The two of us first met in July, 2020, when we were asked to serve 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. Health equity, social justice, and anti-racism are important concepts, but they can easily degenerate into little more than buzz words. Our challenge was to transform those six words into a focused, integrated, and transformative learning experience for our students.
During our first three years we planned and taught individual modules on various HESJAR topics. In the process we tried to avoid creating a curricular hodge-podge, with marginally-related modules leading in multiple directions and building to nothing. Instead we worked toward developmental coherence based on two critical decisions.
First, we decided that HESJAR would focus on the patient. We would use our limited student contact hours (four-to-five two-hour modules during each of the first two years) to concentrate on helping students improve the health care experiences and outcomes for patients from traditionally marginalized groups. Second, we created a mnemonic model based on the word, EQUITY, which we use as a focusing framework for both critical analysis and clinical action.
E — Examine Assumptions
Q — Question Privilege
U — Uncover Biases
I — Investigate Context
T — Treat Equitably
Y – Yield to Patient’s Voice
We use this framework as we construct and connect individual modules, so that each module both introduces new concepts and reinforces ideas from previous sessions. In the process we have shaped the four years of HESJAR using the following sequence:
Year One: Developing a Health Equity Mindset.
Year Two: Engaging Divergent Health Care Experiences
Year Three: Transforming Thinking and Action
Year Four: Becoming an Effective Change Agent
During the first year, we emphasize the development of a health equity mindset and use the individual modules to enhance the EQUITY conceptual framework. To address assumptions, biases, and the importance of the patient’s voice, we bring in a specialist in diversity and neuroscience, who engages students in a series of activities for better understanding the power and limitations of the brain. To help students better understand the interplay of equity and social justice, we involve students in a two-hour examination of the concept of privilege and how it influences health care. To help students better understand the context of upstream forces that help shape the health care world and the implications for downstream health outcomes, we bring in a scholar who has dedicated himself to the history of race-related factors in health care.
During the second year we build upon the health equity mindset by applying the EQUITY framework to the health care experiences of specific marginalized groups. A session on disability involving an extended conversation with the president of the Riverside Blindness Support Center. A session on cultural brokering with health care language interpreters, who provide insights into the complexities of dealing with patients and families with different language capabilities and cultural orientations. A session on the health care experiences of LGBTQIA+ patients. A session on trauma.
In the third year we focus on thought and action through a capstone assessment process involving standardized patients. That is, people who are trained both to act as patients in designed scenarios and to assess student performances. In this way we can better determine the extent of student success in applying the EQUITY framework while working with patients.
In the fourth year we emphasize critical reflection and participatory action research to help students consider their possible roles as career-long health equity change agents. We hope that students will complete this four-year process with both a dedication and a capacity to making our health care system more equitable and inclusive for all.
This year is a historical landmark. The initial cohort of students that began their medical education during the first year of HESJAR will be graduating from medical school. It is also a time for us to ponder the results of students’ HESJAR journey and to continue our efforts to make HESJAR more transformative for future cohorts.
Photo by Hush Naidoo Jade Photography on Unsplash
Adwoa Osei is Co-Director of the Health Equity, Social Justice, and Anti-Racism curriculum, Director of Pediatric Undergraduate Medical Education, and Associate Clinical Professor of Pediatrics of the University of California, Riverside, School of Medicine.She has received multiple awards for clinical care and teaching excellence.Dr. Osei has developed innovative methods for involving diverse local communities to share their experiences in educating medical personnel for cultural competence.She leads the UCR clinic for Leadership Education in Neurodiversity and has served on expert panels on disabilities for the Centers for Disease Control and American Academy of Pediatrics.