We're excited to present the podcast recording of our special live podcast session at ACP's IM Future Experience! The podcast session features a roundtable discussion of ACP leaders and representatives from the three ACP Councils: the Council of Student Members (Amanda Collar), Council of Resident and Fellow Members (Dr. Jake Quinton), and Council of Early Career Physicians (Dr. Ricardo Correa). Guests Dr. Denise M. Connor and Dr. Omar Atiq join the session to talk about their leading work in advancing justice, equity, diversity, and inclusion in essential work of the American College of Physician and their institutions.

Show Notes
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IM2021 Future Experience: A Livestreamed Episode from The DEI Shift 

Seize the DEI: Shaping the Future of I.M. 
Show Notes

[00:00] Intro to Session’s Agenda, Co-Hosts, and Round Table Discussants
  • Amanda L. Collar, BS, MD-PhD Candidate - ACP Council of Students Member and representative of CSM to the ACP DEI Committee
  • Dr. Jacob (Jake) Quinton, MD, MPH - Immediate Past Chair of the ACP Council of Resident and Fellow Members)
  • Dr. Ricardo Correa, MD, EsD, FACP - endocrinologist, member of the ACP Council of Early Career Physicians, and representative of CECP to the DEI Committee 


[02:57] Intro to First Guest
  • Dr. Omar Atiq, MD, FACP - medical oncologist, ACP Regent, chair of ACP Health and Public Policy committee, past chair of ACP Board of Governors, AMA delegate from Arkansas, and Professor of Medicine and Otolaryngology – Head and Neck Surgery at the Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences


[03:59] Summary of Dr. Atiq’s IM2021 Talk
  • “Addressing Disparities  and Discrimination in Healthcare”
    • Recommend policies for education and the workforce
    • Reform criminal justice and law enforcement systems
    • Address disparities involving specific populations

[06:06] First Question for Dr. Atiq
  • “You made a strong point for physicians being involved in political engagement and advocacy. What would you say to those who are hesitant that their political views may jeopardize their career or their relationships with patients?”
    • Keep the goal of an equitable healthcare system in mind and be prepared to adjust your path to reach that goal
    • Be sensitive of others in order to avoid being perceived as condescending or argumentative
    • Have physicians understand and be understood by others in order to get a healthy society
    • Seek the right opportunity for political engagement and advocacy
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[10:47] Second Question for Dr. Atiq
  • “How, as trainees, can we advocate for elimination of health disparities in our hospital systems and/or our educational institutions?”
    • Change ourselves before asking others to change
    • Address and acknowledge our own implicit biases
    • Stay focused on patients and patient care 
    • Support minority colleagues 
    • Continue talking about issues with the people in our institutions 

[15:45] Summary of Dr. Atiq’s Points

[18:40] Interlude and Transition to Next Guest

[19:06] Intro to Second Guest
  • Dr. Denise M. Connor, MD - Associate Professor of Medicine and the Gold-Headed Cane Endowed Teaching Chair in Internal Medicine at the University of California, San Francisco (UCSF), chairs the UCSF Academy of Medical Educators’ Diversity, Equity and Inclusion Committee, and the first Director of the UCSF School of Medicine’s Anti-Oppression Curriculum

[20:20] Summary of Dr. Connor’s IM2021 Talk
  • “Improving Diagnostic Reasoning: Recognizing and Addressing Errors from Implicit Bias in Patient Care”
    • System 1 thinking (pattern recognition) is prone to diagnostic reasoning traps like premature closure and anchoring bias
      • Sukhera J, Watling C. A Framework for Integrating Implicit Bias Recognition Into Health Professions Education. Acad Med. 2018 Jan;93(1):35‐40.
    • Forms of oppression latent in society are threats to the ability to accurately make diagnoses and treat patients
    • Ways to mitigate the aforementioned threats
      • Before visits, cognitively reappraise our emotional responses and remind ourselves to be grateful for the trust of patients
      • During visits, build empathy by considering patients to be on the diagnostic team, encourage questions
      • After visits, measure communication patterns and take data when talking about patients from various backgrounds for research
    • Patients are not medically trained and therefore use communication as a proxy for medical care
      • Must be an effective communicator in order for patients to be engaged in their care 
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[22:55] First Question for Dr. Connor
  • “You mentioned in your talk that research on implicit bias in physicians shows an increase in bias as a student progresses through training. Are there particular times in our curriculum when this happens and how, as medical students and trainees, can we be aware and counter this change?”
    • Moments of vulnerability during medical student training that can increase future bias 
      • Clinical time, hearing negative comments from supervising physicians and residents correlated with an increase in implicit bias in medical students
        • Zestcott CA, Blair IV, Stone J. Examining the presence, consequences, and reduction of implicit bias in health care: A narrative review. Group Process Intergroup Relat. 2016;19:528–542.
    • Strategies to combat developing biases 
      • Be aware of negative comments to prevent internalization of biases  
      • Humanize patients, think of them as individuals rather than members of stereotyped groups, use first-person language
      • Notice how we identify with patients, engage in perspective-taking
        • Ruben, B. D. (2016). Communication Theory and Health Communication Practice: The More Things Change, the More They Stay the Same1. Health Communication, 31(1), 1‐11.
        • Schoenthaler, A., Allegrante, J. P., Chaplin, W., & Ogedegbe, G. (2012). The effect of patient‐provider communication on medication adherence in hypertensive black patients: Does race concordance matter?. Annals of Behavioral Medicine, 43(3), 372‐382.
      • Explicitly think of patient as part of the medical team
      • Cognitive behavioral therapy, reappraisal, reframe negative emotions to be present for patient
      • Mindfulness, optimize positive emotional state, increase empathy and patient connection 
        • Lueke A, Gibson B. Mindfulness meditation reduces implicit age and race bias: The role of reduced automaticity of responding. J Pers Soc Psychol. 2015;6:284–291
        • Djikic, M., Langer, E.J. & Stapleton, S.F. Reducing Stereotyping Through Mindfulness: Effects on Automatic Stereotype‐Activated Behaviors. J Adult Dev 15, 106–111 (2008).
        • Burgess, D., Van Ryn, M., Dovidio, J., & Saha, S. (2007). Reducing racial bias among health care providers: lessons from social‐cognitive psychology. Journal of general internal medicine, 22(6), 882‐887.
      • Systems level change, build structures through advocacy 
        • Zestcott CA, Blair IV, Stone J. Examining the presence, consequences, and reduction of implicit bias in health care: A narrative review. Group Process Intergroup Relat. 2016;19:528–542.

[28:54] Follow-Up Question for Dr. Connor
  • “We teach medical students in a way that can introduce bias. The question goes directly to standardized tests. How can we make changes there as it has been proven that there is unconscious bias that we introduce in the way that we do standardized tests?”
    • Advocate for systems level change
    • Educate that race is not a risk factor for disease but rather racism and other social determinants of health are risk factors for disease 

[31:20] Second Question for Dr. Connor
  • The "hidden curriculum" of clinical work can often perpetuate bias. As trainees who may be lower down in the power structure of a team, how can we influence a supervisor or a team culture to better stand with our patients?”
    • Medical schools, residency, fellowship programs can invest in faculty development rather than put burden on trainees
    • At an individual level, use humble inquiry, preserve relationship, speak up for patients, engage with questions, for example:
      • "I am curious to learn why…" 
      • "Can we take a time out so we can unpack that a bit?" 
      • "I’m confused about what you just said, would you mind explaining it a little bit more?" 
      • "I’m uncertain about what you just said, can I take a moment and get back to you on that?" 
    • Pause and reflect on what was just said
    • Reflection can be in the moment or at a later time with other trusted members of their team

[35:09] Summary of Dr. Connor’s Points
  • Clinical training period is a time when implicit bias can be heightened
    • Be aware of unfavorable interactions 
    • Be active in critiquing interactions and immediate reactions
    • Foster internal change 

[36:36] Closing
  • Thanks to listeners, panelists, production team
  • Website: thedeishift.com
  • Instagram: @thedeishift
  • Twitter: @thedeishift

Credits:

Co-Hosts: Dr. Pooja Jaeel, Dr. Tiffany Leung
Editors/Assistant Producers: Joanna Jain, Deepti Yechuri
Production Assistants: Alexandra Babakanian, Lynn Nguyen
Social Media Team:  Dr. DJ Gaines, Ann Truong, Joanna Jain
Website/Art Design: Ann Truong
Music: Chris Dingman

Special Thanks: Joanne Ey, Director, ACP Board of Regents & Governance Activities, and Ed Vassallo, ACP Public Relations and Social Media Associate, during the planning and livestreaming of this episode. 

Disclaimer: The DEI Shift podcast and its guests provide general information and entertainment, but not medical advice. Before making any changes to your medical treatment or execution of your treatment plan, please consult with your doctor or personal medical team. Reference to any specific product or entity does not constitute an endorsement or recommendation by The DEI Shift. The views expressed by guests are their own, and their appearance on the podcast does not imply an endorsement of them or any entity they represent. Views and opinions expressed by The DEI Shift team are those of each individual, and do not necessarily reflect the views or opinions of The DEI Shift team and its guests, employers, sponsors, or organizations we are affiliated with. 

Season 3 of The DEI Shift podcast is proudly sponsored by the American College of Physicians Southern California Region III Chapter. 

The DEI Shift theme music is by Chris Dingman. Learn more at www.chrisdingman.com. 

Contact us: [email protected], @thedeishift, thedeishift.com


Disclaimer

.The DEI Shift podcast and its guests provide general information and entertainment, but not medical advice. Before making any changes to your medical treatment or execution of your treatment plan, please consult with your doctor or personal medical team. Reference to any specific product or entity does not constitute an endorsement or recommendation by The DEI Shift. The views expressed by guests are their own, and their appearance on the podcast does not imply an endorsement of them or any entity they represent. Views and opinions expressed by The DEI Shift team are those of each individual, and do not necessarily reflect the views or opinions of The DEI Shift team and its guests, employers, sponsors, or organizations we are affiliated with.