The Clinical Problem Solvers

https://clinicalproblemsolving.com/wp-content/uploads/2021/07/ARM-EP-10_RTP-1.mp3In this episode, we invite the powerful sister duo Oni Blackstock, MD, MHS and Uché Blackstock, MD to share their experiences on leaving public health and academia to become social entrepreneurs, creating their own organizations in health equity.Episode Learning ObjectivesAfter listening to this episode learners will be able to…Recognize some common factors that influence Black women’s decisions to leave traditional health careersDefine counterspaces and understand their value Apply tools to combat burnout that could be applied to traditional or alternative health careers  CreditsWritten and produced by: Michelle Ogunwole, MD, Naomi F. Fields, LaShyra Nolen, Chioma Onuoha, Rohan Khazanchi, MPH, Dereck Paul, MD MS, Utibe R. Essien, MD, MPH, Jazzmin Williams, and Jennifer Tsai MD, M.EdHosts: Michelle Ogunwole, MD, Naomi Fields, and LaShyra NolenInfographic: Creative Edge Design Audio edits: David HuGuests: Oni Blackstock, MD, MHS and Uché Blackstock, MD Time Stamps00:00 Introduction03:49 Defining “CounterSpaces”5:22 Why Drs. Uché and Oni Blackstock created their counterspaces17:54 Value gained outside of academia, public health24:08 Finding balance in racial equity opportunities34:17 On challenging the self-sacrificing mentality in medicine42:26 On “doing the work” within academia49:01 The meaning of sisterhood52:20 Closing Remarks Episode Takeaways:Definition of CounterSpaces: CounterSpaces are academic and social safe spaces that allow underrepresented faculty to promote their own learning, wherein their experiences are validated and viewed as critical knowledge; they have space to vent frustrations by sharing stories of isolation, microaggressions or overt discrimination; and they can challenge the deficit notion of people of color and establish and maintain a positive collegial racial climate for themselves.Root causes of the exodus Black women physicians from academia and public health: In many academic and public health institutions, Black women feel undervalued, untitled, underfunded, and undersupported. Their contributions to diversity, equity, and inclusion efforts are expected, but not compensated or rewarded. They are disproportionately passed over for promotions and opportunities despite quality work. These factors directly contribute to the growing trend of Black women physicians leaving these fields to pursue nontraditional health careers.You are gifted!: “Sometimes you’re in these environments [academic, public health] for so long where you’re undervalued and underappreciated, you’re not supported the way that you should be, that you actually start thinking that– or start forgetting that you’re actually someone with gifts to share.” — Dr. Uché BlackstockSelf-sacrifice is not the highest virtue: Medicine is its own subculture where people are expected to make sacrifices of their time, personal and family life, and finances in order to demonstrate that they are good physicians. It is okay to say that you don’t want that for yourself, and work to actively counter this cultural norm in order to live a fulfilling personal and professional life.  There are opportunities to advance racial equity inside and outside of academia: For those who feel driven to pursue racial and health equity work within academia and/or public health: (1) understand what you value from working at an academic institution and recognize that there may be options to do that work outside of academia (e.g. research), and (2) build a support structure that enables you to stay true to your values as you work to create change from within. For those having a hard time deciding if they should stay in academia or other traditional research or public health roles, Dr. Oni Blackstock offers important advice about listening to and trusting oneself:“… just listening to your intuition, that’s like our main form of knowing. We have all these other forms of knowledge in books and what we’re taught in school, but really many times, the answer lies within us. So, again, just making sure that we’re in tune and listening to what we feel like our needs are. And if they’re telling us to leave, that we are true to those voices and we leave. And if they’re saying there’s work for us to do here, we want to stay and we have the support to be able to do that, then do that.” — Dr.  Oni BlackstockPearls “The work of liberation is the work of freeing the soul to be exactly who we were meant to be.” — GirlTrek The role of an abundance mindset in achieving work/life balance Many of us operate from a scarcity mindset; we feel that opportunities are limited and therefore take all opportunities that come our way without regard for our genuine interest in the opportunity or our true time availability. Especially for people early in their careers, there is an unspoken pressure to accept all opportunities that could possibly advance one’s career. It is impossible to achieve work/life balance when operating from this mindset, and as a consequence, it leads to burnout.  However, with an abundance mindset, one recognizes that opportunities are not finite and that saying no to one opportunity frees up our ability to say yes to a better opportunity that comes along later down the line. Dr. Uché Blackstock shared an example of how she experienced a tension between a scarcity mindset and an abundance mindset when deciding whether to continue part-time clinical work or to devote full-time effort to the organization she founded. When she embodied an abundance mindset and let go of her clinical career, she was free to say yes to even more fulfilling opportunities that came her way. Relatedly, Dr. Oni Blackstock discussed the importance of pausing before committing to opportunities. White supremacy culture creates an artificial sense of urgency so we often respond reflexively. By taking a moment to pause and reflect, one can take on opportunities that align with one’s values and that one has adequate time for without sacrificing personal responsibilities. Taking a moment to pause ensures that we react from our authentic self and not from institutional culture.   Cultivate tools to sustain a career in traditional and alternative health careers Cultural norms rooted in white supremacy and capitalism create an environment that extracts goods, time, and energy from people without providing a source from which to renew those resources. Dr. Oni Blackstock advises listeners to be “cognizant of the day to day ways in which these systems work against us,” and to actively fight against this culture with things that replenish ourselves. Tools that Dr. Oni Blackstock uses include: daily meditation, creating a gratitude list of 3 things each morning, and yoga and exercise several times a week. Additionally, she spoke about the importance of mentorship and a strong support network so you have people to turn to for advice and encouragement. Finding effective strategies to replenish oneself is important for anyone advancing racial equity work in their careers as social entrepreneurs, academicians, public health officials. Dr. Oni Blackstock shared a treasured quote around this idea: “ Learn to drink as you pour, so the spiritual heart cannot run dry and you always have love to give”-Ma Jaya  Self-reflection is a vital component of professional developmentIt is easy to become consumed by various career opportunities that are presented to us. In order to maintain one’s ability to effectively transform the existing culture of medicine into an anti-racist one, it is important to find time to reflect on one’s journey and direction. Below are some questions that CPSolvers ARM host Dr. Michelle Ogunwole synthesized after this conversation with Drs. Oni and Uché Blackstock.  What are the things (situations, contexts, people) that are making you question your gifts? What are the wake up calls that we need in our life? How can they help you in your next step? Who are you taking advice from? What is keeping you from being your authentic self?  ReferencesNational Academies of Sciences, Engineering, and Medicine 2020. Promising Practices for Addressing the Underrepresentation of Women in Science, Engineering, and Medicine: Opening Doors. Washington, DC: The National Academies Press. https://doi.org/10.17226/25585. National Academies of Sciences, Engineering, and Medicine 2021. Impact of COVID-19 on the Careers of Women in Academic Sciences, Engineering, and Medicine. Washington, DC: The National Academies Press.   https://doi.org/10.17226/26061. Blackstock, U. Why Black doctors like me are leaving faculty positions in academic medical centers. (2020, January 08). Retrieved from https://www.statnews.com/2020/01/16/black-doctors-leaving-faculty-positions-academic-medical-centers/ Forrester A. Why I Stay – The Other Side of Underrepresentation in Academia. N Engl J Med. 2020;383(4):e24. https://www.nejm.org/doi/full/10.1056/NEJMpv2022100 Doll KM, Thomas CR Jr. Structural Solutions for the Rarest of the Rare – Underrepresented-Minority Faculty in Medical Subspecialties. N Engl J Med. 2020;383(3):283-285. https://www.nejm.org/doi/full/10.1056/NEJMms2003544 Blackstock, O, Blackstock, U. Opinion: Black Americans should face lower age cutoffs to qualify for vaccine. https://www.washingtonpost.com/opinions/black-americans-should-face-lower-age-cutoffs-to-qualify-for-a-vaccine/2021/02/19/3029d5de-72ec-11eb-b8a9-b9467510f0fe_story.html https://www.girltrek.org/ https://www.healthjustice.co/ https://advancinghealthequity.com/about/  Disclosures The hosts and guests report no relevant financial disclosures. CitationBlackstock O, Blackstock U, Ogunwole M, Fields NF, Nolen L, Onuoha C, Williams J, Tsai J, Essien UR, Paul D, Khazanchi R. “Episode 10: CounterSpaces in Medicine: Finding Safe Spaces and Redefining Value.” The Clinical Problem Solvers Podcast. https://clinicalproblemsolving.com/episodes. July 15, 2021. Transcript 

https://clinicalproblemsolving.com/wp-content/uploads/2021/07/consult-question-GI-7_8_21-RTP.mp3Dr. Frederick Weber discusses an approach to chronic diarrhea with the TCQ squadChronic Diarrhea SchemaWant to test your learning? Take our Episode QuizDr. Frederick WeberDr. 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

Dive into the intriguing world of neurology as experts discuss involuntary movements and their diagnostic challenges. They explore conditions like Parkinson's disease, acute strokes, and chorea, emphasizing timely intervention. The importance of patient history, imaging, and clinical signs is underscored, while case studies provide valuable insights. Plus, learn how glucose levels can affect movement disorders and the significance of brain CT scan interpretations. This engaging dialogue makes complex concepts accessible and entertaining.

https://clinicalproblemsolving.com/wp-content/uploads/2021/07/7.1.21-Dissecting-the-learning-process-RTP.mp3 Rabih and Reza discuss learning during the process of clinical reasoning on VMR.  Download CPSolvers App herePatreon websiteRLR website  VMR sign up  

https://clinicalproblemsolving.com/wp-content/uploads/2021/06/WDX11-6.24.21-RTP.mp3Simone and Lindsey present a case to Dr. Kirsten Austad, followed by a discussion about women in leadership and “the double bind”  Want to test your learning? Take our episode quiz here Dr. Kristen Austad 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.  SchemaDownload CPSolvers App here Patreon websiteGive us feedback here 

https://clinicalproblemsolving.com/wp-content/uploads/2021/06/6.17.21-HDx-Lindsey-RTP.mp3 Bronson presents a clinical unknown to Mohit, Kai, and Lindsey.Want to test your learning? Take our Episode Quiz Mohit HarshMohit 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 JonesKai 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 KnuzlerBronson 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 herePatreon websiteGive us feedback here 

https://clinicalproblemsolving.com/wp-content/uploads/2021/06/RTP_HDX_Dan_6.15.21_FINAL.mp3Sue Ellen presents a clinical unknown to Nick, Jennifer, and DanSchemaEpisode QuizNicholas HornsteinNicholas 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 LiSuellen 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 PlotkinJennifer 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 herePatreon websiteGive us feedback here 

https://clinicalproblemsolving.com/wp-content/uploads/2021/06/ARM-EP9-SGIM-Annual-Meeting-Moving-Towards-Antiracism-in-Medical-Education_RTP-1.mp3SummaryIn 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 ObjectivesAfter listening to this episode, listeners will be able to…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.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.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.  CreditsWritten 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.EdHost: Chioma OnuohaInfographic: Creative Edge DesignGuests: Rohan Khazanchi, MPH; Naomi F. Fields; Michelle Ogunwole, MD; Utibe R. Essien, MD, MPH; Jazzmin WilliamsTimestamps:00:00 Introduction02:15 Barriers to Entry in Medicine 05:15 How to Identify an Uplifting Institutional Home 11:40 Racism Ingrained in Medical Education15:10 Imagining an Ideal Medical School Curriculum17:40 A Roadmap to Engaging Hyperlocal Communities in Medical Education20:30 Moving Beyond Ahistorical Conversations about Health Disparities 27:05 Engaging All Learners as Stakeholders for Health Equity and Antiracism33:40 Re-examining Who the Experts Are42:40 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: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). 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.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. 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 programsIt 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 StakeholdersAntiracism 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 AntiracismCurricula 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: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 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 Sharma M, Pinto A, Kumagai A. Teaching the Social Determinants of Health. Academic Medicine. 2018;93(1):25-30. doi:10.1097/acm.0000000000001689 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 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 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 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 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 TranscriptDownload the transcript here DisclosuresMr. 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.CitationOnuoha 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.

 https://clinicalproblemsolving.com/wp-content/uploads/2021/06/RTP_Global-VMR-6.3_FINAL.mp3Rabih moderates as an interactive, international virtual morning report community discusses a case of feverFever Overview SchemaInflammation Thought Train SchemaWant to test your learning? Take our episode quiz hereDr. Hernán CarrilloHernán 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 herePatreon websiteVMR sign up  Give us feedback here 

In this insightful discussion, Doug Pet, a neurology resident at UCSF, presents a complex case of headache and blurry vision to his fellow contributors, Dhruv Srinivasachar and Hannah Roberts. Doug emphasizes the importance of thorough patient history and neurological assessments in diagnosing serious conditions. The trio explores the distinctions between primary and secondary headaches, and how social history can influence diagnosis. They also discuss anatomical challenges, like the cavernous sinus's role in cranial nerve function, while highlighting critical teaching points for medical students.