Health Justice Standards in Graduate Medical Education: Moving from Performative to Concrete Change.

BACKGROUND: Inadequate support for underrepresented-in-medicine physicians, lack of physician knowledge about structural drivers of health, and biased patient care and research widen US health disparities. Despite stating the importance of health equity and diversity, national physician education organizations have not yet prioritized these goals. AIM: To develop a comprehensive set of Health Justice Standards within our residency program to address structural drivers of inequity. SETTING: The J. Willis Hurst Internal Medicine Residency Program of Emory University is an academic internal medicine residency program located in Atlanta, Georgia. PARTICIPANTS: This initiative was led by the resident-founded Churchwell Diversity and Inclusion Collective, modified by Emory IM leadership, and presented to Emory IM residents. PROGRAM DESCRIPTION: We used an iterative process to develop and implement these Standards and shared our progress with our coresidents to evaluate impact. PROGRAM EVALUATION: In the year since their development, we have made demonstrable progress in each domain. Presentation of our work significantly correlated with increased resident interest in advocacy (p<0.001). DISCUSSION: A visionary, actionable health justice framework can be used to generate changes in residency programs' policies and should be developed on a national level.

When in Doubt, Cut It Out: Biopsy as Key in Diagnosing Cryptococcal Soft Tissue Infection.

Soft tissue infection is an uncommon presentation of Cryptococcus in the absence of immunosuppression. Most infected patients present with pneumonia or meningitis, often with signs of disseminated disease, which may be fatal. We present a case of an 81-year-old mildly immunocompromised woman with multiple comorbidities, who presented with an extensive soft tissue infection on her right medial thigh. Superficial skin culture grew vancomycin-resistant Enterococcus; however, both initial and subsequent antibacterial therapies failed to resolve the infection. Subsequent biopsy revealed abundant yeasts, and mucicarmine staining confirmed Cryptococcus infection in a patient with no evidence of disseminated disease. Wound debridement and fluconazole for six months resulted in complete resolution of the lesion. In this report, we emphasize the need for tissue biopsy and microbial cultures in diagnosing patients with atypical skin and soft tissue infections who do not respond to appropriate antibiotics.

Gender Identity, Hormone Therapy, and Cardiovascular Disease Risk.

Transgender individuals represent a medically underserved and under researched population. There is a growing number of studies illustrating the importance of hormone therapy treatments in transgender men and women to assist ameliorating gender dysphoria and promoting well-being. However, the cardiovascular effects of these hormones are controversial. Large longitudinal epidemiological studies of cardiovascular event outcomes in these populations do not exist. In addition, studies of cardiovascular complications of transgender hormone therapy are limited in number and complicated by poor control of medication regimen, presence of gender confirming surgery, use of prescribed medications for prevailing conditions, and alcohol, smoking or illicit substance use, and comorbidities, such as HIV infection. The following provides an overview of current guidelines for hormone therapy regimens used by transgender individuals, as well as what is known about the use of exogenous hormones on the cardiovascular system and cardiovascular disease risk. Several gaps in our understanding of the cardiovascular effects of endogenous and exogenous hormones in treated transgender individuals are identified, which provide direction for future study.