The Clinical Problem Solvers

https://clinicalproblemsolving.com/wp-content/uploads/2021/03/RTP_Schema_Dysphagia_BST_FINAL.mp3The CPSolvers team breaks down a *bite-sized​* case of dysphagia.SchemaDownload CPSolvers App herePatreon websiteEpisode Quiz

https://clinicalproblemsolving.com/wp-content/uploads/2021/03/WDx-Episode-8_RTP.mp3Sarah Onorato presents a case to Dr. Ann Marie Kumfer & Dr. Debra BynumWant to test your learning? Take our episode quiz hereDr 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?

https://clinicalproblemsolving.com/wp-content/uploads/2021/03/RTP_SLS_March_FINAL.mp3Jack presents a case of abdominal pain and hypotension to Steph and DanDownload CPSolvers App herePatreon websiteSchema 1Schema 2Episode Quiz

https://clinicalproblemsolving.com/wp-content/uploads/2021/03/RTP_HDx_Lindsey_March_FINAL.mp3Lindsey, Kiara (#bossladies), and Scott discuss a clinical unknown presented by DevikaDownload CPSolvers App herePatreon websiteWant to test your learning? Take our episode quizScott WalkerScott 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 GandhiDevika 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.

https://clinicalproblemsolving.com/wp-content/uploads/2021/02/ARM-EP-6-Manning-Corbie-Smith-FINAL-2_19_21-8.53-PM.mp3In 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 ObjectivesAfter listening to this episode listeners will be able to…Recognize the importance of yielding privilege and power to better center marginalized voices and communities through individual, interpersonal, institutional, and systemic actions.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.Identify potential individual, institutional, and policy-level actions to address COVID-19 vaccine inequities.CreditsWritten 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.EdHosts: Utibe, Lash, JennyInfographic: Creative Edge DesignShow Notes: Rohan KhazanchiGuests: Kimberly Manning MD (@gradydoctor) and Giselle Corbie-Smith MD, MSc (@gcsmd)Download Transcript Here Show Notes – Episode 6: Racism, Trustworthiness, and the COVID-19 VaccineRohan KhazanchiFebruary 23rd, 2021SummaryIn 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. Timestamps00:00 Music/Intro1:25 Guest Introductions02:34 Reflecting upon the current “moment of hope” in the COVID-19 pandemic07:46 Why is Mistrust the “Tip of a 400-Year-Old Iceberg”?12:04 Getting to the Individual “Why” of Declining the COVID-19 Vaccine13:01 Is Mistrust the True Root Cause?16:28 Moving past our preconceptions about vaccine mistrust19:01 “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 deliberations27:58 Recognizing our biases, centering the margins, and avoiding diluted generalizations37:20 Valuing diversity rather than classifying minoritized groups as monoliths43:34 Why Dr. Manning chose to participate in the Moderna vaccine trial49:20 The “allostatic load” of the minority tax in a white supremacist system55:45 Performative advocacy and the “musical chairs” of representation in medicine58:12 The fallacy of the meritocracy59:10 What can health systems do to reduce vaccine disparities?1:06:20 Takeaways and conclusions1:08:51 OuttakesTakeawaysMedical 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 SolutionsThis 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 ManningDr. 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 Mentioned08:14Manning KD. More than medical mistrust. The Lancet. 2020 Nov; 396(10261): 1481-1482. doi:10.1016/S0140-6736(20)32286-8.13:01Corbie-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: 12437405.32:18Corbie-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: 14969653.33:56Corbie-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: PMC1496744.39:42Wilkerson, I. (2020). Caste: The origins of our discontents.59:10Corbie-Smith, G. “A Different Kind of Leader” Podcast. Retrieved from https://adifferentkindofleader.buzzsprout.com/  Additional References 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.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. DisclosuresThe hosts and guests report no relevant financial disclosures. CitationManning 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.

https://clinicalproblemsolving.com/wp-content/uploads/2021/02/RTP_ConsultQuestion_Murphy_Episode1_FINAL.mp3We 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.SchemaEpisode QuizDr. Elizabeth MurphyDr. 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.

https://clinicalproblemsolving.com/wp-content/uploads/2021/02/RTP_Feb_NeuroVMR_FINAL.mp3We continue our mission to #EndNeurophobia with an episode of Neurology VMR with Dr. Aaron Berkowitz Download CPSolvers App herePatreon websiteEpisode QuizDhruv SrinivasacharDhruv 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 VastiElena 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.

https://clinicalproblemsolving.com/wp-content/uploads/2021/02/2_11-BST-Mode-Thyrotoxicosis-RTP-online-audio-converter.com_.mp3Rabih, Reza, PrezSharmin, and Arsalan break down thyrotoxicosis, by revisiting a case initially presented at our December 18th VMR.SchemaPatreon websiteDownload CPSolvers App hereEpisode Quiz

https://clinicalproblemsolving.com/wp-content/uploads/2021/02/WDx-Episode-7_RFP-1.mp3Maani, Priyanka, and Lindsey discuss a clinical unknown with Dr. Jori May.Want to test your learning? Take our episode quiz hereDr. Jori MayJori 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

https://clinicalproblemsolving.com/wp-content/uploads/2021/01/RTP_HDX_1.28_DanMinter_FINAL.mp3Mansour presents a case of sudden vision loss to Dan, Erica, and Kristin. Download CPSolvers App herePatreon websiteSchema 1Schema 2Want to test your learning? Take our Episode QuizDr. 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 AlkhunaiziMansour 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 AndresKristin 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.