Changes to Medical Education in the Time of COVID-19: An Opportunity to Accelerate Health Equity

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Angela H. Nguyen, Angelica C. Martin, M.P.H., Brandon Coleman, Gina Jaqua, Charity Muraya, Ronald Hart, and Erik Fernandez y Garcia M.D., M.P.H.

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Our manuscript, “Changes to Medical Education in the Time of COVID-19: An Opportunity to Accelerate Health Equity,” discusses how academic institutions, through health equity-based training responsive to the pandemic, should and can promote and support students’ efforts in addressing health disparities in their respective communities of interest.

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We are second-year medical students at the UC Davis School of Medicine (UCDSOM) who are committed to serving the underserved and have joined a curriculum track to achieve our goal. We were underserved as children and grew up feeling that healthcare, as an entire entity, does not prioritize us. We know that the healthcare system is not easy to navigate or to understand [1]. The COVID-19 pandemic has profoundly shed light on these health inequities and led us to reaffirm the importance of connectedness, trust, and initiative to put communities first, not only within our medical school class, but also in society [2].

 

The Transforming Education and Community Health for Medical Students (TEACH-MS) curriculum track has always provided novel educational experiences in fulfilling our mission to become culturally humble [3] physicians and community leaders who address larger inequities. We have maintained our mission during the pandemic by using innovative techniques and personal commitment to adapt the TEACH curriculum. We have continued our mission-based learning through meetings with our longitudinal academic coach and weekly real-time video-based group clinical skills teaching sessions. These sessions were developed to teach clinical skills and are attended by all medical students regardless of cohort. However, due to the focus of our cohort and shared mission of our coach, we were able to integrate current issues affecting local communities regarding the pandemic into the sessions. The TEACH curriculum has also supported our mission by requiring a scholarly project and supporting our goal to use that to address the pandemic-related concerns of underserved high school students in Sacramento. In our project, we invited local professionals to engage with students and discuss the influences of COVID-19 on academic success and college preparation. Having a mission-based curriculum during the pandemic has ensured that we learn not only to treat the physical wounds of our patients, but to also accurately explore and decipher the multilayered causes of health disparities within underserved communities. 

 

The COVID-19 pandemic has shown us in visceral detail how food insecurity, housing insecurity, and lack of social and healthcare support in urban underserved communities places their lives at risk to a greater extent than other communities [2].  In response, TEACH-MS students began organizing a patient outreach COVID-19 education program in collaboration with the UC Davis-affiliated student-run clinics. Our outreach is a message to our communities that they are not forgotten or dispensable. COVID-19-related disparities could dishearten us. Instead, it galvanizes us to cultivate relationships and strengthen public health efforts as an example for our medical school community. Our response to the pandemic highlights that medical students are compassionate, committed, and collaborative. We hope that the UCDSOM and other medical institutions will continue to foster these traits in the classroom, by including health equity-focused learning objectives into each course. During this pandemic, some instructors of record in our course curriculum have gone the extra mile by including discussion on how skin disorders appear on differently colored skin in the Dermatology block and on the controversy of glomerular filtration rate accuracy in Black and Asian communities in the Renal block. Missed opportunities, such as a discussion on discrepancies in lung cancer treatment in the Black and Latinx communities, the 1st and 2nd cause of mortality in these populations respectively [4, 5], show us that these points should not be “the extra mile,” but a universal standard. These teaching points, often requiring less than one sentence to convey, will undoubtedly be the most influential in our future clinical practice for all patients.

 

Medical education should capitalize on how the pandemic has galvanized medical students like our cohort to serve the underserved. Medical students have never been more excited and ready to take part in fighting the health disparities that have existed for generations. It is time to nourish these values and initiatives which will lead to more equitable healthcare for all.

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Disclosures & Funding:  None

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Acknowledgments: The authors would like to thank Dr. Melody Tran, who is the program director for the TEACH-MS program and the TEACH-MS-affiliated faculty at the University of California Davis School of Medicine, all of whom have built and supported the TEACH-MS curriculum. We would also like to thank Dr. Laura Kester, M.D., M.P.H, Associate Professor of Pediatrics, Director of Adolescent Medicine, and Director of Outreach Curriculum K-12 Office of Student and Resident Diversity, for her mentorship on our TEACH-MS scholarly project.

 

References

1. Institute of Medicine. 2003. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Washington, DC: The National Academies Press. https://doi.org/10.17226/10260.

2. Williams DR, Cooper LA. COVID-19 and Health Equity—A New Kind of “Herd Immunity”. JAMA. Published online May 11, 2020. doi:10.1001/jama.2020.8051.

3. Tervalon M. and Murray-Garcia J. Cultural humility versus cultural competence: a critical distinction in defining physician training outcomes in multicultural education. J Health Care Poor Underserved. 1998 May; 9(2): 117-25.doi: 10.1353/hpu.2010.0233

4. American Cancer Society. Cancer Facts & Figures for Hispanics/Latinos 2018-2020. Atlanta: American Cancer Society, Inc. 2018.

5. American Cancer Society. Cancer Facts & Figures for African Americans 2019-2021. Atlanta: American Cancer Society, Inc. 2019.