Tim Lahey, M.D., M.M.Sc., presents "How Should We Prepare Students to Fight Clinically Impactful Injustice?” at the 2019 Teaching Academy Mud Season Retreat
From the tiniest ticks of genetic expression to the sweep of organ systems, medical students gain a deep understanding of human body function. They spend hundreds of hours learning how to use tools and technologies, from stethoscopes to point of care ultrasound, to deliver the best patient care they can. However, when it comes to thorny societal issues like the intersection of race and class in medicine, unequal access to health care, and the outsized toll chronic disease can take on marginalized populations, medical students have historically had little opportunity to engage.
Faculty and students at the UVM Larner College of Medicine are working collaboratively to change how the social determinants of health are integrated into a medical education curriculum. They’re naming the systemic challenges that affect health and well-being as squarely within the physician’s purview to address. By extension, they’re inviting the medical establishment to step up, with Larner students poised to lead the way, says Shaden Eldakar-Hein, M.D., associate professor of medicine and course director for Professionalism, Communication and Reflection (PCR).
“To hear the first-year students talking about the social determinants of health is promising,” she says. “They’re thinking about it now, starting at the beginning, instead of working backwards.”
Students themselves asked for the opportunity to confront these issues. Some members of the Class of 2021 founded a book club amongst friends that evolved over time into a group called the Social Justice Coalition, reigniting discussions about the role of the physician in addressing health equity. Students began conversations with faculty including Foundations Director Karen Lounsbury, Ph.D.; Foundations of Clinical Sciences Course Director Stephen Everse, Ph.D.; UVM Medical Center Director of Clinical Ethics and UVM Professor of Medicine Tim Lahey, M.D., M.M.Sc.; and Eldakar-Hein. Together, they sought out opportunities to develop course content.
The key to the curricular changes has been integration: A pilot for the 2018-19 academic year linked topics in the 18-week Foundations of Clinical Sciences course with discussion topics in PCR and casebased work for the 13 sessions in the ethics curriculum. A Theme of the Week ties all three components together. For example, coursework on molecular genetics is paired with a Theme of the Week focused on the genetic basis of race. In PCR, students complete an implicit bias test and discuss readings related to racism in medicine. In ethics discussions, led by Lahey and Eldakar-Hein, students debate a real case that gets at some aspect of race and the role of a physician.
“The goal is for students to be thinking about these topics as they go along,” says Lounsbury, building awareness of the connections between social issues and health as they develop their identities as physicians. “It’s important for students to bring this consciousness to their work,” says Lahey. “So many topics intersect, from historical injustice to healthcare disparities, ethics and beyond. This is about professionalism. This is about quality improvement and public health. These are also neglected topics that are intimately important to the day-to-day work that almost all physicians do.”
Faculty development will continue to be important. Lahey’s keynote presentation at the Teaching Academy’s annual Mud Season Retreat—titled “How Should We Prepare Students to Fight Clinically Impactful Injustice?”—set the stage for one track devoted to teaching for social justice, with topics like understanding implicit bias and social medicine teaching techniques.
For Eldakar-Hein, she sees the College community connecting in meaningful ways. PCR has long been a hub for that type of engagement, as students meet in small groups with a faculty mentor every week for 42 weeks.
“We are all in our own silos of divisions and departments,” she says. “How can we standardize our teaching and teach each other?”
Students, faculty, and the broader College community continue to move efforts forward. A group including Nikkole Turgeon ’22, Richard Brach ’22, Nina Dawson ’21, Raghav Goyal ’21 and Sam Epstein ’21 , with Lounsbury as faculty advisor, recently presented on “Aligning Medical Education for Healthcare Providers with Social Medicine Pedagogy: A Concept in Practice” at the Social Medicine Consortium Conference in Chiapas, Mexico on June 1, 2019. Sheridan Finnie ’22 leads research to assess faculty and student perceptions of the Theme of the Week and related social medicine content, with Lahey as mentor for the project funded by a Summer Research Fellowship. Faculty advisors for the Social Justice Coalition, including Lahey, Eldakar-Hein, Michael Upton, M.D., and Maria Mercedes Avila, Ph.D., continue to be instrumental in guiding discussions about how social issues affect health and well-being.
There’s a direct line between engaging future physicians in this work, promoting professionalism, and preventing burnout.
“Our students show up ready to change the world. If we empower our students to really make a difference, to keep their values alive during medical training, they’re more likely to actually change the world after they graduate,” Lahey says.