A logic framework for addressing medical racism in academic medicine: an analysis of qualitative data.

BACKGROUND: Despite decades of anti-racism and equity, diversity, and inclusion (EDI) interventions in academic medicine, medical racism continues to harm patients and healthcare providers. We sought to deeply explore experiences and beliefs about medical racism among academic clinicians to understand the drivers of persistent medical racism and to inform intervention design. METHODS: We interviewed academically-affiliated clinicians with any racial identity from the Departments of Family Medicine, Cardiac Sciences, Emergency Medicine, and Medicine to understand their experiences and perceptions of medical racism. We performed thematic content analysis of semi-structured interview data to understand the barriers and facilitators of ongoing medical racism. Based on participant narratives, we developed a logic framework that demonstrates the necessary steps in the process of addressing racism using if/then logic. This framework was then applied to all narratives and the barriers to addressing medical racism were aligned with each step in the logic framework. Proposed interventions, as suggested by participants or study team members and/or identified in the literature, were matched to these identified barriers to addressing racism. RESULTS: Participant narratives of their experiences of medical racism demonstrated multiple barriers to addressing racism, such as a perceived lack of empathy from white colleagues. Few potential facilitators to addressing racism were also identified, including shared language to understand racism. The logic framework suggested that addressing racism requires individuals to understand, recognize, name, and confront medical racism. CONCLUSIONS: Organizations can use this logic framework to understand their local context and select targeted anti-racism or EDI interventions. Theory-informed approaches to medical racism may be more effective than interventions that do not address local barriers or facilitators for persistent medical racism.

A unique and atypical presentation of heart failure secondary to incidental left atrial myxoma in a patient post gynecological surgery.

Primary tumors of the heart are rare where nearly half of the benign cardiac masses are myxomas. Clinical features of myxoma are determined by their location, size, and mobility. Most patients present with one or more of the triad of embolism, intracardiac obstruction, and constitutional symptoms. Herein, we present the case of a 60-year-old female with a history of genital prolapse who had new onset worsening dyspnea two days after an elective total abdominal hysterectomy, bilateral salpingo-oopherectomy, and vaginal repair. She was initially thought to have a pulmonary embolism so had a computed tomography scan that revealed a cardiac mass, which was diagnosed to be a myxoma. Although rare, atrial myxomas can present in any patient population. This case report is educational as it highlights the atypical presentation of an atrial myxoma. To facilitate appropriate management, high degree of suspicion should be complemented with a comprehensive physical examination and set of investigations. .