Integrating Discussions on Racism and Health Equity into Clinical Reasoning Conference.

OBJECTIVE: Intentionally discussing racism and health equity in clinical reasoning conference may provide an opportunity to reinforce antiracist praxis. We aimed to understand 1) whether these discussions provide a meaningful opportunity to practice applying an antiracist lens in patient care, 2) the feasibility of implementing these discussions in a clinical reasoning format, and 3) the acceptability to Black, Indigenous, and People of Color (BIPOC) and white residents. METHODS: In 2021, 4 clinical reasoning conference pilot sessions were implemented in a pediatrics residency program. Trained faculty facilitated discussions on mitigating inequity in clinical cases. Residents who attended at least 1 session were invited to participate in focus groups, which were analyzed using grounded theory. RESULTS: Thirty residents attended each pilot session out of the 30 to 35 who had the opportunity to attend. The focus groups included 6 BIPOC and 6 white residents. The discussions offered a meaningful opportunity to practice recognizing and naming racism. Having faculty facilitators made the discussions more feasible. Both groups experienced benefits and wanted the discussions to continue, but BIPOC residents want more engagement from their white peers. CONCLUSIONS: Discussing racism and health equity in clinical reasoning conference was a meaningful, feasible, and acceptable opportunity for antiracist praxis.

URM: Underrepresented or Underrecognized? A Case Study of Black Pediatric Critical Care Physicians.

PURPOSE: This study explored Black physicians' experience via an antideficit lens to gain new ideas for advancing minoritized physicians in academic medicine more broadly. Increasingly, systemic racism in academic medicine is intentionally acknowledged and named. However, many solutions to tackle racism and the overall paucity of Black physicians use a deficit framing, painting Black physicians and trainees as lacking preparation, interest, or experience and qualifications. Such solutions aim to help Black people assimilate into the "White Space" of academic medicine, rather than focusing on Black people's strengths. METHOD: This qualitative study included 15 Black physicians and trainees in pediatric critical care medicine (PCCM) from across the country who participated in semistructured interviews. Through an antideficit lens, the researchers examined the social, cultural, and structural contexts influencing the participants' individual experiences. They analyzed the data combining thematic and narrative qualitative analysis approaches, including restorying. RESULTS: The data help promote understanding of the landscape and context in which Black PCCM physicians become successful. Achievement took on different forms for the participants. Participants described enablers of achievement that supported them through their individual journeys spanning 3 general domains-intrinsic, interpersonal, and systemic. Three additional enablers were tied specifically to participants' Black identities-harnessing Blackness as a superpower, leaning in to lead, and successfully navigating the "unwritten rules." CONCLUSIONS: By using an antideficit framework, this study delineates and centers participants' ingenuity in cultivating repertoires of practice that enabled them to succeed, despite challenges rooted in systemic racism. Going forward, rather than focus solely on what is missing, academic medicine should try to shift systems and regularly recognize and value the knowledge, expertise, and merit Black that physicians bring. Perhaps an appropriate framing is not that Black physicians are underrepresented in medicine; maybe instead, it is that they are underrecognized.

Myocarditis in children after COVID-19 vaccine.

Three healthy adolescents presented with myocarditis confirmed on cardiac magnetic resonance imaging after receiving Pfizer-BioNTech COVID-19 vaccine. All patients were hemodynamically stable and had good short-term outcomes. Long-term outcomes are yet to be determined. Larger studies are needed to determine whether an association between Pfizer-BioNTech COVID-19 vaccine and myocarditis exists.

Beyond satisfaction: evaluating understanding in PICU family centered rounds.

BACKGROUND: Many hospitals have adopted Family Centered Rounds (FCR), as a means to optimize communication. While studies show FCR improves family satisfaction, research on the impact on family understanding of their child's care has been conflicting. Understanding is particularly important when families are asked to share in complex decision making, as occurs in the Pediatric Intensive Care Unit (PICU). This study explores families' experiences of FCR in the PICU and examines how FCR impacts their understanding of their child's care. METHODS: We conducted surveys and interviews of family members after they attended FCR in two PICUs. The survey assessed families' satisfaction with rounds and their understanding across three domains: the child's illness, treatments, and prognosis. Physicians completed a similar survey to examine concordance with families' understanding. In interviews we explored underlying factors. We identified themes from transcripts through thematic analysis. RESULTS: Twenty-five family members completed the survey and participated in interviews. The majority (82%) rated their satisfaction with FCR highly. Discordance between families and physicians in understanding was common, especially in the prognosis domain, with concordance rates as low as 27%. We identified four themes from interviews that shed light on families' experiences and the relationship between FCR and understanding: Jargon, Feeling Part of the Team, Rounds as Overwhelming and Competing Purposes of Rounds. CONCLUSION: Families in our study had similar satisfaction with FCR as previously reported, yet our findings suggest that FCR can be optimized to achieve family understanding. Our findings provide insights into potential ways to accomplish this.