When she was 5 years old, Reine Ibala and her family moved to the United States as refugees amid civil war in their native Republic of Congo. Later, her father developed hypertension and faced challenges as he navigated the American healthcare system. His doctor was dismissive, Ibala recalls, and did not address the real, personal and cultural reasons behind his father’s apprehensions about his treatment plan. With a fractious patient-doctor relationship and a lack of shared decision-making on the best treatment plan, he ultimately died of a dissected aorta.
“Being a good doctor isn’t just about providing scientifically and clinically excellent medicine,” said Ibala, 27, currently a third-year medical student at Weill Cornell Medicine. “It’s about being able to meet patients where they are, understanding where they’re coming from and knowing when to follow their lead.”
That experience, along with her upbringing as a black woman and an immigrant to the United States, was formative for her, she said. This ingrained in her the importance of social justice and health equity, values that underpinned her future medical career. The 2020 murder of George Floyd and the resulting national reckoning on race, as well as the disproportionate impact of COVID-19 on communities of color, further galvanized her, prompting her to participate in a newly created at Weill Cornell Medicine dedicated to advancing these principles through the lens of medical education.
Convened in the summer of 2020 by Dr. Yoon Kang, Senior Associate Dean for Education, the Anti-Racism Curriculum Committee was tasked with reinvigorating the curriculum at Weill Cornell Medical College to ensure medical students acquire a solid understanding of how social, economic and political factors influence health. results. These social determinants of health, which co-chair Dr. Joy Howell calls “social barriers to health,” have been recognized by the Centers of Disease Control and Prevention and the World Health Organization as more important than genetics. or ancestry, health behaviors, and even access to care and the quality of that care.
“We need to impress upon the next generation of healthcare workers the power that societal factors have on the health of the population, as well as the health of an individual, so that they can become well-rounded and well-rounded physicians” , said Dr. Howell, who is also associate dean for diversity and student life at Weill Cornell Medicine. “If you’ve just come up with a drug to treat high blood pressure and you don’t care about the context in which that patient lives, I doubt your ability to effectively control that patient’s blood pressure.”
Integrating anti-racism into the medical curriculum
Comprised of Weill Cornell Medicine administrators, faculty, students, and staff, the Anti-Racism Program Committee met throughout 2020-21 and quickly identified the need to integrate social justice and health equity in a new core medical college learning objective.
The goal, said committee co-chair Dr. Joseph Safdieh, was to develop a framework in which the social determinants of health, including racism, are taught longitudinally, across the four years of faculty. of medicine, rather than in a single course.
“If we segment it into an individual course, then the concepts exist on their own,” said Dr. Safdieh, who is also Gertrude Feil Associate Dean for Curriculum Affairs, Louis Foundation Education Fellow and Rachel Rudin and professor of neurology. at Weill Cornell Medicine. “Students learn it and then move on. We want to show them that understanding the social determinants of health is relevant in heart disease, lung disease, kidney disease, brain disease, in all the different organ systems. This is not a problem unique to medicine, surgery, neurology, or OBGYN. It’s a pervasive societal issue that impacts every patient’s experience.
In addition to understanding health disparities, the committee also wanted to dispel harmful stereotypes that have been perpetuated over centuries due to the structural barriers that society has erected. For example, skin color is often associated with the incidence and severity of a particular medical condition.
“We believe our students need to learn right away that race is a social construct,” Dr. Safdieh said. “It’s not organic. Race is something, as a concept, which has been developed by society to categorize different people into different groups based on their appearance. The impact is that these groups are treated differently. The problem is not race; it’s racism.
Simultaneously, the committee advocated for courts to recognize the different ways the disease can present depending on skin color. The second-year dermatology course now includes pictures of rashes and lesions on black and brown skin, for example.
The Anti-Racism Curriculum Committee has developed an overarching learning objective for the medical education curriculum, which was recently formally approved by the Medical School Medical Education Executive Committee. This learning objective codifies the continued inclusion of the impact of societal factors, including racism, on equitable health care delivery and patient outcomes in the curriculum.
Building a fairer workforce
Dr. Gwendolyne Jack, Assistant Professor of Clinical Medicine, had already conceptualized an expanded Social Justice, Policy, Advocacy and Community Engagement (SPACE) program before the events of 2020, but that work took on more meaning in the weeks and months that followed. .
The curriculum is intertwined throughout the Essentials of Medicine course, which is taught in the first year of medical school. The SPACE program explores the history of racism in medicine, the local and global impacts of prejudice and structural racism, privilege, discrimination, health inequalities, structural determinants of health, and community advocacy through a series of lectures and group sessions on clinical skills.
The course provides students with the fundamentals to apply a health equity lens and recognize how racism, neighborhood safety, food insecurity, and other social determinants can affect patient health and well-being.
“Historically, these concepts were left out of initial discussions with students, and usually added later,” mentioned Dr. Jack, who is co-director of the Patient Care and Physicianship unit within the Essential Principles of Medicine course. “Weill Cornell’s approach to medical education leadership is to really address this issue from the start and apply the principles throughout their four years, so that when students graduate, they are equipped to provide exceptional quality of care to a diverse patient population and advocate for their patients in powerful and meaningful ways.
The Brain and Behavior unit, taught by Dr. Evan Noch, Assistant Professor of Neurology, continues these concepts through the second year of medical school. In small groups, students explore a particular neurological diagnosis through the lens of a patient case. This year, Dr. Noch added personal details about patients — from their cultural and religious understanding of the disease, to the complexities of paying for expensive drugs, to the burden on caregivers — to reflect the real-world people these aspirants are with. doctors will interact.
“Students need to care for real patients, not patients they know about in textbooks,” said Dr. Noch, who presented in March at the Institute for Excellence in Education at the Johns Hopkins School of Medicine. his efforts and those of his colleagues to teach. students on the social determinants of health. “And the patients they see in the hospital and the clinic come from a variety of backgrounds. They must be prepared to deal with the complexity of the care they provide.
Physicians as advocates for social justice
Historically, the prevailing view was that medicine did not have a critical role in addressing the social determinants of health, that these issues were too deeply rooted for physicians and scientists to meaningfully address. . But the cost of inaction is too high, with lives at stake, Dr Howell said.
“We have, as an institution and as a health care community, some formidable structures to dismantle if we seek to meaningfully alleviate disparities in health care,” said Dr Howell, who is also Vice Chair of Diversity in the Department of Pediatrics and Professor. of Clinical Pediatrics at Weill Cornell Medicine. “Our society is still structured in such a way that opportunities and resources do not equitably benefit or disadvantage individuals from different groups. And until our society reduces, if not eliminates, these inequities, it will be difficult to get rid of these inequities in health care.
“But we in the health system need to address the proximal issues that are most within our control and advocate for change at a societal level,” she added. “We must be advocates for social justice.
Weill Cornell medical students inherently believe that, Ibala said. In the aftermath of the events of 2020, students mobilized to create a Student Anti-Racism Task Force to advocate for institutional change. Change in the diversity of the health workforce, so that it reflects the community it serves. Changing the way physicians advocate for their patients, giving them a seat at the table so they are empowered in their own healthcare. Change in how physicians understand their role as advocates for new policies aimed at dismantling the structural barriers that have hampered health.
“What I really hope is that we reach an era where racism and social justice are not just BIPOC (black, indigenous and people of color) issues, where doctors do not believe that inequality , housing, police brutality and even politics, that these issues are not in our way,” said Ibala, who is leaving medical school next year to complete a master’s degree in public health at Harvard TH Chan School of Public Health. “It’s absolutely our path because these are the issues that affect our patients and bring them through our doors.”