The Clinical Problem Solvers

Sharmin, Lindsey, and Alex discuss a clinical unknown with Dr. Natasha Chida from Johns Hopkins

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Dr. Natasha Chida

Dr. Chida is an Assistant Professor in the Division of Infectious Diseases at Johns Hopkins University School of Medicine. She serves as the Associate Program Director for the infectious diseases fellowship training program. She is also the Co-director of the Osler and Bayview Internal Medicine Residency Programs Medical Education Pathway, and firm faculty in the Osler Program, where she serves as a resident coach. Her research interests include career development for early-career professionals, women in medicine, and HIV education for fellows.

In this episode of WDx, Sharmin, Yaz, and Kaylin are joined by Dr. Laila Woc-Colburn. Tune in to hear Dr. Woc expertly discuss a case of a young woman with a worsening headache, followed by a roundtable discussion about what drew her to infectious diseases and her passions in medicine and life.

Bio:

**Laila Woc-Colburn, MD** is an associate professor in the Division of Infectious Diseases at Emory University School of Medicine. A graduate of Universidad Francisco Marroquín in Guatemala, she completed her internal medicine residency at Advocate Illinois Masonic Medical Center in Chicago and her fellowship in infectious diseases and HIV medicine at Case Western University in Cleveland. Dr. Woc-Colburn also holds a Diploma in Tropical Medicine and Hygiene.

Her clinical interests encompass tropical diseases in immunosuppressed individuals, including those with HIV, as well as mycotic diseases, orthopedic infections, and medical education. She is passionate about teaching the next generation of healthcare professionals about infectious diseases and is dedicated to empowering women and BIPOC individuals in medicine.

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RLRCPSOLVERS

Ann Marie presents a case to Dan, Jack, and Sharmin of a young patient with tachycardia, lower extremity edema, who later develops pharyngitis.

Thyrotoxicosis Schema

Pharyngitis Schema

Peripheral Edema Schema

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RLRCPSOLVERS

Summary

In this special episode of the Antiracism in Medicine Series, originally recorded for the 2021 Society of General Internal Medicine Annual Meeting, the CPSolvers Antiracism team discusses what must be done to make medical education more antiracist. The conversation spans stages of academic medical career progression, ranging from recruitment to training to retention. The ARM team draws upon their own research and personal experiences to provide listeners with recommendations and actionable next steps.

Learning Objectives

After listening to this episode, listeners will be able to...

1. Explore the common barriers to entering the medical profession that minoritized trainees face and discuss strategies that trainees and institutions can adopt to overcome them.
2. Recognize how racist ideologies are often perpetuated in medical education and ways that academic medical centers can revise their curricula to prepare a physician workforce that is invested in recognizing and addressing the root cause of health disparities.
3. Understand the “minority tax” that minoritized trainees and faculty experience in diversity, equity, and inclusion reform efforts; identify models to properly compensate individuals for their time and expertise.

Credits

• Written and produced by: Dereck Paul, MD, MS; Chioma Onuoha, Utibe R. Essien, MD, MPH; Rohan Khazanchi, MPH; LaShyra Nolen; Naomi F. Fields; Michelle Ogunwole, MD; Jazzmin Williams; and Jennifer Tsai MD, M.Ed
• Host: Chioma Onuoha
• Infographic: Creative Edge Design
• Guests: Rohan Khazanchi, MPH; Naomi F. Fields; Michelle Ogunwole, MD; Utibe R. Essien, MD, MPH; Jazzmin Williams

Timestamps:

00:00 Introduction

02:15 Barriers to Entry in Medicine

05:15 How to Identify an Uplifting Institutional Home

11:40 Racism Ingrained in Medical Education

15:10 Imagining an Ideal Medical School Curriculum

17:40 A Roadmap to Engaging Hyperlocal Communities in Medical Education

20:30 Moving Beyond Ahistorical Conversations about Health Disparities

27:05 Engaging All Learners as Stakeholders for Health Equity and Antiracism

33:40 Re-examining Who the Experts Are

42:40 Recognizing Privilege and Positionality

45:25 Patient Safety Analogy and “Racism Saps the Strength of the Whole”

49:44 Where Do You Find Your Hope?

Takeaways:

1. Reimagining the learning environment: Creating a more antiracist learning environment will require institution-level commitments and broader reforms in the medical education regulatory environment (i.e. board examinations and mandated competencies).
2. Valuing health equity work: antiracism and health equity work must be properly compensated at all levels of training. Such compensation could be monetary or come in the form of academic currency, like co-authorship of publications.
3. How to be a good ally and co-conspirator: Power and access are needed to sustain and amplify antiracist justice within medicine. Many times, granting this power and access will require that individuals with privileged identities historically possessing a disproportionate amount of power transfer that power to individuals from marginalized backgrounds. Rather than centering the importance of individual advancement, we can remember that whenever racism is operational, as Dr. Camara Jones says, it “saps the strength of the whole society.” Using justice to guide our distribution of power will improve everyone’s livelihood.
4. Advancing beyond ahistorical teaching on racial health disparities: Health equity education must include racism as a driver of health inequities. As prior podcast episodes have highlighted, misleading theories of racialized biological differences cannot be presented as the cause of racial health disparities.

Pearls:

Acculturation to Medical Education

While the process of medical education is exciting, progressing through clinical training involves acculturation for all. This acculturation can differentially affect learners based on their own backgrounds and experiences. It is important for learners to reach out to mentors and peers who can offer insight into learning the ropes, and a safe place to land; it is also important for educators to recognize this and offer this to their learners. Additionally, it is important that institutions create environments where students have educators and faculty of similar backgrounds as theirs to...

CPSolvers: Anti-Racism in Medicine Series

Episode 14: Race, Place, and Health: Clinician and Community Perspectives

Show Notes by Alec Calac

February 15th, 2022

Summary: This episode highlights how racism manifests in the built environment, and how community and individual-level efforts can mitigate these inequities. This discussion is the second of three planned conversations around the connections between race, place, and health. Our latest episode welcomes first-time guests Dr. Eugenia South, a physician-scientist and Vice Chair for Inclusion, Diversity, and Equity in the Department of Emergency Medicine at the Perelman School of Medicine, and Noelle Warford, Executive Director of the grassroots organization Urban Tree Connection. Hosted by team members Naomi Fields and LaShyra Nolen,our guests present their community-based work in Pennsylvania and lay bare the connections between race, place, and health.

Episode Learning Objectives:

After listening to this episode, learners will be able to...

1. Understand the historical and present-day role of land dispossession and property rights in determining health along lines of race and place.
2. Learn how advancing individual agency and distributive justice can empower community organizers and initiatives.
3. Understand the factors that promote and inhibit long-term resiliency and sustainability of place-based initiatives.
4. Learn how we can reimagine health by decolonizing wealth and philanthropy in modern society.

Credits

• Written and produced by: Naomi F. Fields, LaShyra Nolen, Rohan Khazanchi, MPH, Michelle Ogunwole, MD, Alec Calac, Victor Lopez Carmen, MPH, Utibe R. Essien, MD, MPH, Jennifer Tsai MD, MEd, Sudarshan Krishnamurthy, Chioma Onuoha, Dereck Paul, MD, MS, Ayana Watkins, Jazzmin Williams
• Hosts: Naomi F. Fields, LaShyra Nolen
• Infographic: Creative Edge Design
• Audio edits: David Hu
• Show notes: Alec Calac
• Guests: Dr. Eugenia South, MD, MSPH, and Noelle Warford, MSW

Time Stamps

00:00 Introduction

05:40 Built environments and structural racism

11:18 Agricultural perspective, land rights, and settler colonialism

15:00 Responsible community engagement and catalyzing individual agency

21:58 Engaging communities outside of the ivory tower

27:00 Scaling up interventions to the community level

32:29 Intervention sustainability

37:18 Decolonizing philanthropy and place-based investments

42:40 Navigating trade-offs and mitigating ethical tensions

49:20 Key takeaways

Episode Takeaways

1. Your “why” has to be clear before you engage in community-based work.

Ms. Warford reminds us that we need strong, sound ideological positions and guiding principles before engaging with the communities around us. She asks to think about what we are doing today to make it easier for people to live in the future. Our ancestors considered our present to be impossible, so how can we use our ideas and experiences to effect positive change in our communities? These movements require action, not passivity.

2. Take time to learn from your patients. Be curious.

Clinicians are incredibly privileged individuals. Dr. South reminds us that it is our great honor to talk to people in an exam room. Our patients are not just a list of problems. They are individuals who interact with environments that affect their health. She encourages us to see beyond these problems, and ask patients about their lives, challenges, and successes. Everything is important. Unfortunately, medical practice does not always allow us to slow down and take this time to listen. But, finding ways to do so can prove illuminating as well as rewarding.

Pearls

Built Environment, Physical Health, and Mental Health

• Dr. South detailed that there are clear physical health benefits associated with place-based interventions, but unfortunately many lots and buildings sit vacant and destitute across the US. There’s also more. When interviewing community members in Philadelphia, she shared that longstanding disinvestments in their communities made them feel “unimportant” and “neglected” by society, which had effects on their mental health.
• The 2021 Build Back Better Act recognized the impact that the built environment has on health, calling for environmental improvements such as planting trees.
• Ms. Warford is the Executive Director of Urban Tree Connection, a grassroots organization in West Philadelphia that uses land-based strategies an...