Rebecca D. Walker

All Publications

• Experiences of Workplace Violence Among Healthcare Providers in Myanmar: A Cross-sectional Survey Study CUREUS Lindquist, B., Feltes, M., Niknam, K., Koval, K. W., Ohn, H., Newberry, J., Strehlow, M., Walker, R. 2020; 12 (4)

  View details for DOI 10.7759/cureus.7549

  View details for Web of Science ID 000523464200005

• Experiences of Workplace Violence Among Healthcare Providers in Myanmar: A Cross-sectional Survey Study. Cureus Lindquist, B., Feltes, M., Niknam, K., Koval, K. W., Ohn, H., Newberry, J., Strehlow, M., Walker, R. 2020; 12 (4): e7549

  Abstract

  Background Healthcare providers face enormous threats to personal safety from workplace violence (WPV). Prior investigations estimate a highly varied prevalence of WPV in the United States and around the world, including both verbal and physical assault. Little is known about WPV in Myanmar. Only a single prior study has evaluated WPV experiences among physicians in Myanmar, reporting an unusually low prevalence of verbal (8.7%) and physical (1.0%) assault. Given this much lower prevalence compared with similar studies in other low- and middle-income countries (LMICs), we embarked on a study to identify the prevalence of WPV in a separate cohort of healthcare providers in Myanmar. Methods This was a cross-sectional analysis of WPV prevalence among healthcare providers who attended a national emergency medicine conference in Myanmar in November 2018. The survey instrument was adapted from a validated survey from the Joint Program on Workplace Violence in the Healthcare Sector (International Labour Office, International Council of Nurses, World Health Organization, and Public Services International), which had been used in other global settings. Results Sixty-three participants completed the survey questionnaire, including 35 women (55.6%) and 26 men (41.3%). Among them, 25 (39.7%) were primary care providers. Overall, the combined prevalence of WPV in the previous 12 months was found to be 47.6% (n = 30; 95% CI: 34.9-60.6%). The prevalence of verbal assault was 47.6% (n = 30; 95% CI: 34.9-60.6%), and that of physical assault was 4.8% (n = 3; 95% CI: 1.0-13.3%). Twenty-four participants (42.4%) reported that they were encouraged to report violence in the workplace, and five (8.1%) reported they had received training on how to manage WPV. Respondents who were 30-34 years in age and those working in private facilities were significantly less likely to report WPV on univariate analysis. Conclusion Although our cohort comprised a limited sample of a select group of providers, we found a dramatically higher prevalence of WPV experiences among healthcare providers attending an emergency medicine conference in Myanmar when compared with a prior investigation. Very few participants had received training on WPV, and less than half reported a work culture where WPV reporting is encouraged. To combat healthcare provider shortages, more investigation is required into WPV to understand its impact and identify amelioration strategies.

  View details for DOI 10.7759/cureus.7549

  View details for PubMedID 32382453

  View details for PubMedCentralID PMC7202584

• Comparing Teaching Methods in Resource-Limited Countries. AEM education and training Mahadevan, S. V., Walker, R., Kalanzi, J., Stone, L. T., Bills, C., Acker, P., Apfeld, J. C., Newberry, J., Becker, J., Mantha, A., Tecklenburg Strehlow, A. N., Strehlow, M. C. 2018; 2 (3): 238

  View details for PubMedID 30051096

• Comparison of online and classroom-based formats for teaching emergency medicine to medical students in Uganda AEM Education and Training Mahadevan, S., Walker, R., Kalanzi, J., Luggya, T., Bills, C., Acker, P., et al 2018; 2 (1)

  View details for DOI 10.1002/aet2.10066

• Comparison of Online and Classroom-based Formats for Teaching Emergency Medicine to Medical Students in Uganda. AEM education and training Mahadevan, S. V., Walker, R., Kalanzi, J., Stone, L. T., Bills, C., Acker, P., Apfeld, J. C., Newberry, J., Becker, J., Mantha, A., Tecklenburg Strehlow, A. N., Strehlow, M. C. 2018; 2 (1): 5?9

  Abstract

  Severe global shortages in the health care workforce sector have made improving access to essential emergency care challenging. The paucity of trained specialists in low- and middle-income countries translates to large swathes of the population receiving inadequate care. Efforts to expand emergency medicine (EM) education are similarly impeded by a lack of available and appropriate teaching faculty. The development of comprehensive, online medical education courses offers a potentially economical, scalable, and lasting solution for universities experiencing professional shortages.An EM course addressing core concepts and patient management was developed for medical students enrolled at Makerere University College of Health Sciences in Kampala, Uganda. Material was presented to students in two comparable formats: online video modules and traditional classroom-based lectures. Following completion of the course, students were assessed for knowledge gains.Forty-two and 48 students enrolled and completed all testing in the online and classroom courses, respectively. Student knowledge gains were equivalent (classroom 25 ± 8.7% vs. online 23 ± 6.5%, p = 0.18), regardless of the method of course delivery.A summative evaluation of Ugandan medical students demonstrated that online teaching modules are effectively equivalent and offer a viable alternative to traditional classroom-based lectures delivered by on-site, visiting faculty in their efficacy to teach expertise in EM. Web-based curriculum can help alleviate the burden on universities in developing nations struggling with a critical shortage of health care educators while simultaneously satisfying the growing community demand for access to emergency medical care. Future studies assessing the long-term retention of course material could gauge its incorporation into clinical practice.

  View details for PubMedID 30051058

• Educating Health Care Professionals on Human Trafficking PEDIATRIC EMERGENCY CARE Grace, A. M., Lippert, S., Collins, K., Pineda, N., Tolani, A., Walker, R., Jeong, M., Trounce, M. B., Graham-Lamberts, C., Bersamin, M., Martinez, J., Dotzler, J., Vanek, J., Storfer-Isser, A., Chamberlain, L. J., Horwitz, S. M. 2014; 30 (12): 856-861

  Abstract

  The US Department of State estimates that there are between 4 and 27 million individuals worldwide in some form of modern slavery. Recent studies have demonstrated that 28% to 50% of trafficking victims in the United States encountered health care professionals while in captivity, but were not identified and recognized. This study aimed to determine whether an educational presentation increased emergency department (ED) providers' recognition of human trafficking (HT) victims and knowledge of resources to manage cases of HT.The 20 largest San Francisco Bay Area EDs were randomized into intervention (10 EDs) or delayed intervention comparison groups (10 EDs) to receive a standardized educational presentation containing the following: background about HT, relevance of HT to health care, clinical signs in potential victims, and referral options for potential victims. Participants in the delayed intervention group completed a pretest in the period the immediate intervention group received the educational presentation, and all participants were assessed immediately before (pretest) and after (posttest) the intervention. The intervention effect was tested by comparing the pre-post change in the intervention group to the change in 2 pretests in the delayed intervention group adjusted for the effect of clustering within EDs. The 4 primary outcomes were importance of knowledge of HT to the participant's profession (5-point Likert scale), self-rated knowledge of HT (5-point Likert scale), knowledge of who to call for potential HT victims (yes/no), and suspecting that a patient was a victim of HT (yes/no).There were 258 study participants from 14 EDs; 141 from 8 EDs in the intervention group and 117 from 7 EDs in the delayed intervention comparison group, of which 20 served as the delayed intervention comparison group. Participants in the intervention group reported greater increases in their level of knowledge about HT versus those in the delayed intervention comparison group (1.42 vs -0.15; adjusted difference = 1.57 [95% confidence interval, 1.02-2.12]; P < 0.001). Pretest ratings of the importance of knowledge about HT to the participant's profession were high in both groups and there was no intervention effect (0.31 vs 0.55; -0.24 [-0.90-0.42], P = 0.49). Knowing who to call for potential HT victims increased from 7.2% to 59% in the intervention group and was unchanged (15%) in the delayed intervention comparison group (61.4% [28.5%-94.4%]; P < 0.01). The proportion of participants who suspected their patient was a victim of HT increased from 17% to 38% in the intervention group and remained unchanged (10%) in the delayed intervention comparison group (20.9 [8.6%-33.1%]; P < 0.01).A brief educational intervention increased ED provider knowledge and self-reported recognition of HT victims.

  View details for PubMedID 25407038

• Implementing an emergency medical services system in kathmandu, Nepal: a model for "white coat diplomacy". Wilderness & environmental medicine Walker, R., Auerbach, P. S., Kelley, B. V., Gongal, R., Amsalem, D., Mahadevan, S. 2014; 25 (3): 311-318

  Abstract

  Wilderness medicine providers often visit foreign lands, where they come in contact with medical situations that are representative of the prevailing healthcare issues in the host countries. The standards of care for matters of acute and chronic care, public health, and crisis intervention are often below those we consider to be modern and essential. Emergency medical services (EMS) is an essential public medical service that is often found to be underdeveloped. We describe our efforts to support development of an EMS system in the Kathmandu Valley of Nepal, including training the first-ever class of emergency medical technicians in that country. The purpose of this description is to assist others who might attempt similar efforts in other countries and to support the notion that an effective approach to improving foreign relations is assistance such as this, which may be considered a form of "white coat diplomacy."

  View details for DOI 10.1016/j.wem.2014.04.006

  View details for PubMedID 24954196