The Clinical Problem Solvers

Schema

Want to test your learning? Take our episode quiz here

This episode is available on Patreon only.

Why? 

More about the RLR series here. 

Dr. Frederick Weber discusses an approach to chronic diarrhea with the TCQ squad

Chronic Diarrhea Schema

Want to test your learning? Take our Episode Quiz

Dr. Frederick Weber

Dr. Frederick Weber is a Clinical Professor of Medicine at the University of Alabama Birmingham in the Division of Gastroenterology and Hepatology.  He is the former Medical Director of the Division.

Download CPSolvers App here 

Patreon website

We continue our campaign to #EndNeurophobia, with the help of Dr. Aaron Berkowitz

Neurology DDx Schema

Want to test your learning? Take our episode quiz here

Gabriela Pucci

Gabriela has graduated from Medical School at Unicamp and recently finished her neurology residency at Unesp, both in Brazil. She is interested in Medical Education and Clinical Reasoning and has obviously fallen in love with CPSolvers and VMRs since day 1. In her free time, she likes to practice pilates, play with her dogs, binge-watch Netflix comedy series, read biography books, go out with her friends (pre-COVID), drink wine, and cook (still learning).

Download CPSolvers App here 

Patreon website

Rabih and Reza discuss learning during the process of clinical reasoning on VMR. 

Download CPSolvers App here

Patreon website

RLR website  

VMR sign up  

Kirsten Austad MD, MPH is an Assistant Professor of Family Medicine at Boston University School of Medicine and a hospitalist at Boston Medical Center. She earned her undergraduate degree in English Literature and Medical Microbiology and Immunology from the University of Wisconsin-Madison and her medical degree from Harvard Medical School in the New Pathway Program. She completed her residency in Family Medicine at Boston Medical Center, the largest safety-net hospital in New England. Following residency, she completed a research fellowship at Brigham and Women’s Hospital in Global Women’s Health and earned a Masters in Public Health from the Harvard T.H. Chan School of Public Health. During this time she worked clinically as a nocturnist at Brigham and Women’s Hospital / Dana Farber Cancer Institute. After fellowship she returned to Boston Medical Center where she is a hospitalist and the Medical Director of the HealthNet Inpatient Family Medicine service, one of the largest family medicine hospitalist services in the country.

Her research focuses on global implementation science aimed at improving the delivery of women’s health care in low-resource settings, including respectful maternity care and family planning. In addition to global health research, she also has extensive experience in program development, having spent 6 years as the Director of Women’s Health for Maya Health Alliance, a non-profit providing care to indigenous Maya patients in the highlights of Guatemala, where she trained and supervised a team of over 20 nurses and doctors to provide community-based patient-centered women’s health care.

Download CPSolvers App here 

Patreon website

Give us feedback here 

Bronson presents a clinical unknown to Mohit, Kai, and Lindsey.

Want to test your learning? Take our Episode Quiz 

Mohit Harsh

Mohit is a current Chief Resident in the Department of Internal Medicine at WashU. He is from Huntington, West Virginia and attended Marshall University School of Medicine in his hometown. He loves clinical reasoning and has a special interest in Hospital Medicine. Outside of work, he enjoys cooking new recipes, hiking, walks in the park, and has recently developed a green thumb with over 30 house plants and a garden.

Kai Jones

Kai Jones is from Tulsa, Oklahoma and studied Biology and Anthropology at Washington University in St. Louis. She attended Washington University for medical school and is now a second-year resident in Internal Medicine at Barnes-Jewish Hospital. She is interested in Endocrinology, and  community based participatory research. Her hobbies include golf, and cooking.

Bronson Knuzler

Bronson Kunzler was born and raised in Salt Lake City, Utah, he studied finance at Utah State University and is currently an MS3 at Penn State University College of Medicine. He is interested in Internal Medicine with hopes to become a Cardiologist. In his free time he enjoys cheering for the Utah Jazz, barbeque, and visiting museums.

Download CPSolvers App here

Patreon website

Give us feedback here 

Sue Ellen presents a clinical unknown to Nick, Jennifer, and Dan

Schema

Episode Quiz

Nicholas Hornstein

Nicholas Hornstein is a PGY-3 at UCLA Ronald Reagan Medical Center. He was born and raised in Los Angeles, earned his undergraduate degree from Brandeis University, and graduated from Columbia University with an MD and a PhD in Computational Biology. He has a passion for climbing, cooking, furry animals, and the advancement of medical genomics/technology.  He will be furthering his education next year with a Fellowship in Hematology Oncology at MD Anderson Cancer Center and couldn’t be more excited.

Suellen Li

Suellen Li is a PGY-2 internal medicine resident at Massachusetts General Hospital. She grew up in Roanoke, VA and attended Duke University, where she studied Environmental Sciences & Policy and Global Health. She then moved to Chicago to complete medical school at the University of Chicago Pritzker School of Medicine. After finishing residency, she hopes to pursue a career in hospital medicine. In her free time, she enjoys reading, eating chips and being a cat mom.

Jennifer Plotkin

Jennifer Plotkin is a PGY2 in internal medicine at UCLA. She was born and raised in Los Angeles. She attended MIT for undergrad where she majored in Chemistry. She completed her medical school training at Johns Hopkins. She loves internal medicine for its problem solving and meaningful therapeutic relationships with patients. Her interests include primary care, endocrinology, and medical education, particularly in the veteran population. Outside of medicine, she enjoys running, rooting for the Lakers and Dodgers, and exploring restaurants.

Download CPSolvers App here

Patreon website

Give us feedback here 

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 learn from.

For trainees: What to consider when evaluating medical schools and residency programs

It can be challenging for students and residents  to decide if an institution is truly committed to antiracism, social justice and equity. While time and action are true measures of this commitment, some things to consider include:

• Is there diversity, which is more than skin deep, in the leadership?
• Does the institution involve community members in training?
• What is the relationship between community members and the academic medical center?
• How does the institution respond to issues of injustice that affect trainees?
• Is advocacy celebrated or at least respected and encouraged?
• Does the institution recognize past historical transgressions? What have they done to address a painful history if one exists?
• Does the curriculum equip learners with a vocabulary to discuss racism?
• Does the curriculum include historical context about the communities served by the academic medical center?

Engaging All Students as Stakeholders

Antiracism education can seem relegated to students with niche interests. Nevertheless, there are ways to engage all students as stakeholders. 

• Board exam writers can shape their learning objectives toward antiracism based on our evolving knowledge base and more accurate paradigms of racism-as-the-risk factor, given that board exams shape what educators include in their curricula. 
• On an institutional level, we can incentivize scientifically accurate, ethically responsible, justice-based means of representing and incorporating race, racism, and health equity within faculty members’ work. These are the people that learners often look up to and after whom they model their careers. 
• Finally, we might eschew the idea that learners are disinterested in these topics, and commit to deep education regarding race/racism in medicine. Learners are often intellectually curious with a heart to learn what is needed to provide the best care for their patients. 

Curricular Reforms to Operationalize Antiracism

Curricula seeking to address health inequities cannot be ahistorical. Health disparities are not created in a vacuum; thus, discussion of disparate outcomes should include conversations about the systemic and structural underpinnings of inequity.

Similarly, medical curricula must become comfortable reframing who the “experts” are on health disparities topics. In brief, community stakeholders are crucial experts on the lived experiences and health of their neighbors. Community engagement, as well as prioritization of hyperlocal issues impacting communities proximate to academic institutions, can and should be integrated in health equity curricula.

References:

1. Amutah C, Greenidge K, Mante A et al. Misrepresenting Race — The Role of Medical Schools in Propagating Physician Bias. New England Journal of Medicine. 2021;384(9):872-878. doi:10.1056/nejmms2025768
2. Nolen L. How Medical Education Is Missing the Bull’s-eye. New England Journal of Medicine. 2020;382(26):2489-2491. doi:10.1056/nejmp1915891
3. Sharma M, Pinto A, Kumagai A. Teaching the Social Determinants of Health. Academic Medicine. 2018;93(1):25-30. doi:10.1097/acm.0000000000001689
4. Phelan S, Burke S, Cunningham B et al. The Effects of Racism in Medical Education on Students’ Decisions to Practice in Underserved or Minority Communities. Academic Medicine. 2019;94(8):1178-1189. doi:10.1097/acm.0000000000002719
5. Khazanchi R, Keeler H, Marcelin J. Out of the Ivory Tower: Successes From a Community-Engaged Structural Competency Curriculum. Academic Medicine. 2021;96(4):482-482. doi:10.1097/acm.0000000000003927
6. Tsai J, Ucik L, Baldwin N, Hasslinger C, George P. Race Matters? Examining and Rethinking Race Portrayal in Preclinical Medical Education. Academic Medicine. 2016;91(7):916-920. doi:10.1097/acm.0000000000001232
7. Jones C. Toward the Science and Practice of Antiracism: Launching a National Campaign Against Racism. Ethn Dis. 2018;28(Supp 1):231. doi:10.18865/ed.28.s1.231
8. Tsai J, Lindo E, Bridges K. Seeing the Window, Finding the Spider: Applying Critical Race Theory to Medical Education (MedCRT) to Make Up Where Biomedical Models and Social Determinants of Health Curricula Fall Short. Front Public Health. 2021. doi: 10.3389/fpubh.2021.653643

Transcript

Download the transcript here

Disclosures

Mr. Khazanchi is a member of the American Medical Association’s Council on Medical Education, but the views presented herein represent his own and not necessarily those of the AMA or the Council. The hosts and guests report no other relevant financial disclosures.

Citation

Onuoha C, Khazanchi R, Fields N, Ogunwole M, Williams J, Essien UR, Tsai J,  Nolen L, Paul D. “Episode 9: Moving Towards Antiracism in Medical Education.” The Clinical Problem Solvers Podcast. https://clinicalproblemsolving.com/episodes. June 10, 2021.

Rabih moderates as an interactive, international virtual morning report community discusses a case of fever

Fever Overview Schema

Inflammation Thought Train Schema

Want to test your learning? Take our episode quiz here

Dr. Hernán Carrillo

Hernán Carrillo is Head of the Internal Medicine Department at Las Higueras Hospital in Talcahuano, Chile. He’s also an Assistant Professor at Concepción’s University. He is passionate about his work in public health care and is specially crazy about diagnostic process. Loves to play guitar and singing, and he’s learning a little bit of piano. Also enjoys photography. He is totally in love with his family!

Download CPSolvers App here

Patreon website

VMR sign up  

Give us feedback here 

Description: We continue our campaign to #EndNeurophobia led by Aaron Berkowitz! This time, Doug presents a case of headache and blurry vision to Hannah and Dhruv.

Neurology DDx Schema

Want to test your learning? Take our Episode Quiz 

Dhruv Srinivasachar

Dhruv Srinivasachar is a soon-to-be 1st year Medicine-Pediatrics resident at Western Michigan University and a graduate of Virginia Commonwealth University School of Medicine (the Medical College of Virginia for all the veteran attendings out there). Introduced to medicine through research, Dhruv has shifted his passions to empathetic clinical care and medical education, as a contributor to the CPSolvers (especially through VMR as a case presenter, discussant, and compiler of cases) and team member for the Not Just Little Adults podcast (CPedsSolvers, if you will). When he’s not looking for apartments or stressing about intern year, he can be found biking, gardening, and cooking.

Hannah Roberts

Hannah is currently finishing medical school in Arizona with plans for emergency medicine. She graduated from the US Naval Academy and completed active duty before starting med school. Her interests in medicine include nuclear weapons safety, medical education, and clinical applications of evolutionary biology. Outside of medicine she is a dog person and loves being outside mountain biking, running, and camping.

Doug Pet

Doug Pet is a resident in neurology at UCSF. He grew up surrounded by cow farms and crab-apple trees in New Milford, CT. He completed a dual-degree program at Tufts and the New England Conservatory studying medical anthropology, community health, and jazz saxophone. He later worked for a non-profit in Berkeley, CA on bioethical and social justice issues related to genetic and reproductive technologies. Doug attended Vanderbilt University School of Medicine, after which he returned to the Bay Area for neurology residency at UCSF. He loves Brazilian music, playing Spike ball, and making custom wooden pens on his lathe.

Download CPSolvers App here 

Patreon website

Give us feedback here 

Sharmin, Rabih, Reza, and Arsalan tackle a schema for pulmonary disease with eosinophilia

Patreon website

Download CPSolvers App here

Schema

Episode Quiz

Give us feedback here 

Dr. Katrina Armstrong and Dr. Vineet Arora join the #bosslady Wdx team to discuss navigating negotiations as women in medicine

Dr. Katrina Armstrong

Dr. Katrina Armstrong is the Jackson Professor of Clinical Medicine at Harvard Medical School, Chair of the Department of Medicine and Physician-in-Chief of Massachusetts General Hospital. She is an internationally recognized investigator in medical decision making, quality of care, and cancer prevention and outcomes, an award winning teacher, and a practicing primary care physician. She has served on multiple advisory panels for academic and federal organizations and has been elected to the American Society of Clinical Investigation and the Institute of Medicine. Prior to coming to Mass General, she was the Chief of the Division of General Internal Medicine of the Robert Wood Johnson Clinical Scholars Program at the University of Pennsylvania.

Dr. Vineet Arora

Vineet Arora, MD, MAPP is an academic hospitalist and Associate Chief Medical Officer for Clinical Learning Environment and Assistant Dean for Scholarship & Discovery at the University of Chicago. Through her role, she bridges educational and hospital leadership to engage frontline staff into the institutional quality, safety, and value mission. An accomplished researcher, she is PI of numerous NIH grants to evaluate novel interventions that combine systems change with learning theory to improve care which has resulted in publications that have been cited over 11,000 times.  She is an elected member of the National Academy of Medicine and the American Society of Clinical Investigation. As an advocate for women in medicine, she was featured in the New York Times for an editorial that called to end the gender pay gap in medicine. She is a founding member of the 501c3 Women of Impact dedicated to advancing women leaders in healthcare. She is on the leadership group of the National Academy of Science Engineering and Medicine’s Action Collaborative to End Sexual Harassment in Higher Education.

Download CPSolvers App here 

Patreon website

Give us feedback here 

Thank you for your continued support and please give us feedback here!

Rabih and Reza tackle a salty problem

Schema

Episode Quiz

This episode is available on Patreon only.

Why? 

More about the RLR series here. 

“There’s nothing new under the sun, but there are new suns” – Octavia E. Butler

Summary: We invite social justice champion and acclaimed scholar of race, gender, and the law, Dorothy E. Roberts, JD, to discuss the history of race-based medicine and the movement for health equity and justice.

Episode Learning Objectives

After listening to this episode learners will be able to…

1. Understand race as a social construct and political invention
2. Explore the history of race as a proxy for genetics and ancestry
3. Explore the history of race-based pharmaceuticals
4. Explore the history of race-based clinical algorithms

Credits

• Written and produced by: Naomi Fields, Rohan Khazanchi, LaShyra Nolen, Michelle Ogunwole, MD, Chioma Onuoha, Jenny Tsai, MD, Jazzmin Williams, Dereck Paul, MS, and Utibe R. Essien, MD, MPH 
• Infographic: Creative Edge Design
• Hosts: Dereck Paul, MS, Utibe R. Essien, MD, MPH, Michelle Ogunwole, MD
• Guest: Dorothy E. Roberts, JD (@DorothyERoberts)

Timestamps:

00:00 Introduction

03:40 Defining Race

13:40 Responses to Common Race Based Medicine Arguments

20:40 Race as a Proxy for Racism

31:00 BiDiL and Race Based Medicine Definition

42:00 Dr. Duana Fullwiley and the “African Gene”

49:30 Debunking Folklore Health Narratives

53:30 Slavery Hypertension Hypothesis

57:00 Importance of Intentional and Plausible Research Methods

1:00:00 Race in Medical Algorithms 

1:12:00 Moving Away from Relying on Simplistic Biological Concepts of Race

1:15:48 Advice for Listeners

1:21:00 Closing Remarks 

Takeaways:

1. Definition of Race: Race is not a biological category, instead it is a permeable, flexible, and unstable social construction and political invention that facilitates political and economic inequality. However it is important to remember that this political invention DOES affect biology because of the way that it creates social inequity.
2. Historical Context: Historically, laws such as interracial marriage bans have protected established structures of white supremacy and reinforced the social construct of race.
3. Race is a Poor Proxy for Genetics: Diseases with genetic or population associations are often evolutionary adaptations to specific geo-environments. Race, a social construction, groups people from large swaths of of global territory based on superficial phenotype is often a poor proxy for these genetic associations with disease. 
4. Race is a proxy for Racism: race was invented as a way to classify people into subordinate groups and support the political sanctioning of inequity.  The very function of race is thus to support and uphold racism. When we evaluate race in medicine we have to recall  this origin story and not rely on race as a placeholder for anything else except racism.
5. The Root of Inequities: Health inequities are overwhelmingly caused by differences in social status, living conditions, and experiences of discrimination. When we cling to race as the cause of  health inequities, we obscure and divert attention away from these social factors that need to be addressed.
6. Intersectionality: Race and racism intersect with socioeconomic status, education, geography, sexual orientation, religion, immigration status, gender and other identities with differential impact. 
7. Our responsibility in medicine: “What we have to do is include medicine in the political movement to bring down the structures of racism and white supremacy and the way in which medicine incorporates those and promotes those. And [this] HAS to be in conjunction with broader social movements…that are dedicated to radically transforming our world into one in which human beings are equally valued…”-Dorothy E. Roberts JD
8. For the patient I see tomorrow:  Beyond recognizing that race is not a proxy for biology, we can all ask ourselves “What way is structural racism affecting my patient and what can I do about it?” The answer to this question may not be easily answered and may not always be found in the clinical setting.

Pearls:

“Genetics is not the end all be all of understanding disease” – Dorothy E. Roberts JD

An Emphasis on Genetics is Not the Solution to Race-Based Medicine

Being antiracist in medicine does not mean being more precise in our understanding of genetics. Rather we need a deeper and broader understanding of the influence of the structural and political determinants of health inequities. Part of the problem with focusing on race in medicine is that it limits our perspectives and encourages research practices that lack the rigor required to identify root causes of racial health inequities. We should be focusing on root causes rather than proxies. It does not mean that we should stop exploring genetic causes of disease, but rather that we should not pretend that understanding genetics is the solution to addressing disparities. Dr. Roberts put it expertly: “to be anti-racist, it doesn’t mean, well, then let’s just be more precise in our genetics. It means being anti all the things that race and racism do.”

Medicine Must Move Beyond Othering Black People

All too often in medicine, Black people are singled out from all other human beings as having different bodies from the norm, aka whiteness. Examples of this include: BiDiL, the blood pressure drug marketed solely to black people; arguments for race-based medicine that cite sickle cell, a disease that is most common in Black people because of geographic varietion rather than innate difference; and the slavery hypertension hypothesis which posits that hypertension disparities observed in Black people are a result of the stress of slavery and the middle passage rather than the longitudinal impacts of structural racism. Rather than searching for obscure explanations for inequalities, we must instead recognize the ways that racism impedes health at both individual and structural levels. 

Race-based algorithms can produce inequity and there is a moral dilemma we must attend to

There is a persistent question about whether race-based clinical algorithms disadvantage patients and how we should think through use of them in clinical medicine. Professor Roberts offers some guidance: whenever you are stuck, go back to the origin story- what is race? Then you can ask yourself, how is race being used and does that use further inequity? 

Professor Roberts also offers a few scenarios.

1. Race-based algorithms: Race is being used as a biological construct AND it can produce harm. For example, GFR- race correction for Black patients. The use of race is  based on a false/biological concept of race AND many studies show that this can harm patients ( i.e. clinical resources are withheld based on results of algorithm). This is the rationale for NOT using these kinds of race-based algorithms.
2. Race “neutral” algorithms, which are used for allocation of resources for most fit patients. Race is not included in the algorithm, however because of the experiences of structural racism, certain groups will have worse scores. These worse scores may lead to the withholding of resources and ultimately further inequity. For example, the proposal of race neutral ventilator algorithms that were set up to allocate ventilators to the most fit patients during the COVID-19 pandemic. This race neutral algorithm could disadvantage Black patients, who because of structural racism may have lower fitness scores. This could worsen existing disparities in COVID-19 outcomes among Black patients. 

Moral dilemma: Including race as a biological construct in clinical algorithms can lead to inequity. However whenever structural racism isn’t included in clinical algorithms, we also risk denying a group who has experienced structural racism access to much needed resources. We have not thought about this enough in medicine and we don’t have a gold standard of how to include race as a proxy for structural racism in our clinical algorithms. As we move forward we must continue to think critically about the ethical and just way to include race or rather structural racism in clinical algorithms and ensure that our algorithms do not further inequity.

References:

1. Lindo E, Nolen L, Paul D, Ogunwole M, Fields N, Onuoha C, Williams J, Essien UR, Khazanchi R. “Episode 140: Dismantling Race-Based Medicine, Part 1: Historical & Ethical Perspectives.” The Clinical Problem Solvers Podcast. https://clinicalproblemsolving.com/episodes. November 17, 2020.
2. Eneanya A, Tsai J, Williams J, Essien UR, Paul D, Fields NF, Nolen L, Ogunwole M, Onuoha C, Khazanchi R. “Episode 4: Dismantling Race-Based Medicine, Part 2: Clinical Perspectives.” The Clinical Problem Solvers Podcast. https://clinicalproblemsolving.com/episodes. December 17, 2020.
3. Roberts D. Fatal Invention: How Science, Politics, and Big Business Re-create Race in the Twenty-first Century. The New Press: 2012.
4. Roberts D. “The problem with race-based medicine.” TEDMED 2015. Link to talk.
5. Roberts DE. What’s Wrong with Race-Based Medicine?: Genes, Drugs, and Health Disparities. Minnesota Journal of Law, Science & Technology. 2011;12(1):1-21.
6. Yudell M, Roberts D, DeSalle R, Tishkoff S. NIH must confront the use of race in science. Science. 2020;369(6509):1313-1314. doi:10.1126/science.abd4842
7. Roberts DE. Is race-based medicine good for us?: African American approaches to race, biomedicine, and equality. J Law Med Ethics. 2008;36(3):537-545. doi:10.1111/j.1748-720X.2008.302.x
8. Taylor AL, Ziesche S, Yancy C, Carson P, D’Agostino R Jr, Ferdinand K, Taylor M, Adams K, Sabolinski M, Worcel M, Cohn JN; African-American Heart Failure Trial Investigators. Combination of isosorbide dinitrate and hydralazine in blacks with heart failure. N Engl J Med. 2004 Nov 11;351(20):2049-57. doi: 10.1056/NEJMoa042934. 
9. The Slavery Hypertension Hypothesis: Dissemination and Appeal of a Modern Race Theory. (2003). Epidemiology, 14(1), 111-118. Retrieved May 9, 2021, from http://www.jstor.org/stable/3703292
10. Roberts, Dorothy E. Killing the Black Body: Race, Reproduction, and the Meaning of Liberty. New York: Pantheon Books, 1997.
11. Sjoding MW, Dickson RP, Iwashyna TJ, Gay SE, Valley TS. Racial Bias in Pulse Oximetry Measurement. N Engl J Med. 2020 Dec 17;383(25):2477-2478. doi: 10.1056/NEJMc2029240.
12. Hansen H, Netherland J. Is the Prescription Opioid Epidemic a White Problem?. Am J Public Health. 2016;106(12):2127-2129. doi:10.2105/AJPH.2016.303483
13. Bibbins-Domingo K, Fernandez A. BiDil for heart failure in black patients: implications of the U.S. Food and Drug Administration approval. Ann Intern Med. 2007 Jan 2;146(1):52-6. doi: 10.7326/0003-4819-146-1-200701020-00009. Erratum in: Ann Intern Med. 2007 Apr 17;146(8):616. PMID: 17200222.
14. Roberts DE. Abolish race correction. Lancet. 2021 Jan 2;397(10268):17-18. doi: 10.1016/S0140-6736(20)32716-1. PMID: 33388099.

Transcript

Download transcript here

Disclosures

The hosts and guests report no relevant financial disclosures.

Citation

Roberts, DE, Onuoha C, Khazanchi R, Nolen L, Fields N, Tsai J, Essien UR, Paul D, Ogunwole M,. “Episode 8: Dismantling Race Based Medicine Part 3: Towards Justice and Race-Conscious Medicine.” The Clinical Problem Solvers Podcast. https://clinicalproblemsolving.com/episodes. May 10, 2021.

Thank you for your continued support and please give us feedback here!

Dan, Doug, and Lindsey are joined by expert neurologist Dr. Aaron Berkowitz to help break down a consult question about back pain and double vision 

Schema

Download CPSolvers App here

Patreon website

Episode Quiz

Thank you for your continued support and please give us feedback here!

Epic RLR case of a rash!

Want to test your learning? Take our episode quiz here

This episode is available on Patreon only.

Why? 

More about the RLR series here. 

Thank you for your continued support and please give us feedback here!

We continue our campaign to #EndNeurophobia, as Gabriela, Sherry, and Kaitlyn discuss a case with Dr. Aaron Berkowitz

Download CPSolvers App here

Patreon website

Schema

Episode Quiz

Kaitlyn Thomas

Kaitlyn Thomas is a 3rd year medical student at Lake Erie College of Osteopathic Medicine at their Seton Hill campus in Greensburg, Pennsylvania. She is interested in medical education, advocacy and assisting underserved populations. She has contributed to the CPSolvers on Virtual Morning Report on several occasions and produced a few videos for their illness scripts. In her free time, she enjoys hiking, spending time with family, and finding new recipes to cook.

Sherry Chao

Sherry Chao is a 4th year medical student at University of North Carolina at Chapel Hill. She is interested in medical education and is also an aspiring physician-scientist hoping to apply computational systems biology to understanding hematologic diseases. In her free time, she likes to travel and explore outdoors with her husband, try out new escape rooms, and play with her bearded dragon, Toothless.

Gabriela Pucci 

Gabriela has graduated from Medical School at Unicamp and recently finished her neurology residency at Unesp, both in Brazil. She is interested in Medical Education and Clinical Reasoning and has obviously fallen in love with CPSolvers and VMRs since day 1. In her free time, she likes to practice pilates, play with her dogs, binge-watch Netflix comedy series, read biography books, go out with her friends (pre-COVID), drink wine, and cook (still learning).

Reza and Rabih work through a case of dyspnea and finger swelling, presented to them by Dr. Usha George.

Download CPSolvers App here

Patreon website

Schema 

Episode Quiz

Dr. Usha George

Dr. Usha George, MBBS (MAHE India), MSc (Respiratory Medicine) Imperial College University of London, FRCP London, is at present attached to Sunway Medical Centre, Malaysia. It is a 650 bedded private tertiary hospital, also involved in training medical students. I practice as a Respiratory and General Medicine Physician. My special interest is in clinical and diagnostic reasoning.

Rabih and Reza tackle a case of headache and blurry vision

Want to test your learning? Take our episode quiz here

This episode is available on Patreon only.

Why?  

More about the RLR series here

Download CPSolvers App here 

During this WDx VMR series episode, Kiara presents a case of chest pain to Priyanka, Ana Clara, Elena, and Anna. 

Download CPSolvers App here

Patreon website

Schema 

Episode Quiz

Ana Clara

Ana Clara Miranda is a 4th-year medical student from Brazil. She grew up in Belo Horizonte and moved to Rio de Janeiro in 2017 to attend medical school. Her medical interests are Pediatrics and Infectious Diseases. Today, she intends to go to the United States for an international clinical experience as a visiting student and, in 2023, apply for a Residency Program. Outside medical environment, she loves going to the beach with friends, enjoying nature and baking cakes.

Elena Vasti

Elena Vasti is a second year resident at Stanford in the department of Internal Medicine. She attended UC Davis to study Human Development and Exercise Biology and went on to UCLA Fielding School of Public Health to complete an MPH in Epidemiology and Community Health Sciences. She decided to switch careers to pursue clinical medicine and matriculated at UCSF School of Medicine in 2015. She enjoys running every day, analyzing movie trailers and both listening to and joining the CPSolvers any chance she gets! She plans to pursue a career in academic cardiology.

Raha and Shub join #PrezSharmin to tackle a clinical unknown presented by Carlos

Download CPSolvers App here

Patreon website

Want to test your learning? Take our Episode Quiz 

Dr. Agrawal

Shub Agrawal is a PGY-2 at Emory’s J. Willis Hurst Internal Medicine Residency. She grew up in Athens, GA and attended New York University for undergraduate degrees in neuroscience and anthropology. She attended the AU UGA Medical Partnership for medical school where she first became passionate about medical education. She is currently doing medical education research about how to best use podcasts in UME and GME curriculum. She hopes to spend her career teaching and designing curriculum in academic medicine. Outside of medicine, she enjoys spending time with her family, friends and imagining all the trips she will take once it is safe to travel again! 

Dr. Sadjadi

Raha Sadjadi is a PGY2 internal medicine resident at Emory University School of Medicine. She grew up in the San Francisco Bay Area and attended UC Berkeley for undergrad. After spending her whole life in the Bay Area, she moved to Atlanta to complete medical school at Emory University. At Emory she pursued her passion for caring for underserved populations while rotating at Grady Hospital and she found wonderful mentors invested in her growth as a physician and human.  For these very reasons, she remained at Emory to complete her internal medicine residency. She is interested in transplant hepatology and in reducing healthcare disparities. 

Dr. Rubiano

Carlos Rubiano is an Inpatient Medicine chief at UNC Hospitals where he also completed his internal medicine residency training. Prior to moving to North Carolina with his wife with whom he couples matched with, he completed his medical school training at Florida State University and undergraduate training in Biology at Florida Gulf Coast University. In medicine, he has a particular interest in medical education and hopes to be a clinician-educator as a soon-to-be hospitalist and one day as an ID clinician. Outside of medicine he loves playing pickleball and invites everyone to try this booming sport. 

Eamonn and Ashley join Jack in tackling a clinical unknown presented by Travis

Take our episode quiz here

Eamonn Maher

Eamonn hails from Charleston, West Virginia. He attended Marshall University for medical school and is currently in his final year of Dermatology residency at SLU. He will complete a Complex Medical Dermatology fellowship at NYU next year and hopes to practice with a focus on cutaneous lymphomas, connective tissue diseases, and immunobullous disorders. Outside of work he enjoys jiu jitsu, playing soccer, and spending quality time with his wife. 

Ashley Boerrigter

Ashley Boerrigter is a third-year OBGYN resident at St. Louis University, where she will be Administrative Chief Resident for the 2021-2022 academic year. She attended medical school at the University of Kentucky and her academic interests include medically complex pregnancies and curriculum development. Hobbies include tennis, sailing, and alternating between beach sunning and mountain skiing. 

Reza spends his birthday in the best way possible – masterfully breaking down a case presented to him by Rabih!

Want to test your learning? Take our episode quiz here!

Summary

In this episode of Clinical Problem Solvers: Anti-Racism in Medicine, we are joined by Michelle Morse, MD, MPH, Deputy Commissioner for the Center for Health Equity and Community Wellness (CHECW) and the inaugural Chief Medical Officer at the NYC Department of Health and Mental Hygiene (NYCDOHMH), and Paul Farmer, MD, PhD, Kolokotrones University Professor of Global Health and Social Medicine at Harvard University. Together, we discuss what global health equity looks like in the age of COVID-19.

Learning Objectives

After listening to this episode listeners will be able to…

1. Recognize that  global health equity and global vaccine equity are everyone’s responsibility 
2. Understand what decolonizing global health really means 
3. Appreciate the importance of solidarity and human interconnectedness 

Credits

• Written and produced by: Dereck Paul, MS, Chioma Onuoha, Utibe R. Essien, MD, MPH, Rohan Khazanchi, LaShyra Nolen, Naomi Fields, Michelle Ogunwole, MD, Jazzmin Williams, and Jennifer Tsai MD, M.Ed
• Hosts: Utibe Essien, MD, MPH, Dereck Paul, MS, Chioma Onuoha
• Infographic: Creative Edge Design
• Show Notes: Chioma Onuoha
• Guests: Michelle Morse, MD, MPH (@michellemorse) and Paul Farmer, MD, PhD

Timestamps

00:00    Introductions

04:00 What Brought You to Global Health Work?

11:50    Why is Global Health Equity Everyone’s Problem?

23:40   How has COVID-19 Changed Global Health Work and Perspectives? 

40:30  The Role of Identity in Global Anti-Racism Work

49:00   Decolonize Global Health Movement

1:02:49 Hope for the Future 

Takeaways

1. The Global COVID-19  Response Must Be Anti-Racist 

An anti-racist COVID-19 response means that quality care, quality vaccines, and quality public health information must be provieded to all. From social distancing to contact tracing to vaccin distribution, every step should be considered through an anti-raicst framework. This includes financing vaccine acquisition for all countries and avoiding the global north vaccine hoarding that is happening today. It is important that we avoid vaccine tunnel vision and recognize the broader social context and need for social support systems worldwide. 

2. The Four S’s  

As Dr. Paul Farmer often says, an effective infectious disease global health response requires: 

• Staff – caregivers with the knowledge and passion to address health concerns
• Stuff – the physical materials required for effective treatment or intervention 
• Space – places where people can safety receive appropriate care 
• Systems – policies and institutional systems that facilitate needed health responses

3. Why should everyone care about global vaccine equity?

“Unless everyone is safe, no one is” – Dr. Paul Farmer

The world is incredibly interconnected and, as COVID-19 has shown, we have to recognize the idea of collective survival. Health and well being is a global endeavor and an interdependent fight. Furthermore, we must reclaim the heart and soul of medicine: caretaking, healing, and the creative aspects of the profession that oftentimes get pushed to the side. American physicians and health professionals have immense power and a duty to use that power for the greater good to interrupt, and interrogate the colonial and imperial practices perpetrated by our own government. We must hold our government accountable. At the heart of this is a need for global solidarity. 

Pearls 

The Importance of this Moment 

Both of our guests highlighted the HIV/AIDS movement as a catalyst for their continuing passion for global health equity. The COVID-19 pandemic provides a similar opportunity today for us to scale up our critical consciousness and re-examine the functioning of our society. People are naming racism, settler colonialism, and imperialism more than ever. In this current moment we can build on that momentum, shift perspectives and work towards long lasting equitable and anti-racist change.

Dangers of American Exceptionalism 

It is imperative that we look beyond the walls of our nation and the privileges that living in the United States afford us in order to recognize the danger of American exceptionalism and how it impacts people across the world. For example, currently the United States, and other wealthy countries, are hoarding COVID-19 vaccines making it difficult for other countries to vaccinate their populations. Considering the interconnectedness of our world, by preventing equitable vaccine distribution we will only lengthen the current pandemic. As a country, we must expand our global critical consciousness and strive towards global equity by financing vaccine acquisition, investing in our education systems, interrogating American privilege and more. 

Decolonizing Global Health – Allow the Global South to Lead 

Part of decolonizing global health means being willing to take a backseat when it comes to defining, researching, and executing global south health priorities. This is especially true for large outside universities and institutions that habitually fail to engage domestic stakeholders in research and health decision making processes. We must trust the communities we serve to teach us and to guide initiatives. 

References Mentioned

21:30         

Rwanda Vaccine Roll Out https://www.usnews.com/news/world/articles/2021-03-05/rwanda-becomes-first-african-nation-to-use-pfizer-covid-19-vaccine

55:00

Equal Health Students “#KnowBeforeYouGo” Video on Volunteering in Haiti 

http://www.equalhealth.org/news/2016/8/7/equalhealth-students-launch-video-knowbeforeyougo-addresses-misconceptions-about-volunteering-in-haiti 

Additional References 

1. Farmer, P., Kim, J. Y., Kleinman, A., & Basilico, M. (2013). Reimagining global health: An introduction. Berkeley: University of California Press.
2. Farmer, P. (2020). Fevers, feuds, and diamonds: Ebola and the ravages of history. New York: Farrar, Straus and Giroux.
3. Goodwin, C. (2020, December 23). Paul Farmer on How We Tell the Story of a Pandemic. Retrieved from https://www.thenation.com/article/culture/paul-farmer-fever-feuds-interview/
4. Richardson, E. T., Malik, M. M., Darity, W. A., Mullen, A. K., Morse, M. E., Malik, M., . . . Jones, J. H. (2021). Reparations for Black American descendants of persons enslaved in the U.S. and their potential impact on SARS-CoV-2 transmission. Social Science & Medicine, 113741. doi:10.1016/j.socscimed.2021.113741

Transcript

Download Transcript Here

Disclosures

The hosts and guests report no relevant financial disclosures.

Citation

Morse M, Farmer PE, Onuoha C, Khazanchi R, Nolen L, Fields N, Ogunwole M, Tsai J, Essien UR, Paul D. “Episode 7: Anti-Racism, Global Health Equity, and the COVID-19 Response.” The Clinical Problem Solvers Podcast. https://clinicalproblemsolving.com/episodes. April 1, 2021.

Download CPSolvers App here

Patreon website

RLR website  

VMR sign up  

Dr. Usha George

We continue our campaign to #EndNeurophobia by tackling this neurology clinical unknown, with the guidance of Aaron Berkowitz.

Episode Quiz

Download CPSolvers App here

Patreon website

Maria Jimena Aleman

Maria Jimena Aleman was born and raised in Guatemala where she currently is a medical student in Universidad Francisco Marroquin. After suffering from long standing neurophobia, she has embraced her love for neurology and will pursue a career in this field.  She also looks forward to dedicating her life to breaking barriers for Latin women in medical fields and improving medical care in her country. Maria is one of the creators of a medical education podcast in Spanish called Intratecal. Her life probably has a soundtrack of a mix between Shakira and Louis Armstrong. Outside of medicine she enjoys modern art, 21st century literature and having hour long conversations over a nice hot cup of coffee or tequila.

Mohamed Elashwal

Mohamed is a senior medical student at Alfaisal University in Riyadh Saudi Arabia. He was born in Egypt before he moved with his family to Saudi. Mohamed is interested in adult neurology; his neurophilia started in one morning report during his neuroscience rotation when he could feel his heart racing and his brain twisting thinking about the cases. He plans to apply to neurology residency next year. In his free time, Mohamed enjoys baking, and cooking; he also likes playing the piano (level: very amateur).

Kannu Bansal

Kannu is a junior resident at All India Institute of Medical Sciences, New Delhi, India working in the Kidney Transplant Wing. Despite my current affiliation with transplantation, I love to explore everything related to medicine. My passions include quizzing, teaching, and learning, and that’s how I came to know about CPSolvers. I plan to pursue Internal Medicine Residency in United States. Outside of medicine, I like to watch soccer, Formula 1, and sketch pencil portraits.

Rabih and Reza tackle a case of vision loss.

Episode Quiz

This episode is available on Patreon only.

Why?  

More about the RLR series here. 

The CPSolvers team breaks down a *bite-sized​* case of dysphagia.

Schema

Download CPSolvers App here

Patreon website

Episode Quiz

Sarah Onorato presents a case to Dr. Ann Marie Kumfer & Dr. Debra Bynum

Want to test your learning? Take our episode quiz here

Dr Ann Marie Kumfer is a new residency graduate and academic hospitalist at UNC. After completing medical school at Texas Tech University, she moved up to North Carolina for residency. She liked UNC so much, she decided to stay as an academic hospitalist after completing residency in June. She also serves as a section editor for the Human Diagnosis project. She is passionate about diagnostic reasoning, teaching, and guacamole.

Dr. Debra Bynum is the Director for the Internal Medicine Residency Program at the University of North Carolina. Originally from eastern North Carolina, she graduated from Davidson in 1990 with a degree in Biology and a focus on ecology and marine biology. From there, she came to Chapel Hill for medical school and stayed at UNC for residency training. After completing a year as Chief Resident, she joined the faculty at WakeMed hospital where she worked in the clinic caring for Raleigh’s underserved, attended on the inpatient service with UNC residents and students, and helped to found one of the first hospitalist programs in the area.

After three years at WakeMed, she returned to UNC for further training as a fellow in the Geriatric Medicine program and was appointed to a faculty position in 2001. During the subsequent fourteen years, she held multiple leadership positions within the School of Medicine, the Department of Medicine, and the Geriatric Medicine Fellowship and Internal Medicine Residency programs. She directed the Acting Internship for senior students as well as co-directed the clinical skills course for second year students, served on the School of Medicine education committee, and helped to design, implement, and co-direct both a transition course for new third year students as well as a teaching elective for fourth year students. She served as the Program Director for the Geriatric Medicine Fellowship from 2008-2014 and was selected to lead the Internal Medicine residency program in May of 2014.

Want to learn more about the Women in Diagnosis (WDx) series?

Jack presents a case of abdominal pain and hypotension to Steph and Dan

Download CPSolvers App here

Patreon website

Schema 1

Schema 2

Episode Quiz

Lindsey, Kiara (#bossladies), and Scott discuss a clinical unknown presented by Devika

Download CPSolvers App here

Patreon website

Want to test your learning? Take our episode quiz

Scott Walker

Scott Walker grew up in Knoxville, Tennessee (Go Vols) where he completed his Bachelors in Kinesiology and Nutrition. He currently attends The University of Central Florida College of Medicine as a third year medical student. He is interested in entering the field of Emergency Medicine and is passionate about medical education and medical mission trips. He spends his spare time watching The Office with his wife or weight lifting.

Dr. Devika Gandhi

Devika Gandhi is a third-year internal medicine resident at Indiana University. She is originally from Dayton, Ohio and received her undergraduate degree from the University of Akron. She earned her medical degree from Northeast Ohio Medical University in Rootstown, Ohio (Go Walking Whales!). After residency she will be an incoming gastroenterology/hepatology fellow at Loma Linda University in California. During her free time, she enjoys reading, cooking, and going out to trivia with friends.

In Episode 6 of the Antiracism in Medicine series, “Racism, Trustworthiness, and the #COVID19 vaccine,” we are joined by two forces in the field of health equity and academic medicine, Dr. Giselle Corbie-Smith and Dr. Kimberly Manning, to discuss why the pandemic is the moment to ensure trust in medicine.

Learning Objectives

After listening to this episode listeners will be able to…

1. Recognize the importance of yielding privilege and power to better center marginalized voices and communities through individual, interpersonal, institutional, and systemic actions.
2. Understand the importance of looking beyond isolated and individual instances of mistrust, in recognition that the continued and ubiquitous insults of structural and systemic racism are the primary forces perpetuating mistrust among minoritized communities.
3. Identify potential individual, institutional, and policy-level actions to address COVID-19 vaccine inequities.

Credits

• Written and produced by: Utibe R. Essien, MD, MPH, Rohan Khazanchi, LaShyra Nolen, Naomi Fields, Dereck Paul, MS, Michelle Ogunwole, MD, Chioma Onuoha, Jazzmin Williams, and Jennifer Tsai MD, M.Ed
• Hosts: Utibe, Lash, Jenny
• Infographic: Creative Edge Design
• Show Notes: Rohan Khazanchi
• Guests: Kimberly Manning MD (@gradydoctor) and Giselle Corbie-Smith MD, MSc (@gcsmd)

Download Transcript Here

Show Notes – Episode 6: Racism, Trustworthiness, and the COVID-19 Vaccine

Rohan Khazanchi

February 23rd, 2021

Summary

In this episode of Clinical Problem Solvers: Anti-Racism in Medicine, we are joined by Dr. Kimberly Manning, Professor of Medicine and Associate Vice Chair for Diversity, Equity, and Inclusion at Emory University, and Dr. Giselle Corbie-Smith, the Kenan Distinguished Professor of Social Medicine and Director of the Center for Health Equity Research at University of North Carolina-Chapel Hill. We dig into Dr. Manning’s leading perspectives on trust in the Black community and Dr. Corbie-Smith’s longstanding community-engaged research agenda, and we discuss implications for ongoing discourse about COVID-19 vaccine equity.

Timestamps

00:00 Music/Intro

1:25 Guest Introductions

02:34 Reflecting upon the current “moment of hope” in the COVID-19 pandemic

07:46 Why is Mistrust the “Tip of a 400-Year-Old Iceberg”?

12:04 Getting to the Individual “Why” of Declining the COVID-19 Vaccine

13:01 Is Mistrust the True Root Cause?

16:28 Moving past our preconceptions about vaccine mistrust

19:01 “When your immune system is knuckin’ and buckin’, it’s gonna be a little raucous!”

22:43 Shifting our framing  from “vaccine hesitant” to vaccine deliberations

27:58 Recognizing our biases, centering the margins, and avoiding diluted generalizations

37:20 Valuing diversity rather than classifying minoritized groups as monoliths

43:34 Why Dr. Manning chose to participate in the Moderna vaccine trial

49:20 The “allostatic load” of the minority tax in a white supremacist system

55:45 Performative advocacy and the “musical chairs” of representation in medicine

58:12 The fallacy of the meritocracy

59:10 What can health systems do to reduce vaccine disparities?

1:06:20 Takeaways and conclusions

1:08:51 Outtakes
Takeaways

Medical Mistrust in the Black Community is More than Tuskegee 

Framing medical mistrust solely around watershed incidents like the U.S. Public Health Service Study of Untreated Syphilis at Tuskegee is harmful. It treats Black Americans as a monolith, when there is an enormous diversity and heterogeneity within the Black community. It treats mistrust as an isolated construct, when medical mistrust is intertwined with broader societal injustices. Lastly, our rhetoric often treats mistrust as an individual failing or “uninformed belief”, rather than a consequence of structural inequity.

In contrast, scholarship and clinical care which acknowledges within-group differences and shifts from a deficit-based to an asset-based view of marginalized groups can help us better serve our minoritized patients. Dr. Manning reaffirmed what Dr. Camara Jones told us last episode– that solutions lie in simultaneously emphasizing the importance of individual humanity and value in “hard to reach” (hardly reached) communities and dismantling the structures which push those communities down.

“Black Why’s Matter”

“Simply telling people what to do doesn’t work on your children, and it doesn’t work on your patients.”  – Dr. Kimberly Manning 

Every person who declines a COVID-19 vaccine has a reason to do so which is theirs, and theirs alone. As clinicians, we need to slow down and demonstrate our willingness to hear the “why’s” of our patients, colleagues, neighbors, and community members. In particular, racial concordance is a key piece of doing this work; authentic communication styles from people who personally understand the needs of their community and can better help motivate a “slow yes” through shared decision-making.

Addressing Racial Vaccine Inequities Requires Race and Community-Informed Solutions

This pandemic has highlighted a faultline between public health and medicine. Crossing that breach must involve organizing with faith-based and community-based organizations, community health workers, and beyond. Geographically-based interventions need to prioritize individuals from those communities, rather than allowing outsiders to take designated slots. Scapegoating mistrust can no longer be an excuse for not meeting people where they are and addressing longstanding, long-understood barriers.

Pearls 

Reframe “Vaccine Hesitancy” as “Vaccine Deliberations”

“Vaccine hesitancy” is a symptom of a larger, chronic issue about the way Black and Brown people are treated in the United States. Yet, our narrow focus on the individual drives us to assign blame to those who decline a vaccine as “hesitant” or “distrusting” when there are a plurality of reasons why. Deliberating on big decisions is quite normal, especially when the lived experiences of individuals in historically marginalized groups inform their reasonable apprehension about inequities in U.S. systems writ large.

Minority Tax and the “Musical Chairs” of Representation in Medicine

“My taxation is not without representation… [musical chairs] is all fun and games until somebody has to give up their seat. If everything has been built on privilege, you have to be willing to give something up” – Dr. Kimberly Manning

Dr. Manning presented an analogy to us about a game of musical chairs, in which everyone is happy to participate and speak up for marginalized groups until the music stops and only one seat is left. Minoritized clinicians and researchers face the allostatic burden of stepping up to fix a broken system designed within a white supremacist culture. Performative activism only goes so far; when our colleagues with privilege aren’t willing to give up that power, the needle doesn’t get moved.

“I’m not interested in changing hearts and minds; I’m interested in seeing behavior change and changes in policies, practices, and norms.”  – Dr. Giselle Corbie-Smith

References Mentioned

08:14

Manning KD. More than medical mistrust. The Lancet. 2020 Nov; 396(10261): 1481-1482. doi:10.1016/S0140-6736(20)32286-8.

13:01

Corbie-Smith G, Thomas SB, St George DM. Distrust, race, and research. Arch Intern Med. 2002 Nov 25;162(21):2458-63. doi: 10.1001/archinte.162.21.2458. PMID: 12437405.

32:18

Corbie-Smith G, Miller WC, Ransohoff DF. Interpretations of ‘appropriate’ minority inclusion in clinical research. Am J Med. 2004 Feb 15;116(4):249-52. doi: 10.1016/j.amjmed.2003.09.032. PMID: 14969653.

33:56

Corbie-Smith G, Thomas SB, St George DM. Distrust, race, and research. Arch Intern Med. 2002 Nov 25;162(21):2458-63. doi: 10.1001/archinte.162.21.2458. PMID: 12437405.

Corbie-Smith G, Thomas SB, Williams MV, Moody-Ayers S. Attitudes and beliefs of African Americans toward participation in medical research. J Gen Intern Med. 1999 Sep;14(9):537-46. doi: 10.1046/j.1525-1497.1999.07048.x. PMID: 10491242; PMCID: PMC1496744.

39:42

Wilkerson, I. (2020). Caste: The origins of our discontents.

59:10

Corbie-Smith, G. “A Different Kind of Leader” Podcast. Retrieved from https://adifferentkindofleader.buzzsprout.com/ 

Additional References 

1. Sengupta S, Corbie-Smith G, Thrasher A, Strauss RP. African American elders’ perceptions of the influenza vaccine in Durham, North Carolina. N C Med J. 2004 Jul-Aug;65(4):194-9. PMID: 15481486.
2. Quinn SC, Jamison A, An J, Freimuth VS, Hancock GR, Musa D. Breaking down the monolith: Understanding flu vaccine uptake among African Americans. SSM Popul Health. 2017 Nov 14;4:25-36. doi: 10.1016/j.ssmph.2017.11.003. PMID: 29349270; PMCID: PMC5769118.

Disclosures

The hosts and guests report no relevant financial disclosures.

Citation

Manning KD, Corbie-Smith G, Khazanchi R, Nolen L, Fields N, Ogunwole M, Onuoha C, Tsai J, Paul D,  Essien UR. “Episode 6: Racism, Trustworthiness, and the COVID-19 Vaccine.” The Clinical Problem Solvers Podcast. https://clinicalproblemsolving.com/episodes. February 23, 2021.

Rabih and Reza tackle a case of fever, dyspnea, and back pain presented by guest presenter Lawrence Yuen.

This episode is available on Patreon only.

Why? 

More about the RLR series here. 

Want to test your learning? Take our episode quiz here

We kick off our new series, “The Consult Question”, aimed at highlighting the clinical reasoning of our subspecialty colleagues, with a case of hypoglycemia presented to master endocrinologist Dr. Elizabeth Murphy.

Schema

Episode Quiz

Dr. Elizabeth Murphy

Dr. Elizabeth Murphy is a professor of Medicine at the University of California, San Francisco, where she serves as the Deborah Cowan Endowed Professor of Endocrinology and chief of the Endocrinology and Metabolism Division at Zuckerberg San Francisco General Hospital.

We continue our mission to #EndNeurophobia with an episode of Neurology VMR with Dr. Aaron Berkowitz 

Download CPSolvers App here

Patreon website

Episode Quiz

Dhruv Srinivasachar is a 4th year medical student at Virginia Commonwealth University School of Medicine (the Medical College of Virginia for all the veteran attendings out there). Introduced to medicine through research, Dhruv has shifted his passions to empathetic clinical care and medical education, as a contributor to the CPSolvers (especially through VMR as a case presenter, discussant, and compiler of cases) and team member for the Not Just Little Adults podcast (CPedsSolvers, if you will). When he’s not interviewing for Med-Peds residency, he can be found biking around Richmond, VA, gardening, and cooking.

Elena Vasti

Elena Vasti is a second-year resident at Stanford in the Department of Internal Medicine. She attended UC Davis to study Human Development and Exercise Biology and went on to UCLA Fielding School of Public Health to complete an MPH in Epidemiology and Community Health Sciences. She decided to switch careers to pursue clinical medicine and matriculated at UCSF School of Medicine in 2015. She enjoys running every day, analyzing movie trailers and both listening to and joining the CPSolvers any chance she gets! She plans to pursue a career in academic cardiology.

Sean presents a case of dyspnea to Rabih and Reza.

Schema

This episode is available on Patreon only.

Why? 

More about the RLR series here. 

Want to test your learning? Take our episode quiz here.

Rabih, Reza, PrezSharmin, and Arsalan break down thyrotoxicosis, by revisiting a case initially presented at our December 18th VMR.

Schema

Patreon website

Download CPSolvers App here

Episode Quiz

Ryan presents a case of dyspnea to Rabih and Reza.

Schema

This episode is available on Patreon only.

Why? 

More about the RLR series here. 

Want to test your learning? Take our episode quiz here

Maani, Priyanka, and Lindsey discuss a clinical unknown with Dr. Jori May.

Want to test your learning? Take our episode quiz here

Dr. Jori May

Jori May, MD, is Assistant Professor of Medicine in the Division of Hematology/Oncology at the University of Alabama at Birmingham (UAB).  Her clinical interest is non-malignant hematology, focusing on the care of patients with thrombosis and coagulation disorders.  Additionally, she focuses on systems-based hematology, which works to improve hematologic care delivery across health systems.  Dr. May earned her M.D. from Washington University School of Medicine in St. Louis. She completed her residency, chief residency, and fellowship in Hematology/Oncology at UAB. 

Want to learn more about the Women in Diagnosis (WDx) series?

Blog post– by Smitha

Rabih and Reza tackle a case of hypotension and leg pain.

This episode is available on Patreon only.

Why? 

More about the RLR series here.

Want to test your learning? Take our episode quiz here

Mansour presents a case of sudden vision loss to Dan, Erica, and Kristin. 

Download CPSolvers App here

Patreon website

Schema 1

Schema 2

Want to test your learning? Take our Episode Quiz

Dr. Erica Smith 

Erica Smith is a fourth year Internal Medicine-Pediatrics resident at the University of Michigan. She is from Detroit, MI and attended Wayne State University School of Medicine for medical school. She is planning to pursue a career in hospital medicine. In her free time, she enjoys golf, yoga, and hiking. 

Dr. Mansour Alkhunaizi

Mansour Alkhunaizi went to the Royal College of Surgeons in Ireland for medical school and is currently an Internal Medicine Resident at Baylor College of Medicine. He is interested in a career in pulmonary/critical care medicine. Outside of work, he enjoys hiking, working out, and watching his favorite soccer team Manchester United! 

Dr. Kristin Andres

Kristin Andres is currently a third year Internal Medicine-Pediatrics resident at the University of Michigan. She grew up in Lexington Kentucky and attended the University of Kentucky for both undergraduate and medical school. She hopes to pursue Pediatric Cardiology fellowship with a career goal of optimizing transitional care for patients with congenital heart disease.   Outside of the hospital, Kristin enjoys musical theatre, pub-style trivia, making ice-cream, and snuggling on the couch with her husband Andrew and dog Nutmeg.

Dr. Sabal presents a case of bilateral wrist pain to Sharmin, Dr. Davey, and Dr. Singh. 

Download CPSolvers App here

Patreon website

Want to test your learning? Take our episode quiz here

Dr. Sonya Davey

Sonya Davey attended medical school at the Perelman School of Medicine at the University of Pennsylvania and is currently an Internal Medicine PGY-1 at Brigham & Women’s Hospital. She loves to travel, read, and enjoy meals with family and friends.

Dr. Nicky Singh

Nicky Singh attended medical school at the Perelman School of Medicine at the University of Pennsylvania and is a current PGY-3 resident at Massachusetts General Hospital. As a resident, he has been involved with several educational initiatives, including co-leading the Residents in Medical Education interest group and the Point of Care Ultrasound group and serving as an Education Council representative and Simulation Program Chief. He is interested in cardiology and medical education. Outside of medicine, he enjoys hiking, South Asian dance, exploring new recipes with his Instant Pot, and trying to up his Peloton numbers.

Dr. Aaron Sabal

Aaron is currently a PGY-3 at Mercy Health Muskegon aspiring for a career in hospital medicine. He was born and raised in Westland, MI (Detroit metro area) and went to Wayne State University for his undergraduate studies thinking he would be a physical therapist, massage therapist, and dietitian (yes, all three of those). However, one week prior to starting a massage therapy program, he had an epiphany and decided to go to medical school instead. He was fortunate to be accepted at MSUCOM and fell in love with Internal Medicine. His passions include all things medical. In particular, he is passionate about medical education, how best to help physicians learn, diagnostic reasoning, and creating an environment of learning where no one is afraid to express what they’re thinking. When he is not pursuing his love of learning, he is spending time with his wife and their boys (2 cats and a dog), playing with his animals, preparing to be a father to his soon-to-be-born son, crossfitting, doing DIY home-improvement projects, exploring national parks, or reading good nonmedical fiction with a cat or dog in his lap begging for his love and attention.

Rabih and Reza discuss a case of abdominal pain.

This episode is available on Patreon only.

Why? 

More about the RLR series here.

Want to test your learning? Take our Episode Quiz

In this episode of Clinical Problem Solvers: Anti-Racism in Medicine, we are joined by Aletha Maybank MD, MPH, the American Medical Association’s (AMA) inaugural Chief Health Equity Officer and director of the AMA’s Center for Health Equity, and Camara Jones MD, PhD, MPH, thought leader in the fields of health equity and public health and former president of the American Public Health Association (APHA). We discuss policy, professional organizations, and history as they relate to advancing health equity, and imagine what the anti-racist health system of the future looks like. 

Learning Objectives

After listening to this episode listeners will be able to…

• Recognize that racism is both structural and interpersonal, and that both aspects must be addressed simultaneously.
• Appreciate the importance of acknowledging history and sustaining institutional memory in advancing anti-racism efforts and achieving structural change.
• Understand that collective action and a focus on community, rather than individualism, are most effective in combating racism and achieving health equity.

Credits

• Written and produced by: Rohan Khazanchi, LaShyra Nolen, Naomi Fields, Dereck Paul, MS,  Utibe R. Essien, MD, MPH, Michelle Ogunwole, MD, Chioma Onuoha, Jazzmin Williams, and Jennifer Tsai MD, M.Ed
• Hosts: Rohan Khazanchi, LaShyra Nolen, Naomi Fields
• Infographic: Creative Edge Design
• Show Notes: Chioma Onuoha 
• Guests: Aletha Maybank MD, MPH, (@DrAlethaMaybank) and Camara Jones MD, PhD, MPH (@camarajones)

Download Transcript Here

Episode 5: Racism, Power, and Policy: Building the Antiracist Health Systems of the Future

Show Notes

Chioma Onuoha

Timestamps

00:00 Music/Intro

01:14 Guest Introductions

03:09 Framing Racism 

05:15 Allegory: Cement Dust in Our Lungs 

07:00 The AMA’s Declaration on Racism as a Public Health Threat 

13:28 History and the AMA and APHA Movements 

15:20 Barriers to Achieving Health Equity in Medicine 

20:55 Documenting, Centering, and Institutionalizing “The Work” 

23:30 The AMA’s Racist Past 

31:00 How Do We Create Sustainable Work? 

35:25 Creating and Maintaining Urgency 

39:00 Racism Saps the Strength of the Whole Society 

43:43 Building an Anti-Racism Health Care System from A Grassroots Level

52:15 Building an Anti-Racism Health Care System from A Governmental Level 

53:45 Health is Not Created with the Health Sector 

56:53 Why Must All Health Workers Practice Anti-racism? 

1:05:57 Outtakes 

Takeaways

1. Name Racism for What It Is

If we don’t explicitly say the word racism, and identify its historical context,  then we are complicit in its denial.  Racism denial is deeply ingrained in our society and it needs to be called out and recognized as a system in order to be addressed. Though the field of medicine often fails to think systematically, it is imperative that all healthcare workers learn to recognize racism, actively practice anti-racism, and acknowledge the many systems that impact people and community’s health.

Four Key Messages for Naming Racism: 

• Racism Exists
• Racism is a System
• Racism Saps the Strength of the Whole Society
• We can Act to Dismantle Racism

1. History and Documentation are Key 

Our country habitually denials racism by working to make its impacts invisible. Remembering history and collecting institutional memory avoids the danger of repeating work, wasting labor, and makes clear racism’s long standing effects. Part of this effort also includes learning the history of the organizations and institutions we are a part of. 

1. Focus on the Community 

While the health sector is where illness and ailments are often treated, a person’s health largely manifests outside of the health sector and is impacted by their community and environment. One of the biggest barriers to health equity is the narrow focus on the individual and a failure to see health as a widespread community issue. We must recognize that all policy is health policy and that which affects someone outside of the health sector may also affect their health. Our future should be grounded in our communities; our solutions cannot solely be declarative or institution-driven.

Pearls 

Barriers to Achieving Health Equity 

• Narrow focus on the individual – makes systems and structures invisible or irrelevant
• We as a nation are ahistorical – we need to bring history into the fold 
• Our endorsement of the myth of meritocracy – the uneven playing field 
• White supremacist ideology 

To learn more, read about  Dr. Jones’ Seven Values Targets for Anti-Racism Action

Institutionalizing Anti-Racism 

A movement can disappear as quickly as it arose if it is not institutionally ingrained. This means that anti-racism must be embedded into practice, performance standards and institutional culture. All policies, decisions, and behaviors should occur through the lens of anti-racism in order for its impact to be longstanding and effective. 

The Power of Collective Action 

“When we acknowledge each other’s work we acknowledge the power of collective action” 

– Dr. Camara Jones 

Addressing structural racism is a collective effort and is more effective when we shift from “what can I do” to “what can we do”. When we lift up our peers and validate/center the work of people on the margins, we recognize the power of collective action and ensure that efforts are not erased or lost. This includes recognizing the experts that have come before us and reaching out to younger generations.

Addressing Structures and Values 

Racism is a system of structuring opportunity and assigning value based on the social interpretation of how one looks. In order to address racism, we must address both the structures and the values. Structures include the ways that racism is institutionalized and systematically reinforced, and values include the way that racism manifests in our shared consciousness. Addressing values will require us to make clear that “racism saps the strength of the whole society” and to highlight the urgency of anti-racism efforts. Additionally, we should equip educators, parents, and those who will guide the next generations with the tools to operate within the framework of anti-racism. Because structural racism often operates through inaction and complacency, the work to combat it must be persistent and collective. Racism hurts all people and achieving anti-racism will require active “fellows in the struggle” not just feeling allies. 

References Mentioned

01:55

Jones, C. Camara Jones, Allegories on race and racism | Camara Jones | TEDxEmory. [Video]. YouTube. https://www.youtube.com/watch?v=GNhcY6fTyBM&ab_channel=TEDxTalks. Published June 10, 2014. Accessed January 11, 2021.

03:55

Jones, C. Camara Jones, APHA executive director citation award acceptance speech. [Video]. YouTube. https://youtu.be/BGmIXV859YQ. Published December 2, 2020. Accessed December 9, 2020.

16:20

Jones, CP. (2020). Seeing the Water: Seven Values Targets for Anti-Racism Action. Harvard Medical School Primary Care Blog. Retrieved from http://info.primarycare.hms.harvard.edu/blog/seven-values-targets-anti-racism-action 

27:17

Berney, B., & Friedman, R. (Producers), & Burnett, C., Loewenthal, D. (Directors). (2018). Power to Heal: Medicare and the Civil Rights Revolution. Retrieved from https://www.blbfilmproductions.com/ 

28:55

Baker, RB., et al. Creating a segregated medical profession: African American physicians and organized medicine, 1846-1910. J Natl Med Assoc. 2009 Jun;101(6):501-12. doi: 10.1016/s0027-9684(15)30935-4. PMID: 19585918.

Washington, HA., et al. Segregation, civil rights, and health disparities: the legacy of African American physicians and organized medicine, 1910-1968. J Natl Med Assoc. 2009 Jun;101(6):513-27. doi: 10.1016/s0027-9684(15)30936-6. PMID: 19585919.

Additional References 

1. Boyd RW, Krieger N, Jones CP. In the 2020 US election, we can choose a just future. Lancet. 2020;396(10260):1377-1380. doi:10.1016/S0140-6736(20)32140-1
2. Crear-Perry J, Maybank A, Keeys M, Mitchell N, Godbolt D. Moving towards anti-racist praxis in medicine. Lancet. 2020;396(10249):451-453. doi:10.1016/S0140-6736(20)31543-9
3. Ford CL, Airhihenbuwa CO. The public health critical race methodology: praxis for antiracism research. Soc Sci Med. 2010 Oct;71(8):1390-8. doi: 10.1016/j.socscimed.2010.07.030. Epub 2010 Aug 11. PMID: 20822840.
4. Jaffe S. Aletha Maybank: AMA’s Chief Health Equity Officer. The Lancet. 2020;395(10242):1963. doi:10.1016/S0140-6736(20)31408-2
5. Jones CP, Holden KB, Belton A. Strategies for Achieving Health Equity: Concern about the Whole Plus Concern about the Hole. Ethn Dis. 2019;29(Suppl 2):345-348. doi:10.18865/ed.29.S2.345
6. Jones CP, Jones CY, Perry GS, Barclay G, Jones CA. Addressing the social determinants of children’s health: a cliff analogy. J Health Care Poor Underserved. 2009;20(4 Suppl):1-12. doi:10.1353/hpu.0.0228
7. Jones CP. Allegories on “Race,” Racism, and Antiracism. 2019. Accessed December 7, 2020. https://www.radcliffe.harvard.edu/video/allegories-race-racism-and-antiracism-camara-phyllis-jones
8. Jones CP. Confronting Institutionalized Racism. Phylon 2003;50(1-2):7-22. 
9. Jones CP. Overcoming Helplessness, Overcoming Fear, Overcoming Inaction in the Face of Need. Am J Public Health. 2016;106(10):1717. doi:10.2105/AJPH.2016.303406
10. Jones CP. Systems of Power, Axes of Inequity: Parallels, Intersections, Braiding the Strands. Medical Care. 2014;52:S71. doi:10.1097/MLR.0000000000000216
11. Jones CP. Toward the Science and Practice of Anti-Racism: Launching a National Campaign Against Racism. Ethn Dis. 2018;28(Suppl 1):231-234. doi:10.18865/ed.28.S1.231
12. Jones, C. Camara Jones, APHA executive director citation award acceptance speech. [Video]. YouTube. https://youtu.be/BGmIXV859YQ. Published December 2, 2020. Accessed December 9, 2020.
13. Jones, CP [@CamaraJones]. (2020, Nov 28). My map with the 28 states (in red) with at least one city/county/state-level body declaring “Racism is a public health crisis.” Each state name is followed by the number of jurisdictions making these declarations. State name is in CAPS if there is a state-level declaration. [Tweet]. Twitter. https://twitter.com/CamaraJones/status/1332729107952627712?s=20
14. Maybank A. A Historic Day For Black Women, A Historic Day For The American Medical Association. Essence. Published November 18, 2020. Accessed December 7, 2020. https://www.essence.com/lifestyle/health-wellness/black-women-american-medical-association-racism/
15. Maybank A. The Pandemic’s Missing Data. The New York Times. https://www.nytimes.com/2020/04/07/opinion/coronavirus-blacks.html. Published April 7, 2020. Accessed December 7, 2020.
16. Metzl JM, Maybank A, De Maio F. Responding to the COVID-19 Pandemic: The Need for a Structurally Competent Health Care System. JAMA. 2020;324(3):231-232. doi:10.1001/jama.2020.9289
17. O’Reilly KB. AMA: Racism is a threat to public health. American Medical Association. Published November 16, 2020. Accessed December 7, 2020. https://www.ama-assn.org/delivering-care/health-equity/ama-racism-threat-public-health
18. Prioritizing Equity video series. American Medical Association. Accessed December 7, 2020. https://www.ama-assn.org/delivering-care/health-equity/prioritizing-equity-video-series

Disclosures

Dr. Maybank is the AMA’s Chief Health Equity Officer and director of the Center for Health Equity. Mr. Khazanchi is a member of the American Medical Association’s Council on Medical Education. The views presented herein represent their own and not necessarily those of the AMA. The hosts and guests report no other relevant financial disclosures.

Citation

Jones CP, Maybank A, Nolen L, Fields N, Ogunwole M, Onuoha C, Williams J, Tsai J, Paul D,  Essien UR, Khazanchi, R. “Episode 5: Racism, Power, and Policy: Building the Antiracist Health Systems of the Future.” The Clinical Problem Solvers Podcast. https://clinicalproblemsolving.com/episodes. January 19, 2021.

Dr. Dayyan Adoor and Dr. Keith Albrektson present a clinical unknown case to Dr. Armitage

Download CPSolvers App here

Patreon website

Want to test your learning? Take our episode quiz here

Dr. Dayyan Adoor

Dayyan Adoor is a 2nd year internal medicine resident at Case Western Reserve/University Hospitals. Following residency, he hopes to pursue a fellowship in Gastroenterology! In his free time, he likes to spend his time outdoors, often exploring the beautiful parks in Cleveland, and lately, learning how to ski! 

Dr. Keith Armitage

Dr. Keith Armitage is a professor of medicine in the division of infectious diseases at the Case Western Reserve University School of medicine. He is also the program director for the internal medicine residency at the Case Western Reserve/University hospitals internal medicine residency program where he is currently serving his 29th year as program director. In his free time Dr Armitage enjoys cheering on his beloved Arsenal Football Club and spending time with his wife and three daughters. 

Dr. Keith Albrektson 

Keith Albrektson is a current chief resident at the Case Western Reserve/University hospitals internal medicine residency where he completed his internship and residency in internal medicine. Following his chief year he will be continuing his training in pulmonary and critical care at the University of New Mexico Medical Center.  

Our campaign to #EndNeurophobia continues with a neuro VMR featuring one of our favorite chief complaints, AMS!

Download CPSolvers App here

Patreon website

Schema

Want to test your learning? Take our Episode Quiz

Kaitlyn Thomas

Kaitlyn Thomas is a 3rd year medical student at Lake Erie College of Osteopathic Medicine at their Seton Hill campus in Greensburg, Pennsylvania. She is interested in medical education, advocacy and assisting underserved populations. She has contributed to the CPSolvers on Virtual Morning Report on several occasions and produced a few videos for their illness scripts. In her free time, she enjoys hiking, spending time with family, and finding new recipes to cook.

Ninad Bhat

Ninad Bhat is a third-year medical student at UCSF. He has always been fascinated by communication and the brain, seeking to combine his interests by becoming a neurologist involved in medical education. In his free time, he writes poetry and works to keep his obligatory medical student plants alive. 

Andrew Levy

Andrew Levy is a 4th-year medical student at the University of Colorado SOM applying to Family Medicine with interests in Primary Care, Global Health, and Population Health. After taking a year off to help implement a WHO educational community-based first aid response program, he is now pursuing further public health training through UCSF in Implementation Sciences. He has been a fan of CPSolvers since being turned onto it, as well as the general topic of diagnostic reasoning, through Juan Lessing, an IM attending at the University of Colorado Hospital. In his free time, he enjoys exploring the great outdoors with his wife, Emily a fourth-year medical student at RVU in Colorado, and their three dogs Layla, Jade, and Avalanche.

Rabih and Reza take us on a journey through liver function test abnormalities

This episode is available on Patreon only.

Why? 

More about the RLR series here.

Want to test your learning? Take our episode quiz here

Sharmin, Rabih, Reza, and Arsalan tackle a schema for glomerulonephritis 

Patreon website

Download CPSolvers App here

Schema

Want to test your learning? Take our Episode Quiz

Reza and Rabih take a “MIST”ical journey through a case of confusion

This episode is available on Patreon only.

Why? 

More about the RLR series here.

Schema

Want to test your learning? Take our episode quiz here

Dr. Amara Finch presents a case of abdominal pain at VMR to Maani, Maria, Anna and Smitha.

Want to learn more about Women in Diagnosis (WDx) series?

Blog post– by Smitha

Download CPSolvers App here 

Patreon website

Schema

Want to test your learning? Take our Episode Quiz

Dr. Amara Finch

Originally from Atlanta, Georgia, Amara spent time in Massachusetts, Vermont, British Columbia, Connecticut and Colorado before returning to the vibrant ATL for medical school. She is now an intern in the Med-Peds program at the University of Arizona in Phoenix. She is passionate about better understanding the relationship between early life exposures and lifelong health as a means to improve preventive medicine for kiddos, re-imagine our approach to adult disease, and disrupt intergenerational cycles of health inequity. Outside of the hospital you can find her hiking, biking, writing, and working on her collection of fermented foods including kimchi and hot sauce.