Empowering future physicians to advocate for health equity: A blueprint for a longitudinal thread in undergraduate medical education

Abstract

In light of a growing body of evidence demonstrating pervasive health disparities, medical schools are increasingly incorporating educational programs on social medicine in undergraduate and graduate medical curricula. In 2015, we significantly restructured the cultural competency instruction for medical students at our institution, focusing on achieving greater health equity through caring for vulnerable populations and acknowledging and addressing bias and stereotyping. In order to facilitate educational sustainability while students were immersed in clinical care, a key element of our approach included extending teaching into the clerkship year. The resulting longitudinal thread, Health Equity and Social Justice, empowers future physicians with the knowledge and skills to work towards greater health equity. This article discusses the lessons learned in the implementation of this novel educational program. Our approach can serve as a model for other institutions considering similar instructional reform.

Keywords:

• Health equity
• cultural competency
• social justice
• bias
• microaggressions

Acknowledgements

The authors wish to thank James Hill, PhD, Dean of Students at Rutgers New Jersey Medical School, for his thoughtful guidance throughout this journey and his dedication to students; and Mercedes Padilla-Register, MA for her unwavering commitment to supporting programs dedicated to diversity, community outreach, and health equity at Rutgers New Jersey Medical School.

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article.

Glossary

Health disparities: Measurable differences in health status between population groups—defined in social, economic, demographic, or geographic terms—that are unfair and unavoidable (Whitehead and Dahlgren 2007)

Health equity: The fair distribution of resources needed for health, fair access to opportunities for wellness, and fairness in the support offered to people when ill (Whitehead and Dahlgren 2007)

Healthcare disparities: Differences in the quality of healthcare that are not due to access-related factors, clinical needs, preference, or appropriateness of intervention (Smedley et al. 2003)

Unconscious Bias: Attitudes or stereotypes that are outside of our awareness but nonetheless affect our understanding, interactions, and decisions. Unconscious bias may influence our feelings and attitudes and result in involuntary discriminatory practices, especially under demanding circumstances (Staats et al. 2017)

Microaggressions: The daily, commonplace interactions, whether intentional or unintentional, that communicate hostile, derogatory, or negative slights and insults towards members of marginalized groups (Sue et al. 2007)

Previous presentations

We presented a description of HESJ at the Northeastern Group on Educational Affairs (NEGEA) April 2018, Hempstead, New York, and the Society of General Internal Medicine (SGIM) Mid-Atlantic Regional meeting, November 2018, Morristown, NJ.

Additional information

Funding

This work was supported by the New Jersey Medical School Hispanic Center of Excellence, under Health Resources and Services Administration [Grant D34HP26020].

Notes on contributors

Michelle DallaPiazza

Michelle DallaPiazza, MD, is Assistant Professor, Department of Medicine, Division of Infectious Diseases, Rutgers New Jersey Medical School, Newark, New Jersey, United States.

Manasa S. Ayyala

Manasa S. Ayyala, MD, is Assistant Professor, Department of Medicine, Division of General Internal Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, United States.

Maria L. Soto-Greene

Maria L. Soto-Greene, MD, MS-HPEd, is Professor and Executive Vice Dean, Department of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, United States.