The annual SGIM meeting focuses on inclusion

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In her welcome video on the opening day of the annual meeting of the Society of General Internal Medicine, the chair of the meeting, Rita Lee, MD, said she hoped this year’s event, though be virtual, allow attendees the opportunity to “regroup, find inspiration, and celebrate the incredible strengths and diverse voices of our community”.

“We live in an incredibly polarized world,” Lee said in an interview. “The theme of the conference‘ Transforming Values ​​into Action ’is especially important at this time, as recent events, such as the deaths of George Floyd and many others, in addition to the disparities revealed by the COVID-19 pandemic, have led to issues of structural racism and oppression in the United States at the forefront, ”he said in the interview.

“Given these circumstances, it is important now, more than ever, that GPs translate our values ​​into action (to make changes in health system, community and policy levels) so that our patients they can achieve optimal health, ”Lee stressed.

He noted that SGIM’s vision: “A fair care system in which all people can achieve optimal health,” is based on the sessions of the meeting.

Some challenges related to the adoption of more anti-racist training at the medical education center on faculty development, Lee noted. “There are also students who do not feel that this is part of the role of being a doctor. One way to overcome these challenges is to directly link structural competence with the health outcomes of our patients,” he added. “We have evidence that structural racism affects health and we should make it clear to our educational leaders and teachers to increase purchasing. So many of our SGIM members are working on developing curricula for this.”

Two of the meeting workshops that addressed racism in medicine and medical education and strategies for change were “Demystifying Structural Competence – How to Develop Anti-Racist Training in Medical Education” and “Combating Systemic Racism in the System health: practical actions you can take today “. “Here are some details on these aspects.

Medical education is evolving to include structural competence

In the workshop “Demystifying Structural Competence: How to Develop Anti-Racist Training in Medical Education,” participants used interactive exercises to construct structural differentials for patient cases. The workshop was based in part on experiences of including structural competencies in medical education at Albert Einstein College of Medicine, New York, and the University of Pittsburgh.

During the session, participants practiced the construction of a structural differential diagnosis in small groups and also practiced the use of a structurally competent 1-minute preceptor version to promote structural competence in students.

“Structural competence represents a shift in medical education toward attention to the forces that influence health outcomes at levels above individual clinical interactions and develop a provider’s ability to recognize and respond to health and disease as subsequent effects of social, political, and economic structures, ”said presenter Iman Hassan, MD, of the Albert Einstein College of Medicine and Montefiore Health System, both in New York, said in a interview.

“At the same time, structural competence incorporates structural humility, which decentralizes the role of the provider in addressing structural factors and emphasizes collaboration with patients and communities,” he said in the interview. “Structural competition is a useful anti-racist framework because it explicitly involves learners with the broader structural forces that lead to health disparities, including structural racism and its downstream effects,” Hassan explained.

Addressing structural competence is important in medical education because structural and social determinants of health contribute more than half of overall health outcomes, Hassan said.

A structural competency framework equips students to identify, discuss, and work with patients to navigate social needs, such as lack of health insurance, food, or transportation, that prevent them from accessing necessary health services, Hassan noted.

“It is important to note that training in structural skills allows physicians to be agents of change within their clinics, health systems and communities and to recognize the value of community-led promotion in promoting health equity,” he said. he said.

Training in structural skills will also “allow them to relate more fully to the set of literature that exists around the social determinants of differences in health and well-being and the use of approaches such as critical race theory through of which health care can be seen, ”he stressed. “It is important to note that understanding the historical and structural context of medicine allows physicians to more easily recognize when their own clinical practices, such as the use of race-based clinical prediction tools, can perpetuate disparities and work collectively to eliminate these practices “.

Recalibrator calculators for clinical care

Another workshop, “Combating Systemic Racism in the Health System: Practical Actions You Can Take Today,” took on the challenge of the bias inherent in clinical care caused by various factors, particularly medical calculators, such as those that used to measure kidney function and lung function. .

Lamar K. Johnson, MD, of Christiana Care Hospital Partners / Christiana Care Pediatric Hospitalists in Newark, Del., And Celeste Newby, MD, of Tulane University, New Orleans, discussed the biases inherent in some calculators and how to have them in note these biases. account. One of the stated goals of the workshop was to raise awareness about the origins of medical calculators to improve equity and improve shared decision-making between patients and providers.

Addressing the implicit bias in clinical practice is important because it has been shown that this bias negatively affects physician behavior and clinical decision making, Johnson said in an interview.

“These effects can also negatively affect the physician-patient relationship and lead to worse health outcomes due to delays or avoidance of care or avoidance of the health care system, and mistrust, resulting in non-adherence,” Johnson noted.

“Implicit bias training helps medical students and residents recognize and address biases and advocate for patients. This training can also be beneficial for faculty,” Johnson emphasized in the interview.

“Race is primarily a social construct, not a biological one, and we need to be careful when we use it, as its use in the past has been largely inappropriate and not scientifically sound,” he said.

During the session, one of the presenters said that removing race-specific mentions from clinical documentation can reduce racial bias in clinical practice.

Presenters also highlighted the estimated glomerular filtration rate (eGFR) used to estimate renal function.

The eGFR “reports higher eGFR values ​​for blacks based on a flawed assumption that black people have higher muscle mass. This higher estimated value may delay referral for specialized care or transplantation, leading to worse results, ”Johnson explained in the interview.

In response, “Many major institutions have removed the race modifier in eGFR and a joint working group created by the National Kidney Foundation and the American Society of Nephrology has recommended not using a career modifier as of March 2021.” , Johnson said.

The presenters had no relevant financial conflict to disclose.

This article originally appeared on MDedge.com, which is part of the Medscape professional network.





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