The Clinical Problem Solvers

https://clinicalproblemsolving.com/wp-content/uploads/2021/11/ARM-EP12_RTP.mp3CPSolvers: Anti-Racism in Medicine SeriesEpisode 12: Our Land is Our Health: Addressing Anti-Indigenous Racism in MedicineShow Notes by LaShyra NolenNovember 23rd, 2021Summary: This episode is about the ways we can combat anti-Indigenous sentiments and actions in our efforts to promote anti-racism in medicine and public health. This discussion is hosted by our new team members Alec Calac and Victor Lopez-Carmen, as they interview Dr. Tom Sequist, member of the Taos Pueblo Tribe and Chief Patient Experience and Equity Officer at Mass General Brigham, and Dr. Sophie Neuner, proud member of the Karuk Tribe, and a Research Associate at the Johns Hopkins Center for American Indian Health. Together, these two phenomenal guests help us understand the structural and individual challenges of Indigenous peoples in academic medicine, public health, and beyond.Episode Learning Objectives:After listening to this episode learners will be able to…Understand the historical and present-day role of settler colonialism behind health disparities in Indigenous populations.Learn ways to address the lack of representation of Indigenous peoples in academia and how to create safe learning environments for Indigenous peoples in these academic spaces.Understand the importance of disaggregated health data and how the burden of proof for “blood quantum” requirements can be detrimental to Indigenous peoples.Learn the ways COVID-19 and climate change have exacerbated health inequities within Indigenous populations.Learn tangible ways to center the Indigenous communities in advocacy efforts at the interpersonal and institutional level.CreditsWritten and produced by: Rohan Khazanchi, MPH, Michelle Ogunwole, MD, Alec Calac, Victor Lopez Carmen, MPH, Utibe R. Essien, MD, MPH, Jennifer Tsai MD, MEd, Sudarshan Krishnamurthy, Naomi F. Fields, LaShyra Nolen, Chioma Onuoha, Dereck Paul, MD, MS, Ayana Watkins, Jazzmin WilliamsHosts: Alec Calac and Victor Lopez Carmen, MPHInfographic: Creative Edge DesignAudio edits: David HuShow notes: LaShyra NolenGuests: Dr. Tom Sequist, MD, MPH and Dr. Sophie Neuner, MD, MPHTime Stamps00:00           Introduction05:25           What do I call you?10:37           “Blood quantum” and the burden of proof18:05           Challenges of Indigenous Peoples in medical spaces24:50           COVID-19 and climate change’s impact on Indigenous Peoples30:27           Racism in academia and creating safe spaces41:22           “Data genocide”  50:11           What can listeners do going forward?62:10           Key takeawaysEpisode Takeaways:Take the time to learn about how Indigenous Peoples influence the world around you.From the street names of the cities in which we live to the nature that surrounds us, Dr. Sequist reminds us of the importance of taking the time to learn about how Indigenous Peoples have influenced and continue to influence every aspect of our lives. He encourages us to learn about the original inhabitants of lands on which we reside and to do the work to learn about the ongoing contributions from tribes around us. This is especially important when we consider the lasting role colonialism, genocide, and racism has played in attempted erasure of these communities and their culture.Learn about the good and the ugly when it comes to the history of Indigenous Peoples.Victor reminds us that we can hold two truths at the same time. Dr. Sequist also encourages us to, in addition to learning about the rich cultural traditions and invaluable contributions of Indigenous Peoples, to also acknowledge the historical and ongoing oppression these communities face. Indigenous Peoples continue to suffer disproportionately from health inequities, mental illness, poverty, climate change and police brutality, all of which have been exacerbated by the COVID-19 pandemic. We must recognize these struggles were born out of settler colonialism and learn this history while actively working to undo present harms.Do not exclude Indigenous peoples in your research narratives. If you’re going to, acknowledge your limitations. Dr. Neuner reminds us of the importance of centering Indigenous Peoples in our research and data because this information helps drive policy and health initiatives that can address barriers to health in the community.Pearls Common Terms Used to Refer to Indigenous PeoplesOur guests and hosts remind us of the importance of not making assumptions about someone’s identity. It is often preferable to use tribal affiliation when referring to Indigenous Peoples rather than terms like Indigenous or Native American. By not doing so, we obscure critical knowledge about relationality, Indigenous clans, and communal origins.The term “American Indian or Alaska Native” is a legal racial and ethnic identifier which is why we might see it used in legal documents and research manuscripts. Many manuscripts have moved towards using Black, Indigenous, People of Color (BIPOC), but this term may be doing more harm than good for Indigenous Peoples. Read III.A.I-2 of Why BIPOC Fails (Deo, M., 2021) to understand why.The term “Native American” is frequently used but does not cover Indigenous Peoples from across the worldThe Burden of ProofDr. Sequist discusses “blood quantum”, which is an attempt by the federal government to reduce one’s identity as an Indigenous person to a percentage of blood affiliated with specific Tribes in the US. This flawed measure can be harmful for many reasons. It notably creates a burden of proof for Indigenous trainees to prove their identity, which can provide additional stress during application and interview cycles.COVID-19 and Indigenous PeoplesAlec reminds us that Indigenous Peoples represent 6% of the global population across more than 70 countries, but around 15% of the global population experiencing poverty.Many of the health inequities we have seen for Indian Country during COVID-19 are directly linked to settler colonialism. This is further exacerbated by poverty, lack of cell phone coverage, food insecurity, broadband internet, and a shortage of trusted messengers with appropriate training in Tribal communities.Dr. Neuner reminds us that many Native communities live in multigenerational housing (over 65% of communities have elders living with them) which made it challenging to socially distance during the pandemic.Data GenocideDr. Neuner reminds us about the importance of data for advocacy for Indigenous communities, especially during COVID-19. More background here from the Urban Indian Health Institute.“Without data you can’t change anything.” Some of the challenges with data collection discussed were:Limited availability disaggregated data and how being listed as “other” on surveys leads to compounded distrust in medical systems  Limited accessibility to that data for Tribal communities being surveyedLogistical challenges of collecting necessary data, including the training and funding of community membersWays to Help Uplift Indigenous Peoples in Academia  Our guests share some ways we can help support and uplift Indigenous peoples:Community-based participatory research that benefits Tribal communities in meaningful waysWorking towards making education free for Native studentsPromoting Tribal sovereignty Advocating for climate justiceAligning institutional missions to support Indigenous peoples locally, nationally, and globally  Creating Supportive SpacesOur guests remind us of the importance of thinking beyond addressing the “pipeline” to increase representation of Indigenous Peoples in medicine, but also emphasize the importance of creating safe spaces for these students to thrive.This includes being mindful of language and the etiology of the words we use in academic and medical spaces (e.g., “low on the totem pole”, “let’s have a powwow”)This also includes understanding the unique challenges Indigenous students face when away from their communities in predominantly white institutions, which can often affect their mental health and wellbeing.  ReferencesDr. Neuner’s podcast, Indiginae: https://caih.jhu.edu/programs/indigenae-podcastUnited Nations Declaration on the Rights of Indigenous Peoples https://www.un.org/development/desa/indigenouspeoples/declaration-on-the-rights-of-indigenous-peoples.htmlNative Land is an app to help map Indigenous territories, treaties, and languages. https://native-land.ca/NPR Code Switch Podcast Episode: “So What ‘Exactly’ is Blood Quantum?” https://www.npr.org/sections/codeswitch/2018/02/09/583987261/so-what-exactly-is-blood-quantumIndigenous Peoples and global poverty rates https://www.worldbank.org/en/topic/indigenouspeoples#1Teem Vogue: “Native Communities Face Higher Risks During Coronavirus Pandemic Thanks to Legacy of Colonization” https://www.teenvogue.com/story/coronavirus-native-reservationsPerspective by Dr. Tom Sequist “Paving the Way — Providing Opportunities for Native American Students” N Engl J Med 2005; 353:1884-1886. doi:10.1056/NEJMp058218The Impact of Internet Access in Indigenous Communities in Canada and the United States: An Overview of Findings and Guidelines for Research https://www.internetsociety.org/wp-content/uploads/2020/07/Impact-Indigenous_Communities-EN.pdfBoston Globe article: “Where are all the Native American medical students?” by Victor Lopez-Carmen https://www.bostonglobe.com/2021/01/24/opinion/where-are-all-native-american-medical-students/Disclosures The hosts and guests report no relevant financial disclosures.CitationSequist T, Neuner S, Calac A, Lopez-Carmen V, Tsai J, Krishnamurthy S, Ogunwole M, Fields NF, Nolen L, Onuoha C, Watkins A, Williams J, Paul D, Essien UR, Khazanchi R. “Episode 12: Our Land is Our Health: Addressing Anti-Indigenous Racism in Medicine.” The Clinical Problem Solvers Podcast. https://clinicalproblemsolving.com/episodes. November 23, 2021.TRANSCRIPT

https://clinicalproblemsolving.com/wp-content/uploads/2021/11/RLR-66_Ataxia-RTP.mp3Reza discusses the case of a young man who suddenly became to feel unsteady.Support the CPSolvers and tune in to much more RLR by subscribing to Patreon.Learn more about the ABMS Visiting Scholars Program here 

https://clinicalproblemsolving.com/wp-content/uploads/2021/11/ConsultQ11.16-RTP.mp3Dr. Michael Thomashow presents an unknown case to Dr. Anisha Dua, Dan Minter, Doug Pet and Lindsey Shipley. Schema 1Schema 2Anisha B. Dua MD, MPH Anisha B. Dua MD, MPH is an Associate Professor of Medicine in the Division of Rheumatology, Rheumatology Fellowship Program Director and Director of the Northwestern Vasculitis Center at Northwestern University Feinberg School of Medicine. Dr. Dua interests are in rheumatology, education, and vasculitis. She completed her Rheumatology fellowship at Rush University as well as fellowships in medical education at The University of Chicago and Integrative Medicine at Northwestern. She is a former member of the Committee on Training and Workforce for the American College of Rheumatology, worked with the ACGME to develop the new subspecialty milestones for Rheumatology, and is currently the Chair of the ACR In-Training-Exam committee. Dr. Dua currently leads a multidisciplinary team in the clinical management of vasculitis patients. She recently assisted in the development of the American College of Rheumatology (ACR) Guideline for the Treatment and Management of Vasculitis, is on the Board of Directors for the Vasculitis Foundation and a member of the Scientific Advisory Council for the Rheumatology Research Foundation. She has served in leadership capacities both locally and nationally through the American College of Rheumatology, the Vasculitis Foundation, and the ACGME in the areas of education as well as vasculitis. You can follow her on twitter @anisha_duaDownload CPSolvers App here Patreon website

https://clinicalproblemsolving.com/wp-content/uploads/2021/11/RTP-WDx-11.11.21.mp3Sharmin and Dr. Kaylin Nguyen delve deeper into the imposter phenomenon. They discuss the origin of the term, the problems with the mainstream definition, and how it should be reframed. Imposter Syndrome Treat the Cause, Not the SymptomContextualizing the Impostor “Syndrome”Stop Telling Women They Have Imposter SyndromeEnd Imposter Syndrome in Your WorkplaceDr. Kaylin NguyenDr. Kaylin Nguyen was born in Vietnam and grew up in Southern California. After graduating from UCLA, she completed both medical school and Internal Medicine residency at UCSF. She is currently a second year Cardiology fellow at Stanford and has interests in cardiovascular imaging, health disparities, and digital health. She enjoys hiking, drinking copious amounts of herbal tea, and well-timed puns.Download CPSolvers App here Patreon website

 Dr. Ravi Singh interviews CPSolvers team members Rafael Medina, Sukriti Banthiya, and Rabih Geha who illustrate the Do’s (Rafael and Sukriti) and Don’ts (Rabih) of a residency application interview.This is for anyone interviewing, but especially for IMGs.Enjoy part 2 with Rabih Geha. https://clinicalproblemsolving.com/wp-content/uploads/2021/11/RTP-Mock-interview-Part-2.mp3Dr Ravi SinghDoctor Ravi Singh graduated from the University Medical School of Debrecen in Hungary.He did residency at the MedStar Health Internal Medicine Residency program in Baltimore, Maryland. He then moved to Sinai hospital/Johns Hopkins internal medicine residency program as an academic hospitalist.Dr Singh is currently an associate Program Director Internal Medicine Residency Program at Sinai Hospital, in Baltimore and also a clerkship site director at Sinai for Johns Hopkins School.

Dr. Ravi Singh interviews CPSolvers team members Rafael Medina, Sukriti Banthiya, and Rabih Geha who illustrate the Do’s (Rafael and Sukriti) and Don’ts (Rabih) of a residency application interview.This is for anyone interviewing, but especially for IMGs.Enjoy part one with Rafael and Sukriti. https://clinicalproblemsolving.com/wp-content/uploads/2021/11/RTP-Mock-interview-Part-1-.mp3Dr Ravi SinghDoctor Ravi Singh graduated from the University Medical School of Debrecen in Hungary.He did residency at the MedStar Health Internal Medicine Residency program in Baltimore, Maryland. He then moved to Sinai hospital/Johns Hopkins internal medicine residency program as an academic hospitalist.Dr Singh is currently an associate Program Director Internal Medicine Residency Program at Sinai Hospital, in Baltimore and also a clerkship site director at Sinai for Johns Hopkins School.s

https://clinicalproblemsolving.com/wp-content/uploads/2021/10/10_28_21-SLS.mp3In this episode, Simone & Emma review the schemas of Altered Mental Status and Microangiopathic Hemolytic Anemia as they work through a case presented by Moses.Schema 1 Schema 2 Schema 3Download CPSolvers App herePatreon website

https://clinicalproblemsolving.com/wp-content/uploads/2021/10/RLR-with-Lisa-Sanders-RTP.mp3 Lisa Sanders, MD, founder and writer of the popular Diagnosis column for  New York Times Magazine, and Laura Glick, MD, STUMP RR through a very exciting case. We hope you enjoy it as much as we enjoyed being stumped.Join us on  Patreon for more cases with Dr. Sanders, and 5 bonus episodes a month with RLR. 

https://clinicalproblemsolving.com/wp-content/uploads/2021/10/RTP_VMR_IMG_PartTwo_FINAL.mp3CPSolvers team members–Rafael Medina (lead organizer),Valeria Roldán, Gabriel Talledo,  and Andrea Guzman facilitate a conversation with Drs. Gallo and Singh who shared authentic, practical, and inspirational insight into the IMG journey to apply to residency in the USA.   Dr Alice GalloDoctor Alice Gallo graduated from the Medical School of the Pontifícia Universidade Católica do Rio Grande do Sul in Brazil. She did residency at the Hospital Nossa Senhora da Conceição, repeated it at the University of Miami Miller School/Jackson Memorial Hospital/VA Hospital. She did a Pulmonary and Critical Care Fellowship at Mayo Clinic in Rochester, and joined the Critical Care staff at Mayo in 2017. Dr. Gallo is an Associate Professor of Medicine and Associate Program Director for the Internal Medicine Residency Program Mayo Clinic in Rochester.Dr Ravi SinghDoctor Ravi Singh graduated from the University Medical School of Debrecen in Hungary. He did residency at the MedStar Health Internal Medicine Residency program in Baltimore, Maryland. He then moved to Sinai hospital/Johns Hopkins internal medicine residency  program  as an academic hospitalist. Dr Singh is currently an associate Program Director Internal Medicine Residency Program at Sinai Hospital, in Baltimore and also a clerkship site director at Sinai for Johns Hopkins School.Join VMRDownload CPSolvers App herePatreon website

https://clinicalproblemsolving.com/wp-content/uploads/2021/10/VMR_IMG_PartOne-RTP.mp3CPSolvers team members–Rafael Medina (lead organizer),Valeria Roldán, Gabriel Talledo,  and Andrea Guzman facilitate a conversation with Drs. Gallo and Singh who shared authentic, practical, and inspirational insight into the IMG journey to apply to residency in the USA.  Dr Alice GalloDoctor Alice Gallo graduated from the Medical School of the Pontifícia Universidade Católica do Rio Grande do Sul in Brazil. She did residency at the Hospital Nossa Senhora da Conceição, repeated it at the University of Miami Miller School/Jackson Memorial Hospital/VA Hospital. She did a Pulmonary and Critical Care Fellowship at Mayo Clinic in Rochester, and joined the Critical Care staff at Mayo in 2017. Dr. Gallo is an Associate Professor of Medicine and Associate Program Director for the Internal Medicine Residency Program Mayo Clinic in Rochester.Dr Ravi SinghDoctor Ravi Singh graduated from the University Medical School of Debrecen in Hungary. He did residency at the MedStar Health Internal Medicine Residency program in Baltimore, Maryland. He then moved to Sinai hospital/Johns Hopkins internal medicine residency  program  as an academic hospitalist. Dr Singh is currently an associate Program Director Internal Medicine Residency Program at Sinai Hospital, in Baltimore and also a clerkship site director at Sinai for Johns Hopkins School.Join VMRDownload CPSolvers App herePatreon website