Medical Schools Stepping Up to Build Health Equity Curricula

November 17, 2021 - As the healthcare industry faces calls to address racism in medicine, the nation’s medical schools are answering, setting forward revamped plans for diversity, equity, and inclusion and health equity curricula.

That is, after all, what their job is, according to Barbara Ross-Lee, DO, the chair of the American Association of Colleges of Osteopathic Medicine (AACOM) Diversity, Equity, and Inclusion Working Group. It’s been the job of all medical schools, both for DOs like Ross-Lee and medical doctors, to train up the next generation of physicians to be well-equipped to meet the needs of their patients.

“To a large extent, medical education is focused on training each student to be able to address the biomedical issues that confront them with each and every patient,” Ross-Lee, who is also the first African American woman to be dean of a medical school, told PatientEngagementHIT in a recent interview.

“Previously, we focused on the pathophysiology of disease more so than the social determinants that surround that patient. But every medical school—MD and DO—has been challenged to start to address some of the issues of equity and health disparities because of the persistence of health disparities.”

To be clear, health disparities have long existed, according to Ross-Lee for at least a hundred years. But study around health disparities is a bit newer, as more medical professionals have recognized the way social determinants of health impact health—and how some folks experience more SDOH than others.

Most recently during the COVID-19 pandemic, the public has gotten an up-close look at how disease plays out differently across various racial groups, with Black, Hispanic, and American Indian/Alaska Native (AI/AN) people bearing more of the brunt of the virus.

And now, groups like AACOM and their member colleges are pushing their existing health equity efforts even further. If before colleges of osteopathy were prioritizing diversity during medical education, Ross-Lee said they are now coming together to ensure students are trained to deliver medicine to a diverse patient population.

“We've built a framework for diversity, equity, and inclusion in each of our medical schools,” she explained. “We can't let the perfect be the enemy of what's possible. We could definitely increase the diversity. We could definitely add more to address health equity and understanding of that in each of our graduates. But now's the time to make that next step to really focus on competencies for delivering healthcare in a multicultural and multiracial environment.”

That sentiment culminated in an October announcement from AACOM stating that the nation’s colleges of osteopathy had unanimously agreed to prioritize efforts to combat systemic inequity. As part of that agreement, AACOM schools committed to creating “innovative academic, research, community service and healthcare delivery programs,” they wrote in a statement.

To that end, Ross-Lee said medical school will be preparing students to be competent clinicians.

Building out those health equity curricula is not simple feat, she added as a caveat. As with much diversity, equity, and inclusion work, this type of education runs the risk of tokenizing. To avoid that pitfall, Ross-Lee said schools need to walk the walk and support a culture of inclusivity.

“We need to reframe the way we look at it—and it's not just numbers,” she advised. “We've become ‘the more diversity we have the better’... Well, not without reframing it to change the culture so that there is value to having a diverse medical education culture, because that value helps to shape each future physician as to how they respect the health needs of the populations that they will serve.”

It's not enough for a medical college to simply fill a quota, Ross-Lee continued.

“The establishment of diversity, equity, and inclusion as a part of the administrative structure in each medical school was, and is, very much a part of it,” she stated. “But unless we take that effort to the next step and apply it to the culture of the medical school, it does become tokenized.”

Too often, academic medicine will turn to someone in the racial minority group to handle diversity and equity efforts.

“Well, no, that's not what diversity is all about,” Ross-Lee pointed out. “Diversity is a requirement to achieve excellence in any scientific endeavor, healthcare being one of those, because you need more perspective to collaborate on problem solutions. In order to do that, you have to have diversity presence to bring together.”

Health equity curricula will look different at different organizations, Ross-Lee continued. Medical schools need to respond to the unique needs of their students and the patients in surrounding populations. In doing so, medical schools can more effectively shift culture and create a meaningful health equity program.

“Each of the medical schools has its own personality based upon their priorities either in healthcare delivery, in the educational system or in research,” Ross-Lee said.

“Those personalities reflect their geographic location, the regions that they serve, the students that are attracted to them as part of the process,” she continued. “Every single osteopathic school and additional location has established diversity, equity, and inclusion efforts that reflect the communities that they are attracting students from as well as the communities in which they reside.”

Those efforts should be guided by an institution’s health equity experts, Ross-Lee recommended.

“Each medical school can't do that because they don't have all of the expertise that's necessary. Now, they will gain it over time if that becomes a priority for them,” she stated. “But right now, ACOM is developing a program in health inequities and health disparities using national subject-matter experts to deliver this to every single osteopathic medical school. It would at the very least provide the discussion for the curricula component of health and equity into every osteopathic medical school.”

Ultimately, having a diverse medical workforce will be essential to closing gaping health disparities, Ross-Lee acknowledged. The data backs this up. Racial concordance can lead to more family- and patient-centered care and better patient experience.

But medical schools aren’t exactly in a great place to change that, Ross-Lee conceded.

“Medical education occurs near the end of the educational stream. And as we know from the social determinants, there's whole theories of structural biases that influences who is prepared to apply to medical school,” Ross-Lee pointed out.

“Although in medical education we can't change that, that's what's served up to us, every single osteopathic medical school has pathway programs to help enhance the number of students who are prepared and ready to go to medical school.”

Health equity during medical training—and medical school recruitment—is a big challenge, and it’s likely the industry isn’t getting all of the answers correct right now. But for Ross-Lee, the collective action taken especially among DO program deans is an extremely promising step for the future.

“Every osteopathic medical school, even at the additional locations, every single one of the deans is saying, ‘hey, it's time.’”

“It's time for us to move to that next step to change the cultures inside of medical education, to make this very much a part of what our future physicians will look like,” Ross-Lee concluded. “Our responsibility as medical schools and certainly as osteopathic medical schools is to select the next group of physicians. And our second responsibility is to educate them and provide them with the tools that they need to deliver the kind of care that the population in this country requires.”