Marginalized individuals in medicine face many structural inequities which can have enduring consequences on their progress. Therefore, inequity must be addressed by dismantling underlying unjust policies, environments, and curricula. However, once these injustices have been taken apart, how do we build more just systems from the rubble? Many current strategies to address this question have foundational values of urgency, solutionism, and top-down leadership. This paper explores a counternarrative: Design Justice. As a set of guiding principles, Design Justice centers the experiences and perspectives of marginalized individuals and communities. These principles include mutual accountability and transparency, co-ownership, and community-led outcomes, and honoring local, traditional, Indigenous knowledge. Rooted in critical scholarship and critical design, Design Justice recognizes the interconnectedness of various forms of marginalization and works to critically examine power dynamics that exist in every design process. These co-created principles act as practical guardrails, directing progress toward justice. This paper begins with an overview of Design Justice's history in critical scholarship and critical design, providing foundational background knowledge for medical educators, scholars, and leaders in key concepts of justice and design. We explore how the Design Justice principles were developed and have been applied across sectors, highlighting its applications, including education applications. Finally, we raise critical questions about medical education prompted by Design Justice.

Importance: Behavioral flags in the electronic health record (EHR) may introduce bias and perpetuate structural racism and discrimination. Descriptions of differences in the way that markers of behavioral risk are communicated will help clarify the inequities that pediatric patients and their families experience in the hospital.Objective: To assess whether racially and socioeconomically marginalized pediatric patients and families are more likely than their counterparts to be assigned a behavioral flag in their EHR.Design, Setting, and Participants: This retrospective cohort study used EHR data for pediatric patients (aged <18 years) hospitalized from June 2012 to July 2021 across care settings at the University of California, San Francisco health care facilities, an academic quaternary care hospital system that includes 2 pediatric inpatient facilities. The analysis was completed from December 29, 2022, to November 22, 2024.Main Outcome and Measures: The primary outcome of interest was any of the following behavioral flags placed in a patient’s EHR: witnessed substance abuse, history of inappropriate behavior, security, violent behavior, dismissal from practice, and child protective services (CPS) hold. The primary variables were patients’ race, ethnicity, insurance status, and primary language.Results: Of 55 865 pediatric encounters (52.2% among males; median patient age at the first encounter, 3 years [IQR, 0-12 years]), 236 (0.4%) had behavioral flags. Compared with encounters among patients who identified as White, encounters among patients who identified as Black or African American were more likely to have a behavioral flag (incidence rate ratio [IRR], 2.07; 95% CI, 1.32-3.25). Behavioral flags were also more likely among encounters of individuals with government insurance compared with those with private insurance (IRR, 2.60; 95% CI, 1.85-3.65). Black or African American patients younger than 1 year (IRR, 3.53; 95% CI, 1.80-6.91) and aged 1 to 7 years (IRR, 2.87; 95% CI, 1.34-6.15) had a higher likelihood of flag placement compared with their White counterparts.Conclusions and Relevance: This cohort study found significant inequities in incidence of behavioral flags in the EHR among racially and socioeconomically marginalized pediatric patients. This finding was most pronounced for Black or African American patients younger than 8 years, suggesting that this phenomenon may be a response to Black families rather than specific patient behavior.

Many hospitals have adopted Family Centered Rounds (FCR), as a means to optimize communication. While studies show FCR improves family satisfaction, research on the impact on family understanding o...

Purpose: This study explored Black physicians’ experience via an antideficit lens to gain new ideas for advancing minoritized physicians in academic medicine more broadly. Increasingly, systemic racism in academic medicine is intentionally acknowledged and named. However, many solutions to tackle racism and the overall paucity of Black physicians use a deficit framing, painting Black physicians and trainees as lacking preparation, interest, or experience and qualifications. Such solutions aim to help Black people assimilate into the “White Space” of academic medicine, rather than focusing on Black people’s strengths. Method: This qualitative study included 15 Black physicians and trainees in pediatric critical care medicine (PCCM) from across the country who participated in semistructured interviews. Through an antideficit lens, the researchers examined the social, cultural, and structural contexts influencing the participants’ individual experiences. They analyzed the data combining thematic and narrative qualitative analysis approaches, including restorying. Results: The data help promote understanding of the landscape and context in which Black PCCM physicians become successful. Achievement took on different forms for the participants. Participants described enablers of achievement that supported them through their individual journeys spanning 3 general domains—intrinsic, interpersonal, and systemic. Three additional enablers were tied specifically to participants’ Black identities—harnessing Blackness as a superpower, leaning in to lead, and successfully navigating the “unwritten rules.” Conclusions: By using an antideficit framework, this study delineates and centers participants’ ingenuity in cultivating repertoires of practice that enabled them to succeed, despite challenges rooted in systemic racism. Going forward, rather than focus solely on what is missing, academic medicine should try to shift systems and regularly recognize and value the knowledge, expertise, and merit Black that physicians bring. Perhaps an appropriate framing is not that Black physicians are underrepresented in medicine; maybe instead, it is that they are underrecognized.

The medical profession in the USA is—and has long been—a segregated workforce. Currently, just 5.0% of all US physicians are black. Understanding the origins and mechanisms of this disparity is essential to creating a future where black healing and healers are supported by our medical system. In pursuit of this future, this article offers ‘othering’ and ‘belonging’ as frames of analysis and intervention for diversity and equity initiatives. Building on previous historical studies of racism in medicine, this project reveals how the figure of the ‘American physician’ was created through exclusionary/othering tactics. In part 1, we analyse antebellum historical sources to demonstrate the role of medicine in creating and promulgating racial categories and hierarchies. Next, in part 2, we explore the historical conditions that produced the American physician as a significant professional identity by analysing texts by the American Medical Association and affiliated state medical societies. Then, we turn towards solutions in part 3. To redress inequities produced by othering, particularly the continued exclusion of black people from the medical profession, we argue that medical leaders should cultivate a professional culture of belonging. As we will explain, belonging goes beyond tolerating and respecting difference; it entails shared culture, equal rights and inclusive structures.