- Join / Renew
- |
- STFM CONNECT
- |
- News
- |
- Careers
- |
- Contact
- |
- Foundation
- |
- My Account
- |
Inpatient Adult
Nina Piazza, MD (Lead); Victoria Udezi, MD MPH; Ana Tovar, PhD; Alexa Lindley, MD, MPH; Monica DeMasi, MD
- Medical Weathering
- Race-based Calculators in Nephrology
- Bias in Medical Documentation
- Inpatient Power Dynamics
- Inpatient Care of the Patient Who Is Incarcerated
- Cultural Humility in End-of-life Care
- Disability in the Hospital Setting
- Access to Critical Care
- Use of Race in Cardiology
- Cardiology and Women’s Health
- Race-based Calculators and Surgery
- Health Disparities in Cancer
- Planetary Health and Human Health
- Disparities in Pain Management
- Addressing Disparities in Emergency Mental Health Care
- Trauma-Informed Care
THEME: Medical Weathering
SUGGESTED ROTATIONS: Cardiology, Inpatient PGY1, PGY2, PGY3; ER; ICU; Outpatient Clinic PGY1, PGY2, PGY3
OBJECTIVE: Explain the concept of medical weathering.
Resources:
Listen:
-
- 'Weathering' makes the case that the stress of poverty and racism damage health (36-minute podcast or read the 1-page summary provided).
Application and Questions:
-
- Reflect on the concept of medical weathering.
- How might the healthcare system contribute?
- Does using the lens of weathering impact the way you might counsel your patients?
- Reflect on the concept of medical weathering.
THEME: Race-based Calculators in Nephrology
SUGGESTED ROTATIONS: Inpatient PGY1, PGY2, PGY3, Outpatient PGY1, PGY2, PGY3, ICU
OBJECTIVE: Explain the factors that go into GFR calculations and how that might impact the care of Black patients.
Resources:
Read:
Watch:
-
- The Problem With Race-based Medicine (14-minute video)
Applications and Questions:
-
- How might current GFR calculation methods adversely impact the care of Black patients?
- What might be a more accurate way to account for different body types in assessing renal function?
THEME:Bias in Medical Documentation
SUGGESTED ROTATIONS: Inpatient PGY1, PGY2, PGY3; Outpatient PGY1, PGY2, PGY3; ICU
OBJECTIVE: Increase awareness of bias in medical documentation and impact on care.
Resources:
Read:
Applications and Questions:
-
- Review 3 medical notes that you have written for patients that you feel are “challenging”:
- Do they include any language that may transmit bias?
- How might you change your wording in the future?
- Review 3 medical notes that you have written for patients that you feel are “challenging”:
THEME: Inpatient Power Dynamics
SUGGESTED ROTATIONS: Inpatient PGY1, PGY2, PGY3; ICU; ER
OBJECTIVE 1: Discuss the potential harm in labeling a discharge “Against Medical Advice”
Resources:
Read:
Applications and Questions:
-
- How can physicians avoid the AMA designation and promote shared decision making and harm reduction?
- Reflect on a patient that left AMA when you have been on the inpatient service. What factors might have contributed? In hindsight could the team have done anything to change that outcome?
OBJECTIVE 2: Define “Hostage bargaining syndrome” in the hospitalized patient and its negative impact on quality of care.
Resources:
Read:
-
- Hostage Bargaining Syndrome (12-minute read)
Applications and Questions:
-
- What leads some hospitalized patients to adopt behaviors associated with hostages?
- What could you do or say to empower patients and mitigate hostage bargaining behaviors?
THEME: Inpatient Care of the Patient Who Is Incarcerated
SUGGESTED ROTATIONS: Inpatient PGY1, PGY2, PGY3; ICU; ER
OBJECTIVES:
1A.Residents will list ways in which the inpatient care of the incarcerated patient can differ and potentially compromise care.
1B. Resident will examine their institution’s policies and guidelines and evaluate balance between patient rights and correctional system safety mandates.
Resources:
Read:
-
- How to Talk With Patients About Incarceration and Health (11-minute read)
- Incarcerated Patients and Equitability (7-minute read)
Applications and Questions:
-
- Identify 3 ways in which the inpatient care of the incarcerated patient can differ from usual care in areas such as right to privacy, visitation, use of restraints, etc.
- Look online or contact your institution’s Safety and Security Department for existing guidelines, policies and procedures on caring for incarcerated patients.
- What policy elements at your institution regarding the care of incarcerated persons could put them at risk of poorer health outcomes? How might this be remedied?
- Have you cared for an incarcerated patient in restraints in the hospital? How did you feel about it? Examine possible feelings of moral distress.
THEME: Cultural Humility in End-of-life Care
SUGGESTED ROTATIONS: Inpatient PGY1, PGY2, PGY3; Hospice; ICU
OBJECTIVE: Discuss cultural differences in attitudes and beliefs regarding advance directives and end-of life care and identify types of questions that can elicit information about patient preferences.
Resources:
Read:
-
- Cultural humility vs cultural competence (8-minute read)
- A Culturally Responsive Approach to Advance Care Planning: A REFLECTION (7-minute read)
- Applications and Questions:
- State a general question you could use to elicit cultural preferences with regard to advance directives or end of life care.
- How can you incorporate your patients' cultural beliefs into their advance care planning?
THEME: Disability in the Hospital Setting
SUGGESTED ROTATIONS: Inpatient PGY1, PGY2, PGY3; ICU; General Surgery
OBJECTIVE 1A: Residents will list three approaches to care which support the autonomy of patients with disability.
OBJECTIVE 1B: Residents will recognize the bias inherent in using disability as a criterion for care.
Resources:
Read:
-
- Three Things Clinicians Should Know About Disability (6-minute read)
- Personal reflection exercise: Brief Abled Privilege Checklist (12-minute read)
Listen:
- Applications and Questions:
-
- Whose decision should it be to withdraw life sustaining therapy for patients with disabilities?
- During your inpatient rotations, take note of the language used to describe patients with disabilities. Does it differ from that used to describe others?
THEME: Access to Critical Care
SUGGESTED ROTATIONS: Inpatient PGY1, PGY2, PGY3; ICU; General Surgery
OBJECTIVE: Describe the disparities in access to critical care services based on income, particularly in rural areas.
Resources:
Read:
-
- Focus on the Figures: Income Disparities in Access to Critical Care Services (8-minute read)
Application and Questions:
-
- Reflect on your patients' experiences of transfers to the ICU:
- If you work in an urban setting, how does your ICU team discuss patients who are transferred from outside hospitals?
- If you work in a rural hospital, what barriers exist when transferring patients to a higher level of care?
- Reflect on your patients' experiences of transfers to the ICU:
THEME: Use of Race in Cardiology
SUGGESTED ROTATIONS: Cardiology, Inpatient PGY1, PGY2, PGY3; ER; ICU; Outpatient Clinic PGY1, PGY2, PGY3
OBJECTIVE 1: Residents will critically analyze the use of race in the ASCVD calculator.
Resources:
Read:
Application and Questions:
-
- What are the pros and cons of using race in the ASCVD calculator?
- Would you adapt your approach to multiracial patients?
OBJECTIVE 2: Explain how the use of race to inform hypertension treatment recommendations rather than sociocultural, behavioral, and environmental factors can impact care and contribute to health inequities.
Resources:
Read:
-
- Background reading: Race-Based Prescribing for Black People With High Blood Pressure Shows No Benefit (9-minute read)
Application and Questions:
-
- Should your treatment targets or medication choices be different for Black patients?
- Do you need to avoid ACE-inhibitors in Black patients? What are the health equity implications of doing so?
THEME: Cardiology and Women’s Health
SUGGESTED ROTATIONS: Cardiology, Inpatient PGY1, PGY2, PGY3; ER; ICU; Outpatient Clinic PGY1, PGY2, PGY3
OBJECTIVE: Describe how a woman with an acute myocardial infarction (MI) might present differently than a man.
Resources:
Read:
-
- Cardiology’s Problem Women (3-minute read)
Application and Questions:
-
- What do you think of the title of this article? Are women the problem? What would be a better title?
- Please reflect on both the content and how articles with titles like this might reflect bias and possibly contribute to health inequities.
- What other groups may have “atypical” presentations for myocardial infarctions?
THEME: Race-based Calculators and Surgery
SUGGESTED ROTATIONS: General Surgery, Orthopedics, Sports Medicine
OBJECTIVE: List 3 contributors to racial disparities in access to and outcomes for elective surgeries.
Resources:
Apply:
-
- Society of Thoracic Surgeon Risk Calculator. Try calculating risk for different races, ethnicities, etc. (5-10 minute activity)
- Society of Thoracic Surgeon Risk Calculator. Try calculating risk for different races, ethnicities, etc. (5-10 minute activity)
Application and Questions:
-
- How might the inclusion of race in risk calculators affect who has access to elective cardiac surgeries?
THEME: Health Disparities in Cancer
SUGGESTED ROTATIONS: General surgery; Inpatient Medicine PGY1, PGY2, PGY3; Outpatient Clinic PGY1, PGY2, PGY3
OBJECTIVES
1A: Resident will explain the complex factors that contribute to racial inequities in cancer outcomes.
1B: Resident will describe LGBTQIA+ cancer disparities.
Resources:
Read:
-
- The State of Cancer Disparities in the United States Simple brief overview (5-minute read)
- AACR Cancer Disparities Progress Report Deeper dive on cancer disparities (45-minute read)
- When More People Qualify for Medicaid, More Survive Cancer (5-minute read)
- Editorial:Cancer prevention, treatment and survivorship in the LGBTQIA community (xx-minute read)
Watch:
-
- Cancer Disparities American Cancer Society Research Highlights (4-minute video)
Application and Questions:
-
- What can you do to improve cancer outcome equity in your own patient panel?
- Provide an example of how quality improvement (QI) work can improve overall cancer outcomes, but simultaneously increase inequity? How might your QI efforts focus on minoritized groups?
- If you were advocating to your senator, what might you ask for that would improve cancer equity?
OBJECTIVE 2: Resident will explain the complex factors that contribute to inequity in cancer outcomes.
THEME: Planetary Health and Human Health
SUGGESTED ROTATIONS: Adult ER; Urgent care; Community Medicine; Outpatient clinic PGY1, PGY2, PGY3, Inpatient Pediatrics; Peds ER
OBJECTIVE:
1A. Identify health risks from climate change and toxic exposures in your region and ways they might impact certain communities/special populations. i.e Southwest heat risks, Pacific Northwest wildfire risks, pollution, agriculture/ farm worker impact, labor trafficking etc..
1B. List ways to identify, treat, and counsel patients that are at high risk for negative health impact due to extreme weather events in your community. For example, supporting patients with lung disease in wildfire smoke, or thinking of plans for farm workers on high heat days, etc.
1C. Residents will access the environmental health data from their communities and analyze it with an equity lens.
Resources:
Explore:
-
- Guide for health departments about the impact of climate change on health and how to prepare. It mentions at-risk groups and strategies to prevent emergencies. Skim through and pick topics most relevant to your region. (10-15 minute activity)
- Environmental Justice Screen Mapper. Allows you to see mapped out data for your region. You can see lead, air quality issues, health disparities, climate change data and more (5-minute activity)
Application and Questions:
Focus: impact of climate change on health equity
-
- Think of a patient you have cared for who is at an increased risk of climate-related health risks.
- What are patient factors (diagnoses, demographic factors) that increase their risk?
- What are ways that their health risks could be mitigated?
- Look at the Environmental Justice Screen tool for your community. Think about how it might impact your patient counseling. What are the major environmental health hazards for your area? Do you notice differences in exposures for more or less affluent communities in your region?
- Think of a patient you have cared for who is at an increased risk of climate-related health risks.
THEME: Disparities in Pain Management
SUGGESTED ROTATIONS: Adult ER; General Surgery; ICU; Inpatient PGY1, PGY2, PGY3
OBJECTIVE: Identify racial/ethnic disparities in emergency/acute pain control.
Resources:
Read:
-
- Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between blacks and whites (14-minute read)
- How doctors' racial biases can harm black patients (3-minute read)
- A Thousand Cuts: Racial and Ethnic Disparities in Emergency Medicine (4-minute read)
Application and Questions:
-
- Summarize the evidence that implicit bias is one of the causes of racial disparities in the treatment of pain.
- What are some systemic or structural ways that providers and healthcare systems can prevent individual biases from impacting patients with acute pain?
THEME: Addressing Disparities in Emergency Mental Health Care
SUGGESTED ROTATIONS: Inpatient Psychiatry; Behavioral Medicine; Community Medicine; ER; Behavioral Medicine
OBJECTIVE 1: Identify disparities in emergency mental health care
Resources:
Read:
Application and Questions:
-
- If you were designing an equitable system to respond to people in mental health crisis, what would you propose?
- Describe biases you observed in mental health crises.
- What steps might you take to avoid bias in interactions with patients experiencing a mental health crisis?
OBJECTIVE 2: List three downsides to police-based emergency responses to mental health crises and consider some alternatives.
Resources:
Read:
-
- Alternative strategies for mental health crisis responses: Join the campaign! – Portland Street Response (3-minute read)
Listen:
-
- Discussion of police response to mental health crises: Why Are Police the Wrong Response to Mental Health Crises? (30-minute listen)
OBJECTIVE 3: Role play or model de-escalation techniques for agitated patients.
Resources:
Read:
Application and Questions
-
- Reflect on a time security was called for a patient with mental illness. What went well and what didn’t? How could de-escalation techniques be employed effectively in this situation?
THEME: Trauma-Informed Care
SUGGESTED ROTATIONS: Inpatient Psychiatry; ER; Orientation; Community Medicine
OBJECTIVE:
- Describe approaches/skills to appropriately care for people exposed to multiple forms of trauma utilizing trauma-informed care (TIC).
Resources:
Read:
Watch
-
- A guide for practicing trauma-informed care for patients with chronic pelvic pain Practical tips and examples on how to do trauma-informed visits and physical exams. This resources has a chronic GYN pain focus, but is widely applicable. (7-minute video)
Application and Questions:
-
- Reflect on an interaction that you’ve had with a patient who had experienced trauma that could have gone better. How could you use TIC to improve your communication with them?
-
- What are one to two changes you might make in your approach to a trauma-informed pelvic exam after watching the video?
Events
May 3–7, 2025: STFM Annual Spring Conference
May 5, 2025, 7:30–11 pm: STFM Foundation MediPalooza Fundraiser
May 30, 2025, 12 pm CDT/1 pm EDT: Webinar: Ethical Use of AI in the Family Medicine Clinic
September 8–10, 2025: The 2025 STFM Conference on Practice & Quality Improvement
Due Dates
April 1, 2025: Early Bird Deadline for STFM Annual Spring Conference Registration
April 11, 2025: Applications to Serve as STFM Representative to World Organization of Family Doctors (WONCA) Due
April 22, 2025: Deadline to Submit Questions for a CERA Family Medicine Department Chair Survey
May 5, 2025: Deadline for Online Bids in STFM Foundation MediPalooza Auction
May 16, 2025: STFM Foundation Student Scholar Nominations Due
May 23, 2025: Applications to Serve on the STFM Conference on Practice & Quality Improvement Steering Committee Due