PREVENTATIVE MEDICINE
Prevention through Health Equity Training at the Long School of Medicine By Garrett Kneese and Samantha Driscoll
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s medical education continues to advance beyond Flexnerian practices (Flexner, 1910), so does the focus of these educational methods to include the charges of today’s physicians. One of these charges, highlighted by the disparate impacts of the COVID-19 pandemic (Kim et al, 2020) and based in the historical segregations of our American society (NCRC, 2020), is the inequities within the social determinants of health (SDoH). “As the United States contends with the effects of the COVID 19 pandemic, health inequity, and a long overdue reckoning of institutional racism, transforming primary care is essential to meet the moment…” – V.J. Dzau, National Academy of Medicine Over the last decade SDoH literature has expanded enormously, beginning at a measurement and identification stage (ie what social factors determine health, and how might we calculate, quantify and measure them?), and continuing onward to where we are today with respect to implication and intervention (ie what do these determinants tells us about our communities and what can medical society do to respond within this newfound lens?).
Modified figure from Family Medicine Team Care Session, February 2022. (Kneese et al, 2022)
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SAN ANTONIO MEDICINE • June 2022
Reaching back to the educational framework, there are now efforts nationwide at the undergraduate (UME) and graduate medical education levels leveraging this lens to empower medical trainees and those of other health professions as well to work towards not only providing higher quality health services based on a socially-derived understanding of their patient, but also advocating for and working towards reductions in the disparate outcomes that unequal distributions of negative social determinants can cause. Much of this education at the UME level is course-based in pre-clinical years, and occasionally integrated at an elective-only level during fourth-year coursework. Ultimately, we conclude alongside most other global and national health organizations that socioeconomics and health behaviors as influences by social determinants are the primary driving factors that can be modified for prevention of disease across populations (Hood et al, 2016). At UT Health San Antonio, the Department of Family and Community Medicine’s undergraduate medical education division, led by Dr. Nehman Andry, has been hard at work in the post-pandemic setting to bring SDoH education to all medical students at the university in hopes of facing the challenge of health disparities headon. The teams for this article’s highlighted programs comprise of clinical faculty, students, community health workers (promotores) and consultants with the American Board of Family Medicine. With help from several leaders in the department, they have facilitated both longitudinal and interventional programs at the third-year medical student level to improve SDoH clinical competencies in all students and inspire them to advocate for the communities they serve from a foundational understanding of health equity. With additional time available due to limited clinical scheduling for the third-year family medicine clerkship in intra-pandemic education, an impetus to leverage that time for a novel educational experience arose. The idea to create a longitudinal experience over the 6-week rotation framed the pairing of medical students with both a promotore (community health worker, or CHW) from the Department, and a patient well-established with the promotore for an interactive SDoH community-clinical journey.
