ChangeMedEd Initiative

Tips to advance health equity concepts in residency training

Timothy M. Smith , Contributing News Writer

Advancing health equity is a driving ideal behind health systems science (HSS)—an understanding of how care is delivered, how health professionals work together to deliver that care, and how the health system can improve patient care and health care delivery.

Achieving optimal health for all

The AMA is confronting inequity at the system and community level to bring health equity to marginalized and minoritized communities in the U.S.

A plenary session at the inaugural AMA Health Systems Science Summit featured a panel discussion highlighting what needs to be done to manifest health equity as a cornerstone of HSS education. The session included summaries of projects at four U.S. medical schools and residency programs.

Following are highlights from one of them, with lessons learned for residency program staff trying to figure out where to start in tackling this complex issue.

“One primary principle I followed is not to create a scripted curriculum, but instead to develop a framework and supporting resources,” said Theresa Green, PhD, associate professor of public health sciences and the director of community health policy and education at the Center for Community Health within the University of Rochester Medical Center, a member of the AMA Accelerating Change in Medical Education Consortium. “The framework provides standardization across the institution while alsoallowing for  for flexibility and individualization by each residency program.”

Residents want information that’s relevant to their specialties—“immediately applicable and from expert learners that they know and trust and value,” Green noted. “So having the particular leaders in a residency program lead the education around health equity makes a lot of sense.”

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The University of Rochester Medical Center mapped its objectives to three phases of learning to create its knowledge, empathy and equity (KEE) curriculum.

Phase one is basic science learning, Green said. “That's really where you learn the nuts and bolts of social determinants and this idea that things greater than health care delivery impact health.”

Phase two is one-on-one care of patients, and phase three is tackling the issue at the organizational level through quality improvement and systems change.

"Although the objectives fall in line with the different phases, certainly they all overlap all three,” she said.

Another guiding principle was to think small at first and pursue “wins that we can celebrate before tackling the entire system.”

The faculty at the University of Rochester Medical Center started with eight pilot residency programs, including primary care and surgical specialties, representing about 37% of their learners.

“We intentionally chose these residency programs to be some who haven't even started teaching health equity and some who are veterans and have been teaching it for years,” Green said.

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The medical center also created champion teams for the pilot residency programs, each including the chair and program director, as well as an informatics director, a quality person, nursing leaders and other residents. Each pilot champion team then met with the KEE curriculum framework steering committee to ensure they were meeting core competencies.

“We're creating resources that are based on the data of our community,” Green said, noting that the health systems science movement—to this point—is all about “thinking big, working small and incorporating very usable, tangible data.”

The AMA released Health Systems Science Education: Development and Implementation, which outlines how to integrate health systems science into the medical education continuum, in December. It also released the second edition of the Health Systems Science textbook, a framework for this third pillar of medical education. A companion, Health Systems Science Review, provides case-based questions followed by discussions of answers and suggested readings.