The Clinical Problem Solvers

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.

https://clinicalproblemsolving.com/wp-content/uploads/2021/05/5_27_21-Schema-Episode-Eos-Pulm-Infiltrates_RTP.m4aSharmin, Rabih, Reza, and Arsalan tackle a schema for pulmonary disease with eosinophiliaPatreon websiteDownload CPSolvers App hereSchemaEpisode QuizGive us feedback here 

https://clinicalproblemsolving.com/wp-content/uploads/2021/05/5.20.21-WDx-RTP.mp3 Dr. Katrina Armstrong and Dr. Vineet Arora join the #bosslady Wdx team to discuss navigating negotiations as women in medicineDr. Katrina ArmstrongDr. 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 AroraVineet 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 websiteGive us feedback here