In July, 2020, the two of us met for the first time as inaugural co-directors of the University of California, Riverside, School of Medicine’s new Health Equity, Social Justice, and Anti-Racism (HESJAR) curricular initiative. Beginning with our initial conversations it became clear that addressing speech — physician speech, patient speech, medical school speech — would be central to our journey.
For an entire year (2020-2021) we planned. This involved reading, particularly about efforts at other medical schools. It also involved listening: to students; to other faculty and staff; and particularly through a series of community conversations in which medical students interviewed local residents about their experiences with the health care system. Those conversations deeply informed our curriculum development.
Last year (the 2021-2022 academic year), we launched HESJAR, focusing on two main audiences. Students at various stages of their medical education. Faculty who taught in the classroom and in clinical settings.
We created a variety of required learning modules for students. An extended conversation with the president of the Riverside Blindness Support center, who shared the experiences of blind people trying to access the health care system. A specialist in diversity and neuroscience, who engaged students in a series of activities for better understanding the power and limitations of the brain, including implications for physician speech and health equity. A group of health care language interpreters who provided insights into the complexities of dealing with patients and families with different language capabilities. Sessions on privilege and on the impact of trauma and toxic stress from myriad social determinants of health.
With the number of HESJAR modules necessarily limited, we also dedicated ourselves to involving other faculty in the HESJAR initiative. We decided to build on the school’s emphasis on case-based learning (CBL) and clinical settings. The CBL approach permeates the first two years of the curriculum, while intensive clinical experiences dominate the third and fourth years. For community-based rotations of third-year students, we also created simulated patient scenarios that captured the intersectionality of disability and immigrant experiences.
To draw upon the school’s case-based pedagogical approach, we also developed a HESJAR Health Equity Framework (HEF). That Framework revolves around a single foundational question, which we encourage all faculty to pose in their classroom cases and clinical situations. The question: in this case or situation, what personal, systemic, cultural, or structural factors may exist that could facilitate or complicate the pursuit of health equity for the patient?
To help medical school faculty become comfortable and skilled in integrating that question into their case study analyses, we conducted a series of faculty workshops covering a number of themes. The intersectional nature of all of their patients. The art of employing group generalizations with nuance without falling into the trap of stereotyping. Most important, to encourage and empower faculty to address diversity in their teaching, we involved them in applying our Health Equity Framework to medical case studies containing multiple dimensions of diversity.
We had considerable success, but we still face the challenge of overcoming obstacles to vigorous conversations about sometimes delicate diversity issues. Many students and faculty seemed to become more confident in addressing these issues. Yet others remained reticent in these conversations, whether out of fear, disinterest, lack of confidence, or a combination.
With lessons learned from this first year of teaching HESJAR, combined with intensive ongoing input from students, we are modifying our approach this academic year (2022-2023). Continued use of modules on disability, privilege, trauma, language interpretation, and the brain. An expanded use of the Health Equity Framework.
In addition, more emphasis on the use and misuse of the idea race within health care. A more explicit focus on the experiences of LGBTQ patients and families. Expanded space for dialogue and critical reflection. Additional classroom strategies for involving a greater number of students in the health equity conversation. Introduction of concept mapping in health equity-focused clinical case scenarios.
As we wrote in an article last year, we harbor no illusions about the challenge of implementing the HESJAR curriculum within today’s speech climate. We recognize that many faculty and students have decided that it’s safer to remain silent and avoid risking being called out. However, we remain optimistic in our pursuit of making our school a more encouraging space for robust conversations about complex diversity issues.
- Diversity and SpeechPart 39: Creating Health Equity – by Carlos Cortés and Adwoa Osei - October 4, 2023
- Diversity and Speech Part 31: Health Equity – by Carlos Cortés and Adwoa Osei - October 2, 2022
- Diversity and Speech Part 23: Health Equity – by Carlos E. Cortés and Adwoa Osei - September 28, 2021