Acting Wisely: Eliminating Negative Bias in Medical Education-Part 1: The Fundamentals.

Bias is a ubiquitous problem in human functioning. It has plagued medical decision making, making physicians prone to errors of perception and judgment. Racial, gender, ethnic, and religious negative biases infest physicians' perception and cognition, causing errors of judgment and behavior that are damaging. In Part 1 of this series of 2 papers, the authors address the problem of harmful bias, the science of cognition, and what is known about how bias functions in human perception and information processing. They lay the groundwork for an approach to reducing negative bias through awareness, reflection, and bias mitigation, an approach in which negative biases can be transformed-by education, experience, practice, and relationships-into positive biases toward one another. The authors propose wisdom as a conceptual framework for imagining a different way of educating medical students. They discuss fundamental cognitive, affective, and reflective components of wisdom-based education. They also review the skills of awareness, using debiasing strategies, compassion, fostering positive emotion, and reflection that are inherent to a wisdom-based approach to eliminating the negative effects of bias in medical education. In Part 2, the authors answer a key question: How can medical educators do better? They describe the interpersonal, structural, and cultural elements supportive of a wisdom-based learning environment, a culture of respect and inclusion in medical education.

Acting Wisely: Eliminating Negative Bias in Medical Education-Part 2: How Can We Do Better?

In Part 1 of this 2-article series, the authors reviewed the problem of unmitigated bias in medical education and proposed a wisdom-based framework for a different way of educating medical students. In this article, Part 2, the authors answer a key question: How can medical educators do better? Is a bias-free environment possible? The answer to the latter question likely is "no." In fact, having a zero-bias goal in mind may blind educators and students to the implicit biases that affect physicians' decisions and actions. Biases appear to be a part of how the human brain works. This article explores ways to neutralize their destructive effects by: (1) increasing awareness of personal biases; (2) using mitigation strategies to protect against the undesirable effects of those biases; (3) working to change some negative biases, particularly learned biases; and (4) fostering positive biases toward others. The authors describe the concrete actions-interpersonal, structural, and cultural actions-that can be taken to reduce negative bias and its destructive effects.

Case Report: Lower Gastrointestinal Bleeding due to Entamoeba histolytica Detected Early by Multiplex PCR: Case Report and Review of the Laboratory Diagnosis of Amebiasis.

We report a case of Entamoeba histolytica infection in a young man who presented with cerebral infarction and shortly after admission developed bloody diarrhea with fever. A rapid diagnosis of severe E. histolytica colitis was established through the use of a multiplex polymerase chain reaction enteropathogen stool panel. This result was unexpected in a patient native to the United States without known risk factors for amebiasis and negative stool microscopy examination for ova and parasites. Rapid diagnosis allowed prompt initiation of appropriate anti-amebic therapy and ultimately a good outcome in a condition that otherwise carries high morbidity and fatality.

Management of a Mycobacterium immunogenum infection of a peritoneal dialysis catheter site.

Mycobacterium immunogenum is a member of the rapidly growing non-tuberculous mycobacteria and is a relatively new species identified within this group. An 81-year-old immune-competent male was diagnosed with M. immunogenum infection of his peritoneal dialysis catheter exit site and surrounding soft tissue. To our knowledge, this is the first reported case of M. immunogenum infection of a peritoneal catheter. Treatment included catheter removal, local surgical debridement, and combination antimicrobial therapy. Herein, we review literature describing antibiotic management of M. immunogenum, an organism for which optimal therapy is not defined.

Inhibition of HIV-1 infectivity through an innate mechanism involving naturally occurring IgM anti-leukocyte autoantibodies.

In prior studies, we show that naturally occurring IgM anti-leukocyte autoantibodies (IgM-ALA) bind to CD3, CD4, CCR5, and CXCR4 receptors. These observations prompted us to determine whether IgM-ALA have a role in inhibiting HIV-1 infectivity by inhibiting viral entry into cells. We show that purified IgM, but not IgG, from individual sera of both normal and HIV-1 infected individuals is highly inhibitory (>95%) to HIV-1 viral infectivity both in vitro using PHA plus IL-2 activated PBL and in vivo using the human PBL-SCID mouse. Inhibition was observed with physiological doses of purified serum IgM and even after IgM was added 3 days postinfection in the in vitro assays. Absorbing purified serum IgM either with leukocytes or immobilized recombinant CD4 significantly decreased (>80%) the inhibitory effect on HIV-1 infectivity. IgM inhibited by >90% syncytia formation with the X4-IIIB infected SupT-1 cells indicating therefore that IgM inhibits viral attachment to core-receptors. IgM mediated anti-HIV-1 activity was highly specific as only certain IgM-ALA, obtained from human B cell clones inhibited HIV-1. IgM from certain HIV-1 infected individuals were not inhibitory to some R5-HIV-1 viral strains indicating that certain HIV-IgM may lack Abs reactive to strain specific coreceptor epitopes. These data indicate that an innate immune mechanism which is present from birth i.e., IgM-ALA, has a role in inhibiting HIV-1 viral entry into cells. Validation of this data with other in vivo models will be needed to determine whether in vivo administration or enhancement of IgM-ALA, e.g., through a vaccine, could prolong the asymptomatic state in HIV-1 infected individuals.