2/ My first #MedTwitter foray was sharing this project 👇🏽 in 2019.
Our vision was simple: Moving #MedEd from ahistorical discussions of health disparities ➡️ exploring fundamental causes, centering community voices, and honing in on hyperlocal inequities.
3/ We drew from two main pedagogical frameworks: #StructuralCompetency and community-engaged pedagogy (similar to CEnR/CBPR).
Though "community-based medical education" and "service learning" are widely used, we know these approaches often aren't enough: pubmed.ncbi.nlm.nih.gov/21169780/
4/ A few key aspects made our pilot novel:
✅Non-optional
✅Scaled to entire MS1 class (132 students)
✅Multidisciplinary advisory group of @UNMC faculty + @NebraskaMed leaders + community
✅18 community stakeholders involved w/co-creation & facilitation
5/ Our preliminary findings from the pilot are clear-cut:
Across all three respondent groups (faculty, students, community partners), the most frequently noted strength of the curriculum was direct learner-stakeholder engagement.
Some beautiful quotes from our qual analysis 👇🏽
6/ This project has truly been a labor of love with too many collaborators to thank in one thread.
All of us poured hours into it because we believe structural changes to WHAT we teach + HOW we teach it + WHO we consider "content experts" matter.
7/ And, we hope sharing our experience will help others recognize that even institutions like @UNMC (our then-MS1s were 89% non-URM + 29% from rural areas) can/should move beyond bias trainings & IATs, as @ChristleNwora@MaxJordan_N + more have called out.
1/ BREAKING from #AMAmtg: AMA HOD just adopted a report by the @AmerMedicalAssn's Council on Medical Education which aims to begin redressing the harms of the #FlexnerReport.
As a Councilor on CME who is invested in health justice, this is a report I am jazzed about. 🧵
2/ I learned about CME's role as a sponsor of the Flexner Report well before joining the Council, bc the downstream consequences have been huge.
The Report closed 5/7 Black medical colleges, diminishing the projected # of Black docs today by >35k 👇🏽 jamanetwork.com/journals/jaman…
For the first time in AMA history, we have policy to explicitly & actionably fight for #antiracism in #MedEd, health care delivery, research, & practice.
3/ By telling the truth & reconciling harms, and by advocating for actionable paths forward, these new policies will foster a brighter future of robust AMA advocacy for #HealthEquity and #Antiracism.
The adopted Resolved clauses (our resolutions are 005 & 010) are as follows:
2/ #Redlining in the 1930s involved racialized federal mapping of housing "desirability" (L) --> ⬆️💰 into White/affluent areas + systematic disinvestment in "undesirable" areas.
To this day, HOLC maps of urban areas like Omaha STILL align w/deprivation & racial segregation (R).
3/ Omaha is among the most segregated U.S. cities. Our HIV clinic serves ~50% Black and Latinx pts, who disproportionately live in deprived neighborhoods.
We assessed neighborhood disadvantage using the ADI, outlined by @amyjhkind et al. in @NEJM.
2/ @AmerMedicalAssn's Center for Health Equity has followed state demographic reporting. 46 states currently report race/ethnicity, 49 report age, and 48 report gender.
This is a map on which #GoBigRed#GBR has a less than ideal meaning for Nebraska.
3/ Being a flyover state doesn't render us immune to inequity. Data from Douglas County (includes most of Omaha) shows disproportionate case incidence among Hispanic, Black, and Asian patients despite our county being ~70% non-Hispanic & White...
1/ So, today was a big day for @DrJRMarcelin and I. We've been developing curricula on "Structural Challenges & Inequities in Healthcare Delivery" for the @UNMCCOM M1 students as part of the Health Systems Science coil.
Thread on this #MedEd project + today's capstone 👇🏾
2/ With inspiration from @JonathanMetzl & Dr. Helena Hanson's work on #StructuralCompetency, we wanted to assemble a pilot set of experiences that would give @UNMC students a glimpse into local health inequities, from historical & community perspectives:
3/ We gave the M1s several introductory lectures & assignments focused on big-picture issues like #SDoH & disparities, creating a "structural DDx" for patients, unconscious #bias & #microaggressions, developing structural humility, and #racism in medicine...