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Medical students, residents, and faculty have begun to examine and grapple with the legacy and persistence of structural racism in academic medicine in the United States. Until recently, the discourse and solutions have largely focused on augmenting diversity across the medical education continuum through increased numbers of learners from groups underrepresented in medicine (UIM). Despite deliberate measures implemented by medical schools, residency programs, academic institutions, and national organizations, meaningful growth in diversity has not been attained. To the contrary, the UIM representation among medical trainees has declined or remained below the representation in the general population. Inequities continue to be observed in multiple domains of medical education, including grading, admission to honor societies, and extracurricular obligations. These inequities, alongside learners’ experiences and calls for action, led the authors to conclude that augmenting diversity is necessary but insufficient to achieve equity in the learning environment. In this article, the authors advance a 4-step framework, built on established principles and practices of antiracism, to dismantle structural racism in medical education. They ground each step of the framework in the concepts and skills familiar to medical educators. By drawing parallels with clinical reasoning, medical error, continuous quality improvement, the growth mindset, and adaptive expertise, the authors show how learners, faculty, and academic leaders can implement the framework’s 4 steps—see, name, understand, and act—to shift the paradigm from a goal of diversity to a stance of antiracism in medical education.

Health systems worldwide are increasingly unable to meet individual and population health needs. The shortage of healthcare workers in rural and other underserved communities is compounded by inadequate primary care infrastructure and maldistribution of services. At the same time, the medical education system has not changed to address the growing mismatch between population health needs and care delivery capacity. Internationally, leaders are calling for change to address these challenges. Substantive changes are needed in medical education's stance, structure, and curricula. Educational continuity and symbiosis are two guiding principles at the center of current clinical educational redesign discourse. These principles rely on empirically-derived science to guide educational structure and improve outcomes. Educational continuity and symbiosis may improve student learning and support population health through workforce transformation. Longitudinal integrated clerkships (LICs), growing out of workforce imperatives in the 1970s, have demonstrated sustainable educational and workforce outcomes. Alongside the success of LICs, more innovation and more reaching innovation are needed. We propose restructuring clinical medical education specifically to address workforce needs and develop science-minded (rigorous, inquisitive, and innovative) and service-minded (humanistic, community-engaged, and socially accountable) graduates.

Failure to thrive (FTT) in children is an important pediatric problem. Environmental and behavioral causes predominate, and detrimental effects on neurocognitive development are well documented. Multidisciplinary clinics designed to identify and treat FTT are effective but have not been widely adopted. A retrospective chart review was conducted of all patients with FTT seen at the authors' large inner-city children's hospital over a 40-month period, including those referred to a new multidisciplinary clinic. Over 40 months, only 75 children were referred and only 20 had moderate or severe FTT (z-score <-2.0). Nutritional status improved with treatment, but the small number of referrals who were severely affected led to the closing of the clinic. Recommendations for evaluating and treating children with mild FTT in primary care settings and a standardized definition of FTT that warrants more intensive treatment would help ensure that children were referred and treated appropriately.

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PurposeThe authors describe the implementation of the novel Longitudinal Clinical Experiences with Patients (LCEP) curriculum, designed to integrate continuity and longitudinal patient relationships into a traditional block clerkship (BC), and present a mixedmethods analysis evaluating program effectiveness to assess its feasibility, value, and impact.

Background Inguinal hernia repair is still being studied today because it is one of the most commonly performed surgical procedures in the world and is used in people of all ages. Although many centers use spinal anesthetic to treat inguinal hernias, complications such as hypotension from peripheral vasodilation, delayed mobilization from paralysis, urine retention and post‐spinal headache might occur. Regional blocks are a significant component of multimodal anaesthesia that promotes postoperative recovery. Transversus abdominis plane (TAP) block is a regional anesthetic block technique that is effective on the parietal peritoneum, skin, and anterior abdominal wall. Methods This study aimed to show that TAP block administration may be done safely without the use of an extra anesthetic treatment, especially in older patients who may experience complications from general or spinal anesthesia. Without either general, spinal or epidural anesthetic, we conducted a tension‐free — Lichtenstein — inguinal hernia repair operation with only TAP block application. This retrospective case‐control study received ethics committee approval (decision number 21‐5T/108). Between September and December 2019, patients who underwent elective Lichtenstein hernia repair in our clinic were evaluated retrospectively. Results We think that inguinal hernia repair can be safely performed with only TAP block and that TAP block application has fewer anaesthesia‐related complications such as postspinal headache and urinary retention compared with spinal anaesthesia, and that it can be used as an alternative to spinal anaesthesia in patients who cannot tolerate general anaesthesia. Conclusion Even hernia surgery can be very challenging in patients with advanced age and comorbidities. We wanted to show the feasibility of the TAP block method as an alternative to anaesthesia in such patients.

Background: Participation in scholarship is a requirement for Internal Medicine (IM) residencies, but programs struggle to successfully integrate research into busy clinical schedules. In 2013, the IM residency at Brigham and Women's Hospital implemented the Housestaff Research Project (HRP)-a novel residency-wide research initiative designed to facilitate participation in scholarship. The HRP had two components-a formal research curriculum and an infrastructure that provided funding and mentorship for resident-led, housestaff wide projects. Methods: This is a mixed-methods study of 190 IM residents and two HRP-supported research projects. Seventy-seven residents responded to an electronic survey about their interests in research exposure in residency. Fifty-six residents responded to an electronic survey about their participation in the HRP. The success of HRP-supported projects was evaluated through resident comments, interviews with three residents leading the first two HRPs and a description of the success of the projects based on resident involvement and dissemination of the results. Results: Eighty-seven percent (n= 67/77) of residents were interested in additional research exposure during residency. Ninety-five percent (n = 53/56) of residents had heard of the HRP, and 77% had participate in at least one aspect of it. Approximately 20 residents were directly involved in the two resident-led projects. HRP-supported projects resulted in presentations at three local and three national conferences, one manuscript in press, and one manuscript in preparation. The resident project leaders felt that a strength and unique aspect of the HRP was the collaboration with co-residents. Conclusion: The HRP successfully created a culture of research and scholarship within the residency. The HRP leaders and residents that participated in HRP-supported projects expressed the most direct benefits from the program. All residents were exposed to research concepts and methods. Future directions for the HRP include selecting projects that maximize the number of resident participants and integrating a more robust research curriculum.