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An editorial is presented on how Anti-Black racism is perpetuated by the limited compositional diversity of health systems, and racism happens in the absence of overtly racist people. Topics include assigning value to work that advantages White people and disadvantages Black people are the hallmark of systemic anti-Black racism; and resulting diminished supply of Black physicians negatively impacts the care family physicians provide to Black patients.

BACKGROUND AND OBJECTIVES: Mission statements of medical schools vary considerably. These statements reflect institutional values and may also be reflected in the outputs of their institutions. The authors explored the relationship between US medical school mission statement content and outcomes in terms of graduate location and specialty choices. METHODS: A panel of stakeholders (medical school deans, faculty, medical students, and administrators) completed a Web-based instrument to create a linear scale of social mission content (SMC scale), scoring the degree to which medical school mission statements reflect the social mission of medical education to address inequities. The SMC scale and targeted medical school outputs were analyzed via OLS regression, controlling for allopathic/osteopathic and public/private school designation. The medical school outputs of interest included percent physician output in primary care specialties (family medicine, pediatrics, and general internal medicine), as well as percent physician output in designated Health Professional Shortage Areas (HPSA) and Medically Underserved Areas/Populations (MUA/P). RESULTS: SMC scale was a statistically significant, positive predictor of the percent of physician graduates entering primary care (ß=2.526, P=.001). When examining the specialties within primary care, the SMC scale only significantly predicted percent of graduating physicians entering family medicine (ß=1.936, P=.003). SMC scale was also a statistically significant predictor of several measures of physician output to work in underserved areas and populations, the strongest of which was the percent of graduating physicians working in MUA/Ps (ß=4.256, P=.01). CONCLUSIONS: Mission statements that are diligently utilized by leaders in medical education may produce a higher degree of alignment between institutional structure, ideology, and workforce outcomes. [ABSTRACT FROM AUTHOR]

BACKGROUND AND OBJECTIVES: In this article, the authors discuss how various systems in medicine are limiting representation of blacks, Latinos, and Native Americans. Flat and decreasing percentages of Underrepresented Minorities in Medicine (URMM), especially in the black and Native American populations, is concerning for family medicine since members from URMM groups care for minority and underserved populations in greater numbers. Underrepresentation is not only noted in the medical community but also in our medical schools when it comes to numbers of URMM faculty. The changing definition of "disadvantaged" in medical school admissions has also played a part in limiting URMM representation. In addition, the Medical College Admissions Test (MCAT) excludes black, Latino, and Native American students in greater numbers. The authors support these arguments with evidence from the medical literature. Although unintentional, these systems effectively limit representation of blacks, Latinos, and Native Americans in medicine. Effective changes are suggested and can be implemented to ensure that URMM individuals have equal representation in careers in medicine. [ABSTRACT FROM AUTHOR]

With the number of individuals diagnosed with type 2 diabetes on the rise, it has become more important to ensure these patients are effectively treated. The Centers for Disease Control and Prevention estimated that 8.3% of all Americans were diagnosed with diabetes in 2011 and this number will likely continue to rise. With lifestyle interventions, such as proper diet and exercise, continuing to be an essential component of diabetes treatment, more patients are requiring medication therapy to help them reach their therapeutic goals. It is important for the clinician, when determining the treatment strategy for these individuals, to find a balance between reaching treatment goals and limiting the adverse effects of the treatments themselves. Of all the adverse events associated with treatment of diabetes, the risk of hypoglycemia is one that most therapies have in common. This risk is often a limiting factor when attempting to aggressively treat diabetic patients. This manuscript will review how hypoglycemia is defined and categorized, as well as discuss the prevalence of hypoglycemia among the many different treatment options. [ABSTRACT FROM AUTHOR]

Home monitoring of blood glucose and blood pressure levels can provide patients and physicians with valuable information in the management of diabetes mellitus and hypertension. Home monitoring allows patients to play an active role in their care and may improve treatment adherence and clinical outcomes. Glucose meters currently on the market produce results within 15 percent of serum blood glucose readings and offer a variety of features. Although the data are somewhat conflicting, home glucose monitoring has been associated with improved glycemic control and reduced long-term complications from diabetes. These effects are more pronounced in patients who take insulin. Home blood pressure values predict target organ damage and cardiovascular outcomes better than values obtained in the office. Home blood pressure measurements are also effective at detecting borderline hypertension and monitoring the effectiveness of antihypertensive drugs. Validated arm cuffs are the preferred blood pressure devices for home use. Information from home monitoring should always be used in conjunction with that from regular office visits and other data to make appropriate therapeutic decisions. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article on chronic pain visits and academic medicine for underrepresented minorities.

Peer review is primarily thought of as the process used to determine whether manuscripts are published in medical or other academic journals. While a publication may be one outcome of peer review, this article shares a model of 4 Ps to remind faculty of some important additional applications of peer review. The 4 Ps are publication, presentation, promotion, and practice. The medical literature offers few reasons why faculty should get involved in peer review. In this article, we define peer review, illustrate the role of peer review in four important processes, describe how the volume of material to review has changed over time, and share how participation in these processes promotes career advancement. Understanding the peer review process and its benefits can encourage professionals to participate in peer review in any of the four Ps as they recognize the benefits to their discipline and their career., (© 2024 by the Society of Teachers of Family Medicine.)

The jigsaw method which utilises peer-teaching in small-group settings permits a facilitator to incorporate active learning strategies into their educational toolbox. In November 2022, we evaluated the impact of the jigsaw method with groups stratified by post-graduate year (PGY) level. We assessed pre and post learner confidence and medical knowledge during a facilitator-led workshop. Participants were stratified into three groups who presented on the following subtopics about osteoporosis in men: (1) history and physical examination (PGY1s), (2) lab work and imaging studies (PGY2s) and (3) management and interventions (PGY3s). We evaluated if stratifying by PGY level impacted learner medical knowledge and confidence in November 2022. We had an 80% response rate from 16 actual participants from a total of 20 possible participants. Authors found a statistically significant increases in residents' confidence and medical knowledge after the training for all questions, but broad application across a variety of learners is still needed. The jigsaw method showed improvement in learner confidence about osteoporosis in men and may be implemented in teams distributed by PGY levels. Distribution by PGY level allows each team to building on their current training level to educate their peers., Competing Interests: No potential conflict of interest was reported by the author(s)., (© 2024 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.)

Academic medicine continues to characterize the experiences of Black and other minoritized faculty in medicine to enhance their careers and promote their advancement. An issue of discussion is tenure and its role in the advancement and retention of this group. Tenure is a sign of national presence, command of an area of study, and can demonstrate support from the institution in terms of permanent employment, eligibility to apply for awards, sit or vote on certain committees or qualify for certain leadership opportunities. Anecdotally there have been reports that tenure is a thing of the past that has lost relevance prompting some to end tenure in their institutions. Reasons for this are complex, however the literature does not include minoritized faculty as a reason for the need to revise or eliminate tenure and tenure earning tracks. The authors discuss 3 reasons why Black and other minoritized faculty should be afforded the opportunity to achieve permanent status in their academic health centers. They include histories of being denied freedom, having information concealed or being giving false information, and being denied permanent academic employment status., Competing Interests: Conflict of interest: None., (© Copyright 2024 by the American Board of Family Medicine.)

Purpose: To determine the incidence of the documentation of athlete failure of preparticipation sports physicals., Methods: This was a retrospective observational study that involved review of preparticipation examination physical form documentation from multiple clinicians for all student athletes who participated in athletics during the 2018 to 2019 academic year at Galveston Independent School District (GISD). We collected the reasons for failure to pass the preparticipation physical examination., Results: Of the approximately 800 student athlete forms reviewed, 183 forms indicated individual athletes failed the visual acuity or cardiovascular portions of the preparticipation physical examination., Discussion: Athlete failures of the preparticipation physical examination may cause delays in sports participation, and time and monetary costs to students and their parents. Inconsistences in guidelines used to clear athletes as well as variation in form completion impacts whether athletes reportedly failed or passed the examination. Mass participation screening becomes a safety net for communities for athletes who may not have primary care providers to encourage follow-up with a regular clinician for previously undiagnosed medical issues and standardizing guideline use and form completion across clinicians who do these exams may improve numbers of athletes who are cleared to play sports., Conclusion: Focusing on preventable and addressable preparticipation examination failures may help clinicians who perform these exams, while also establishing a safety net for previously undiagnosed medical conditions. Instituting yearly vision checks, addressing cardiovascular issues, and encouraging yearly follow-up with primary care clinicians can more readily address physical and mental health issues and will provide more comprehensive care to student athletes., Competing Interests: Conflict of interest: The authors have no conflicts of interest to declare., (© Copyright by the American Board of Family Medicine.)

Pseudoleadership for faculty underrepresented in medicine (URM) has been defined as when URM faculty are placed in leadership positions only because of the racial and ethnic diversity they bring, when they are not ready or trained for such roles because of being early in their faculty careers. It occurs when senior leaders push early career URM faculty into spaces where it is difficult for them to be successful.  Pseudoleadership can open up URM faculty to manipulation by superiors and impact URM advancement, as work of leadership positions take time away from scholarship and other activities which institutions value for promotion. Pseudoleadership is typically a problem for early career URM faculty and can be seen when ranks such as lecturer or assistant professor are placed in leadership or other administrative positions without careful thought on how to support the advancement and promotion of this group. In this manuscript the authors discuss pseudoleadership, its impact on the advancement and development of faculty who are underrepresented in medicine and a path forward., (Published by Elsevier Inc.)

Competing Interests: Competing interests: None declared.

Underrepresented minority faculty in academic medicine continue to be underrepresented in academic health centers across the country. Their underrepresentation impacts advancements in clinical care, education, and discovery and slows our forward progress in the field. Underrepresented in medicine faculty includes people who are black or African American, Hispanic or Latinx, or Native American. Barriers to underrepresented faculty recruitment, retention, and advancement include minority and gratitude taxes, imposter syndrome, and a lack of an appreciation of power distance and distance traveled. This article reviews five barriers to progress in achieving appropriate diversity among faculty and leadership of academic health centers, focusing on the multiplying effects of these barriers and potential steps forward.

Representing the diversity of an institution and society in senior roles in academia allows for more influence than is usually allowed in roles with diversity titles. This article discusses the transition of the author to a more senior role in the medical school and how the new role provided additional resources and empowerment for diversity and inclusion.

Introduction: Although less than 3% of medical schools are considered Historically Black Colleges and Universities (HBCU), they have played a significant role in the education of Black physicians., Methods: The Association of American Medical Colleges (AAMC) databases were used to obtain faculty and student demographic data from 2003-2013. We analyzed racial distributions of faculty and students at HBCU medical schools compared with all other medical schools and calculated correlations between rates of Black chairs, faculty, and students., Results: Although HBCUs represent 2.4% of medical colleges, they house 31% of Black chairs, 10% of Black faculty and 14% of Black students. A significant (a* < .002) positive correlation was found between rates of Black chairs and students., Conclusions: Black chairs are associated with higher percentages of Black students. Medical colleges may find that increasing the number of Black chairs increases the number of Black medical students.

Purpose: This study evaluates beliefs churchgoing Blacks hold about causes of hypertension and impact on adherence to non-pharmacologic treatment., Methods: We created a 17-question survey about participants' family history, medication use, behavioral modification, causes of hypertension, intake of fruit and vegetables, salt intake and physical activity. Data came from three predominantly Black churches in Florida. We conducted statistical analyses using Microsoft Excel 2010 and Stata Version 12., Results: Over 67% responded that physical activity was effective in lowering blood pressure, while greater than 53% responded that a diet high in fruits and vegetables was effective in lowering blood pressure. Over 78% responded that a low-salt diet is effective in lowering blood pressure. Respondents also felt that exercise (71%) and low-salt diet (72%) were as effective as medications in lowering blood pressure., Conclusions: Our sample believes non-pharmacological treatments are effective in lowering blood pressure, regardless of perceived cause.

Caring for underserved patients presents great challenges for community practices. This report discusses an interdisciplinary underserved practice that was reorganized in 2008 allowing for practice improvement and greater community presence. Current practice structure is discussed and a model provided that can enhance productivity, revenue, and community outreach.