"Intersections of Social Systems, Race, and Health in America: A Historical Perspective": A Novel Elective for Medical Students to Increase Antiracism Advocacy

PROBLEM

There are growing calls for medical education to effectively teach about and explicitly name racism as a driver of inequities in social determinants of health and inspire student action to address health inequities.

APPROACH

Using a novel application of the generative co-design approach, in 2020 Perelman School of Medicine students and faculty implemented a student-led, interdisciplinary elective course for preclerkship medical students. The co-design process allowed for an iterative and conversation-based experience emphasizing how social systems and racist policies shape health care access and outcomes. Active student participation was integral to developing discussion questions to elicit how students' positions in power structures can uphold inequities. Community members and nonprofit leaders taught about the current realities of discrimination and how students could best advocate for patients in the future. Enrolled students (n = 17) and a control group of nonenrolled classmates (n = 37) completed the Anti-Racism Behavioral Inventory (ARBI) pre- and post-course to compare changes in antiracist behaviors.

OUTCOMES

Course participants demonstrated a significant increase in ARBI scores (mean = 4.29 (7.30); t(16) = 2.42; P = .01), while students from the control group did not (mean = 1.43 (6.98); t(36) = 1.25; P = .11). The "individual advocacy" subdomain of the ARBI largely drove the change in ARBI scores, suggestive of increased antiracism behavior in the enrolled cohort. Students provided feedback offering praise for course elements and suggestions for improvement.

NEXT STEPS

Early findings suggest that this course, created with a co-design approach, generated new experiences for medical students, increased their understanding of systemic racism, and increased individual antiracist advocacy. Future work, with larger class sizes and longitudinal measurement of behavior change, should further investigate the transformative effects of applying co-design strategies to medical education courses about race and health.

May-Thurner Syndrome: An Anatomic Predisposition to Deep Vein Thrombosis

May-Thurner syndrome (MTS) is a rare clinical condition caused by extrinsic compression of the left common iliac vein by the right common iliac artery, leading to venous stasis and predisposing to thrombus formation. Here, we present the case of a 39-year-old female with no obviously known other risk factors predisposing to thrombosis who presented with severe left leg pain and swelling for a week. The international normalized ratio was elevated and the venous Doppler study showed extensive thrombosis extending from the left common iliac vein to the common femoral vein and the popliteal vein. She was diagnosed with MTS and treated with catheter-directed mechanical thrombolysis and thrombectomy, along with angioplasty of the left common iliac vein and external iliac vein, with near-complete resolution post-treatment. MTS should be suspected in patients who present with unilateral limb thrombosis regardless of the presence of predisposing factors. Timely management with endovascular procedures is necessary to help prevent other potential life-threatening complications.

Enamel ultrastructure in pigmented hypomaturation amelogenesis imperfecta

Hypomaturation amelogenesis imperfecta (AI) is a hereditary condition of enamel that is presumed to result from defects during the maturation stage of enamel development. This study characterized the enamel ultrastructure and enamel crystallite morphology, as well as the distribution of organic material in enamel affected with pigmented hypomaturation AI. Enamel exhibiting autosomal recessive pigmented hypomaturation AI was sectioned or fractured and examined using light microscopy, scanning electron microscopy and transmission electron microscopy. Enamel samples were treated with 30% NaOCl or 8 M urea to remove organic components and determine the effect of deproteinization on crystallite morphology. These were compared with untreated normal enamel samples. The enamel crystallites in hypomaturation AI exhibited considerable variability in size and morphology. Examination of deproteinized tissue indicated that the AI crystallites had a thick coating, presumably of organic or partially mineralized material, which was not visible in normal enamel. The results of this investigation provide further evidence that hypomaturation AI is associated with the retention of organic material that is most probably enamel protein. Enamel protein retention is likely to be involved in the inhibition of normal crystallite growth resulting in the morphological crystallite abnormalities associated with this disorder.

Anthelmintic efficiency of oxfendazole, fenbendazole and levamisole against naturally acquired infections of Ostertagia ostertagi and Trichostrongylus axei in cattle

The anthelmintic efficiencies of oxfendazole, fenbendazole and levamisole, each at 4 dose rates spanning the manufacturers' recommended dosages were compared in beef cattle with naturally acquired infections of Ostertagia ostertagi and Trichostrongylus axei. In 8 of the 9 cases tested there was no significant increase in anthelmintic efficiency due to increased dose rates of any of the drugs. Percentage efficiencies and their standard errors, calculated from mean worm counts of pooled data for adult worms, developing 4th stage and early 4th stage larvae of O. ostertagi, were respectively, 86.9+/-4.2, 77.4+/-6.1, 74.5+/-7.3 for oxfendazole, 93.7+/-2.0. 80.7+/-6.8, 59.6+/-13.9 for fenbendazole and 69.7+/-6.9, 39.4+/-14.8, 31.2+/-22.6 for levamisole. Counts of O. ostertagi from cattle treated with oxfendazole and fenbendazole were not significantly different, but both were significantly lower than those from cattle given levamisole. Efficiency against T. axei exceeded 99% for all drugs. Practical implications for therapy and preventative control of ostertagiasis are discussed.