The HM20 Virtual conference in August was filled with excellent content that can be applied by all hospitalists. This article summarizes key concepts and takeaways for the pediatric hospitalist.
Racism and bias in medicine
HM20 Virtual session: Structural Racism and Bias in Hospital Medicine During Two Pandemics
Presenters: Nathan Chomilo, MD, FAAP, and Benji K. Mathews, MD, SFHM
Dr. Nathan Chomilo, of HealthPartners in Minneapolis, opened the session sharing how racial disparities were a symptom of racism. The presenters explained how structural racism has been propagated in medicine with the Hospital Survey and Construction Act of 1964 that allowed segregated hospitals, as well as the racism that exists within the “hidden curriculum.”
Dr. Chomilo discussed how personal experiences of racism can lead to worse health outcomes, including depression, obesity, and overall poor health. Dr. Mathews, also of HealthPartners, discussed how implicit biases can be addressed at the individual level, the organizational level, and simultaneously at both levels to create an antiracist culture. He presented strategies to mitigate individual biases; recognizing when biases may be triggered, checking biases at the door, connecting with others from different backgrounds as equals, and practicing antiracism by being an active bystander. Dr. Chomilo concluded the session by sharing that we can all grow by addressing racism at “our houses” (health care systems, medical schools, payer systems) with the goal to create an antiracist system.
- Racial disparities are a symptom of structural racism that has been propagated in medicine for centuries.
- Addressing implicit biases at the individual level, organization level, and simultaneously at both levels can help leaders model and promote an antiracism culture.
HM20 Virtual session: When Grief and Crises Intersect: Perspectives of a Black Physician in the Time of Two Pandemics
Presenter: Kimberly Manning, MD, FACP, FAAP
Dr. Kimberly Manning, of Emory University in Atlanta, discussed the dual pandemics of COVID-19 and the racism that we are currently experiencing and tried to describe the unique perspective of Black Americans. Though it is easy to see that COVID-19 is a pandemic, racism is not always seen in this way. Dr. Manning demonstrated that, when a pandemic is defined as “that which occurs over a wide geographic area and affects a high proportion of the population,” racism is absolutely a pandemic. Black Americans have been disproportionately affected by COVID-19. Dr. Manning said we often hear that we are in unprecedented times but as far as racism is concerned, there is nothing new about this. She shared stories of personal milestones and how each of these instances, though marked by something beautiful, was also marked by something truly awful. Each time she had a reason to smile, there was something awful going on in the country that showed how racism was still present. Dr. Manning described that, though these were her stories, all Black Americans can recount the same stories, emotions, and feelings of grief.
Dr. Manning concluded by sharing how we can “Do The Work” to combat the pandemic of racism: broaden our funds of knowledge, remember that people are grieving, explore our implicit biases, be brave bystanders, and avoid performative allyship
- Though the COVID19 pandemic is unprecedented, the pandemic of racism is not.
- We must “Do The Work” to combat everyday racism and to be cognizant of what our Black colleagues are going through every day.
Immigrant hospitalist challenges
HM20 Virtual session: The Immigrant Hospitalist: Navigating the Uncertain Terrain During COVID-19
Presenters: Manpreet S. Malik, MD, FHM, and Benji K. Mathews, MD, SFHM
Dr. Malik of Emory University in Atlanta, and Dr. Mathews of HealthPartners, opened this session by sharing their personal stories as immigrant physicians in the United States. Dr. Malik noted that physicians born outside the United States make up 29% of U.S. physicians, and 32% of hospitalists are international medical graduates.
The presenters revealed the structural hurdles immigrant physicians face, including lack of empowerment until achieving permanent residency status; limited leadership, administrative, and academic roles; concerns for job security and financial stability; and experiencing micro- and macroaggressions at work. The presenters shared a framework for a developmental orientation inclined toward cultural competency beginning with denial, followed by polarization, progressing to minimization, advancing to acceptance, and culminating in adaptation.
They concluded the session by stressing the importance of advocacy for immigrant physicians and encouraged colleagues to become engaged in efforts within their professional organizations.
- Immigrant physicians experience structural challenges to their professional advancement because of their residency status.
HM20 Virtual session: Call Me Maybe: Balancing Resident Autonomy With Sensible Supervision
Presenter: Daniel Steinberg, MD, SFHM, FACP
Dr. Steinberg, based at Mount Sinai in New York, explained that resident supervision is driven by three factors: what residents need, what residents want, and what the supervisor can provide. Although data is mixed as to whether supervision improves patient outcomes, supervision is essential for patient care and resident education. Dr. Steinberg showcased several relevant medical education studies related to supervision and focused on a key question: Do you trust the resident? The review of medical education literature discussed the meaning and development of trust, oral case presentations to determine trust, and the influence of supervisor experience.
- Resident supervision is driven by what residents need, what residents want, and what the supervisor can provide.
- Trust can be determined from direct supervision, oral presentations, and remote access of electronic medical records, but is also influenced by attending experience and style.
Balancing personal and professional life
HM20 Virtual session: Being a Hospitalist and a Parent: Balancing Roles With Grace
Presenters: Heather E. Nye, MD, PhD, SFHM, and David Alfandre, MD, MSPH
Dr. Nye of the University of California, San Francisco, and Dr. Alfandre of New York University shared their challenges as hospitalists, parents, and partners before and during the COVID-19 pandemic. They described their feelings of guilt during the pandemic related to increasing their families’ infection risks, as well as the gratitude they felt for having stable jobs during the crisis. They shared solutions that worked for their families, including cooperating with their partners, expressing their scheduling needs, and negotiating to meet those needs with their employers.
Dr. Nye and Dr. Alfandre recommended staying connected with others for help, including partners, institutions, neighbors, and colleagues. They also recommended supporting, sharing, collaborating, and connecting with their partners and colleagues to maintain a balanced professional and personal life.
- Stay connected and support, collaborate, and share with your colleagues and partner at home.
Dr. Kumar is the pediatric editor of The Hospitalist. She is clinical assistant professor of pediatrics at the Cleveland Clinic Lerner College of Medicine at Case Western Reserve University and a pediatric hospitalist at Cleveland Clinic Children’s. Dr. Doraiswamy is an assistant professor of medicine and pediatrics and a med-peds hospitalist at The Ohio State University and Nationwide Children’s Hospital, both in Columbus. Dr. Tantoco is an academic med-peds hospitalist practicing in Northwestern Memorial Hospital, Chicago, and Ann & Robert H. Lurie Children’s Hospital of Chicago.