1/💡📝🧵"Building structural competency through community engagement" | @ClinicalTeacher

I tweet often about WHY health equity curricula should center #StructuralCompetency & community voices.

Our new #MedEd paper shows HOW we've tried to make it happen.
onlinelibrary.wiley.com/doi/10.1111/tc… Masthead for our manuscript in The Clinical Teacher, titled
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 👇🏽 Representative quotes from qualitative analysis of learner a
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.
Appendix 1. Full Acknowledgements, recognizing the many indi
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.
8/ Thanks to those who have supported our work over the years -- and, if anyone has trouble w/access, please feel free to DM!

CC @DrAlethaMaybank @JonathanMetzl @fernandodemaio @uche_blackstock @oni_blackstock @UREssien @LashNolen @tsaiduck77 @RheaBoydMD

onlinelibrary.wiley.com/doi/10.1111/tc…
A few quick additional thank yous: @asmeofficial @ClinicalTeacher @MedEd_Journal for the opportunity to share this work in the upcoming Special Issue on Diversity, Equity, & Inclusion + @AmerMedicalAssn for supporting @UNMC @KCaverzagie as an ACE Consortium school! #ChangeMedEd

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More from @rohankhaz

16 Jun
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…
3/
When CME began our report on pathway programs & workforce diversity, it was clear we needed to address our history. As we (@DrAlethaMaybank @FaithCrittenden @glass_heff_full) wrote in @Health_Affairs, this was a chance to go beyond declarative advocacy.
healthaffairs.org/do/10.1377/hbl…
Read 7 tweets
16 Nov 20
1/ @AmerMedicalAssn adopted two resolutions we wrote (CC @glass_heff_full @FaithCrittenden + more).

For the first time in AMA history, we have policy to explicitly & actionably fight for #antiracism in #MedEd, health care delivery, research, & practice.

🧵 from the #AMAmtg ImageImage
2/ First, let's be clear: we passed these policies by standing on the shoulders of giants, & especially women of color.

We cited almost 100 references by scholars including @CamaraJones @DorothyERoberts @zinzinator @DrMaryTBassett @RRHDr @tsaiduck77 @AmakaEMD @IHJM_ & others. ImageImageImageImage
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: ImageImageImage
Read 8 tweets
27 Aug 20
1/ What do #racism & #redlining have to do with inequities in #HIV outcomes?

Our new study just published in #ClinInfectDis examines neighborhood deprivation, race/ethnicity, and HIV viral suppression. Thread 👇🏾

#MedTwitter #MedStudentTwitter #IDTwitter

doi.org/10.1093/cid/ci… ACCEPTED MANUSCRIPT "Neighborhood Deprivation and Racia
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). An official U.S. Home Owners Loan Corporation (HOLC) map of Area Deprivation Index (ADI) map of the Greater Omaha Area, Racial Dot Map of Greater Omaha Area, demonstrating clear pr
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.

nejm.org/doi/full/10.10…
Read 8 tweets
14 May 20
1/ In @OWHnews @OWHopinion this morning, @DrJRMarcelin & I call for racial/ethnic #COVID19 data reporting in Nebraska.

We are currently the ONLY state reporting ZERO state-level demographics. Short thread about why this is a #HealthEquity nightmare 🧵👇🏾

omaha.com/opinion/midlan…
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.

ama-assn.org/delivering-car…
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...

dogis.maps.arcgis.com/apps/opsdashbo…
Read 7 tweets
31 Oct 19
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...
Read 11 tweets

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