrounding racial inequality is unavoidable.

  View details for DOI 10.1111/acem.14164

  View details for PubMedID 33125762

• Are Clinicians Contributing to Excess African American COVID-19 Deaths? Unbeknownst to Them, They May Be. Health equity Milam, A. J., Furr-Holden, D., Edwards-Johnson, J., Webb, B., Patton, J. W., Ezekwemba, N. C., Porter, L., Davis, T., Chukwurah, M., Webb, A. J., Simon, K., Franck, G., Anthony, J., Onuoha, G., Brown, I. M., Carson, J. T., Stephens, B. C. 2020; 4 (1): 139–41

  Abstract

  African Americans are overrepresented among reported coronavirus disease 2019 (COVID-19) cases and deaths. There are a multitude of factors that may explain the African American disparity in COVID-19 outcomes, including higher rates of comorbidities. While individual-level factors predictably contribute to disparate COVID-19 outcomes, systematic and structural factors have not yet been reported. It stands to reason that implicit biases may fuel the racial disparity in COVID-19 outcomes. To address this racial disparity, we must apply a health equity lens and disaggregate data explicitly for African Americans, as well as other populations at risk for biased treatment in the health-care system.

  View details for DOI 10.1089/heq.2020.0015

  View details for PubMedID 32368712

• Black Men's Perceptions and Knowledge of Diabetes: a Church-Affiliated Barbershop Focus Group Study JOURNAL OF RACIAL AND ETHNIC HEALTH DISPARITIES Balls-Berry, J., Watson, C., Kadimpati, S., Crockett, A., Mohamed, E. A., Brown, I., Valdez Soto, M., Sanford, B., Halyard, M., Khubchandani, J., Dacy, L., Davis, O. 2015; 2 (4): 465–72

  Abstract

  Diabetes is the seventh leading cause of death in the United States and disproportionately affects racial and ethnic minorities. These disparities persist despite educational efforts to reduce the prevalence of diabetes. Receptiveness of educational efforts for Black men needs to be studied.This study assesses Black men's receptiveness to a barbershop-based program focused on diabetes prevention and awareness in a church-affiliated barbershop in Rochester, Minnesota.The pastor and barber of a church-affiliated barbershop and academic medical researchers designed a community-engaged research study to determine Black men's perception of diabetes. Recruitment for the 90-minute focus group included flyers (n=60), email, and in-person. Units of analysis included focus-group audio recording, transcripts, and field notes. Using traditional content analysis, we categorized data into themes and sub-themes.Thirteen Black men participated (Group 1, n=6; Group 2, n=7) having a mean age of 40.3 years (range 19 to 65), and employed full-time (77%). Themes included diabetes prevention, treatment, prevalence, risks, and health education. Participants identified diet and exercise as essential components of diabetes prevention. Additionally, participants mentioned that family history contributes to diabetes. Participants agreed that barbershops are an appropriate setting for data collection and health education on diabetes for Black men.Findings indicate that Black men are generally aware of diabetes. The community-engaged research process allowed for development of a culturally appropriate research study on diabetes. This study is the foundation for developing a culturally appropriate health education program on diabetes for Black men.

  View details for DOI 10.1007/s40615-015-0094-y

  View details for Web of Science ID 000218513500006

  View details for PubMedID 26594612

  View details for PubMedCentralID PMC4651172