How Should We Respond to Racist Legacies in Health Professions Education Originating in the Flexner Report?

The Flexner Report damaged and marginalized historically Black medical schools, which today produce more than their fair share of Black medical graduates. As physicians, graduates of Black medical schools have confronted head-on the inequities of American responses to COVID-19 that the pandemic has laid bare to the world. Black physicians' leadership roles in American health care and in American communities have informed the reimagination of health care and medical education as just and inclusive.

Severe Intimate Partner Violence, Sources of Stress and the Mental Health of U.S. Black Women.

Background: We investigate the mental health risk of U.S. Black women by examining the roles of intimate partner violence (IPV), major discrimination, neighborhood characteristics, and sociodemographic factors using one of the largest and most complete datasets on U.S. Blacks. Materials and Methods: The National Survey of American Life (NSAL) used a slightly modified version of the World Health Organization Composite International Diagnostic Interview (WHO-CIDI) with a sample of 6082 participants. We also assess intraracial group differences based on ethnicity and nativity status (U.S.-born African American, U.S.-born Caribbean Black, and foreign-born Caribbean Black). Results: The study provides evidence that severe physical intimate partner violence (SPIPV) is a significant threat to the mental health of U.S. Black women. Bivariate and multivariate analyses indicate that those with a history of SPIPV were at greater risk for mental disorders than women who did not experience violence by a spouse or partner. Racial discrimination was associated with higher odds of anxiety and substance disorders, whereas gender discrimination was associated with higher odds of mood disorders. Neighborhood drug problems also increased the odds of mood, anxiety, and substance use disorders. Older age and being an Afro-Caribbean immigrant were associated with lower odds of three of four mental disorders. Conclusions: Findings from the study indicate the need for community and clinical interventions aimed at addressing IPV and other community factors that influence Black women's mental health.

Tuskegee as Sacred Rhetoric: Focal Point for the Emergent Field of African American Religion and Health.

Scholars in African American religion engage the Tuskegee Syphilis Study as the focal point of the African American experience in institutional medicine. Seeking a way forward from this history and its intentional evil, the author proposes to position Tuskegee as a form of Lynch's culturally contextual sacred rhetoric to make use of its metaphoric value in the emerging field of African American religion and health. In this broader meaning-making frame, Tuskegee serves as a reminder that African American religious sensibility has long been an agential resource that counters abuse of the Black body. It also acknowledges the complex decisions facing African American clinical trial participants.

Ethics, Cultural Competence, and the Changing Face of America.

The population in the United States is increasingly multicultural. So, too, is the U.S. physician workforce. The combination of these diversity dynamics sets up the potential for various types of cultural conflict in the nation's examining rooms, including the relationship between religion and medicine. To address the changing patient-physician landscape, we argue for a broad scale intervention: interdisciplinary bioethics training for physicians and other health professionals. This approach seeks to promote a common procedural expectation and language which can lead to an improved, patient-centered approach resulting in better patient-physician relationships that contribute to better health outcomes across the U.S. population. The authors illustrate their thesis and solution using a well-known case of cross-cultural dynamics taken from religion and medicine-Anne Fadiman's The Spirit Catches You And You Fall Down.