Kirsten R. Brown

Clinically significant adverse events (CSAEs) are harmful or unexpected patient outcomes related to a medical intervention or management (Skelly, 2023). CSAEs may include medical errors, adverse ou...

Purpose: International medical graduates (IMGs) have long sustained the US healthcare system. In the US, 25% of practicing physicians are IMGs, who are pivotal for delivering primary and preventive care and for tending to first-generation immigrants. Despite their contributions, studies primarily have focused on individual challenges and difficulties of IMGs. In contrast, structural barriers-and their impact on IMGs' private lives and emotional wellbeing-are rarely discussed. Using the example of Asian IMGs in the US, we explored structural barriers that complicate everyday thriving, including family wellbeing, work conditions, and emotional life. Method: We conducted a constructivist, qualitative interview study with 20 IMG physicians (60% female) in 2023. We purposefully sampled across multiple specialties, clinical settings, and geographic areas. The average time serving as an attending was 11.8 years. We recorded and transcribed semi-structured interviews, which lasted 45-60 minutes. With attention to IMGs' positionality, we applied reflexive thematic analysis and Burgess-Proctor's strategies for engaging with and empowering participants. We also drew on Ahmed's theory of the politics of emotions to inform our interpretation. Results: IMGs described interconnected structural barriers rooted in the US visa system, including financial hardship, prolonged family separation, and sponsorship-dependent career precarity. Beyond these constraints, participants also encountered institutional selection bias and professional gatekeeping, including an invisible ceiling, tokenization, and limited recognition of IMG status within broader diversity discourse. While expressing gratitude for US career opportunities, participants reported a significant emotional toll characterized by guilt and shame tied to outsider positioning and pressures to justify their legitimacy in US training. Discussion: Structural barriers have a profound impact on IMGs' relational and emotional lives. What might appear as a personal hardship-such as family separation-is in fact a consequence of structurally imposed constraints. Participants pointed to concrete areas where institutional practices could change, including formalized mentorship structures, stronger institutional accountability, more explicit inclusion practices, and policy advocacy. Addressing these inequities will require institutional engagement, with implications for sustaining the US physician workforce.

Introduction: Journal editors-in-chief (EICs) play a central role in shaping scholarly publishing, yet little is known about how they understand and enact their roles. We explored how medical education journal EICs describe their roles in shaping the publication process. Methods: We conducted a qualitative study using thematic analysis of interviews with nine medical education journal EICs. The interviews were part of a broader investigation of publication timelines and explored editorial leadership and practices, including experiences during the COVID-19 pandemic. Participants’ accounts also provided insight into the broader work of leading a journal, which became the focus of the present analysis. Results: Participants described their work not as a set of discrete tasks, but as five interrelated roles: knowledge developer, proactive communicator, steward of time and energy, nurturer, and orchestrator. These roles were enacted simultaneously and often in tension, reflecting the need to balance scholarly rigor, relational commitments, and system constraints. EICs described actively shaping knowledge, orchestrating complex communication networks, safeguarding finite reviewer and editorial resources, supporting authors and editorial teams, and maintaining workflow continuity. Much of this work was characterized as invisible labor occurring behind the scenes and not captured in formal metrics. Participants also highlighted a structural tension between nurturing authors and stewarding limited resources, underscoring the challenges of sustaining both inclusivity and efficiency within a resource-constrained system. Discussion: This study offers a practice-informed framework for understanding EIC work as relational, strategic, and system-oriented. By making visible the often-invisible labor that underpins academic publishing, our findings challenge reductive conceptions of editorial work and highlight the need for training, support, and systemic changes to better align expectations for rigor, inclusivity, and sustainability.

Purpose: Students with disabilities remain disproportionately underrepresented in undergraduate medical education (UME). This scoping review synthesizes the literature on undergraduate medical students with disabilities in the United States to identify the purpose of the literature and map how disability is portrayed. Method: The authors searched 8 databases for relevant publications published between January 2008 through August 2024. Publication inclusion was determined using a 2-phase title/abstract screening process and full-text review conducted by 2 independent authors. Data extraction focused on characterizing the publication, followed by an analysis of the publications’ goals and how disability was portrayed. Results: The authors identified 10,491 publications; 81 were included, most of which were journal articles ( n = 78). In 23 publications, at least one author disclosed their identity as disabled. Five main goals were identified in the publication purpose statements, including describing ( n = 50), calling for action ( n = 25), evaluating ( n = 24), arguing ( n = 14), and creating ( n = 14). Overall, disability was portrayed as (1) diversity, (2) deficiency, (3) inherently connected with accommodation and technical standards, and (4) a place of habitual omissions. Two studies discussed disability in relation to intersectional identities, and 2 used gender or race in multivariable models. No studies explicitly focused on UME and disabled students of color, disability and gender diversity, or disabled LGBQ+ students. Conclusions: This scoping review identified that disability is portrayed from an abled viewpoint as race- and gender-neutral, static, and as diversity, deficit, or a legal construct. Future researchers should consider how disability is conceptualized and the use of intersectional frameworks.

A bstract: Objectives: Diagnostic and management reasoning of neurological disorders may present unique challenges and uncertainty for clinicians, particularly in emergency department settings. This study aims to assess the level of uncertainty emergency department physicians experience when diagnosing neurological versus non-neurological conditions, and whether this uncertainty extends to the management of neurological conditions. Additionally, the study explores whether clinical experience is related to perceived diagnostic and/or management uncertainty. Methods: Fifty-three emergency department physicians completed a survey measuring diagnostic uncertainty, management uncertainty, and associated anxiety. The survey included clinical vignettes depicting neurological and non-neurological cases, as well as items which assessed perceived diagnostic and management uncertainty across eight different specialties. Statistical analyses included paired samples t-test for comparing uncertainty between neurology and non-neurology cases and a general linear model to assess relationship between clinical experience and uncertainty. Results: Emergency department physicians reported greater diagnostic uncertainty for neurological vignettes compared to non-neurological vignettes (Cohen’s d=1.37), as well as greater management uncertainty (Cohen’s d=1.41). They also reported greater anxiety when diagnosing neurological cases compared to non-neurological cases (Cohen’s d=1.33), as well as greater anxiety when managing them (Cohen’s d=0.69). Exploratory analyses indicated that with greater experience, management uncertainty of neurology cases decreased, while diagnostic uncertainty remained unchanged. Conclusions: The results suggest unique diagnostic and management challenges posed by neurological cases in emergency departments, particularly for less experienced providers. Future research could focus on developing interventions to reduce diagnostic and management uncertainty in neurological conditions.

Introduction: In medical education, assessments have high-stakes implications. Yet, assessments are rife with unconscious bias, which contributes to inequitable social structures. Implicit bias in assessment must be addressed because medical educators use assessments to guide learning and promote development of physicians’ careers. In this scoping review, the authors map the literature on implicit bias in assessment, as it applies to: 1) the types of implicit bias addressed, 2) the targets and types of interventions studied or proposed, and 3) how publications describe intervention efficacy. Methods: The authors conducted a scoping review of the literature on interventions to mitigate implicit bias that was published between January 2010 and August 2023. Author pairs independently screened articles for inclusion and extracted data. Discrepancies were resolved with discussion and consensus. Qualitative and quantitative analysis was informed by Anderson et al’s three assessment orientations: fairness, assessment for inclusion (AfI), and justice. Results: 7,831 articles were identified; 54 articles were included. The majority (n = 37; 69%) of articles focus on implicit bias toward those underrepresented in medicine. Interventions to mitigate implicit bias were targeted toward admissions and applications, faculty training, recruitment, summative assessments, and evaluation templates. Interventions had fairness (n = 43; 96%) and AfI (n = 22; 49%) orientations; no articles used a justice-orientation. For the sub-set of research studies (n = 40), almost all (n = 34; 85%) examined a single program/institution. Discussion: This scoping review showed that more work is necessary to address different types of implicit biases, move scholarship beyond single-institution studies, refine existing interventions, and evaluate how efficacy is defined.

Introduction: In medical education, acts of professional resistance have been studied across all racial and ethnic groups as an antidote to the social harm and injustice festering in medical education. However, not everyone experiences medical education in the same way; some groups experience it quite differently because of their social positions. In particular, Black physicians face anti-Black racism in medical education, which has the potential to shape their resistance in a particular way. This study was designed to understand what professional resistance looks like in Black residents/fellows in North America and how being Black shaped their experiences of resistance. Methods: This qualitative study used Endarkened storywork to understand how Black GME physicians experienced acts of resistance. Endarkened storywork is a Black-centered approach to research and a way of reclaiming authority to create knowledge. It weaves Endarkened feminism, Afrofuturism, and Indigenous storywork to center storytelling as essential to Black ways of being. We conducted 14 semi-structured interviews and analyzed the data using thematic, theoretical, and emergent coding through the constructs of Re-storying, Endarkened Storywork, and Black quilting. Results: Black trainees’ stories of resistance produced three quilting blocks to illuminate their experiences. First, resistance means continuing to exist in medicine despite all of the profession’s efforts to eradicate Black physicians. Second, they work tirelessly to improve Black health and facilitate opportunities for the future of Black people to have a career in medicine. Third, their resistance must contend with a long history of anti-Black racism, which takes a significant toll on the emotional and mental well-being of Black trainees in ways that are best described as racial battle fatigue. Discussion: For Black trainees, professional resistance is nuanced and calls into the present a long history of anti-Black racism. Their resistance includes occupying space in medicine, securing a future where Black people exist as physicians, and resisting the emotional burden of doing this work. While all forms of professional resistance are worthy of study, researchers should pay particular attention to how it manifests in various racial groups to understand the nuances of different strategies.