Prioritizing Health Disparities in Medical Education to Improve Care

Agenda

* Presentation times are subject to change.

Abstracts

Education for Equity: A Long Journey
Fitzhugh Mullan, MD, George Washington University

Giving all students at any level a "fair shot" at excellent opportunities at the next level of education and success in the long run is a challenge for a democratic society. Family income, housing, race/ethnicity, and geography often collude to tilt the playing field in ways that are unfair to the rising student. These factors build on themselves so that the barriers to advanced education in fields like medicine can become virtually insurmountable. The Civil Rights movement opened many doors for African Americans and other minorities with the result that many more attended medical school. Fifty years later, however, progress toward parity in attendance has faltered. Why — and what should be done?

Translational Research Education and Career Development: A Route to Eliminate Health Disparities
Estela S. Estapé, MT, PhD, DHL, University of Puerto Rico, Medical Sciences Campus

There are many ways to address the goal of eliminating health disparities and one of them starts after one has become a professional and feels the desire to make a difference in the health of others. One of the routes to follow in this path is by learning the research skills and knowledge of clinical and translational science and implementing what you have learned in a multidisciplinary teamwork environment. The route to follow can have many pathways to reach the target and some of these are crucial in the making of this new generation of clinical and translational researchers: communication, community, technology, mentoring, and entrepreneurship. The candidate can be a physician, clinician, health professional, a scientist, or a chemist; what unites them in this quest is their genuine desire to make a difference for a better quality of life. Therefore, in order to make a significant contribution to help in the elimination of health disparities, one of the effective ways is through the development of innovative multidisciplinary research degree programs with mentoring, collaborations, and formation of research teams as their essence for advancing clinical practice and outcomes.
 
This work was supported in part by the following Public Health Service Grants from the National Institutes of Health: R25MD007607/ R25RR017589, S21MD001830 and U54RR026139 at the University of Puerto Rico.

Linking University Health Resources to Social Determinants in the Community
Arthur Kaufman, MD, University of New Mexico

"Social Determinants" play the crucial role in health and illness in our communities. Educational attainment, food security and access to healthy food choices, adequate housing and safe neighborhoods have more to do with community health than healthcare provided in clinics or hospitals. Yet the focus of health professions education, research priorities, and the clinical services in which graduates work reflect current incentives favoring "downstream" interventions—subspecialty training and hospital- and procedurally-based services. Community-driven and "upstream" models for academic health centers exist, but remain at the margins of institutional effort. The University of New Mexico Health Sciences Center has taken steps to mobilize its education, research and service missions to address social determinants starting with a broad, publicly-disseminated vision that the institution would judge its success on the basis of the health of our communities. All medical students will now graduate with a Public Health Certificate, community engagement is forming a growing component of the institutions research enterprise and a new model of clinical service, the "Health Commons", links clinical service to social determinants by integrating primary care, specialty care, behavioral health, public health with a robust community linkage via community health workers. The "glue" that hold the innovations together at the community level are Health Extension Agents. Built upon an agricultural model, the University's Agents live in communities they serve across the state and link community health priorities with University resources in all mission areas while monitoring the impact of those interventions on community health.

Addressing Health Disparities through Molecular Epidemiology
Fritz François, MD, MSc, FACG, New York University School of Medicine

At its current rate of growth the racial and ethnic composition of the U.S. population will continue a dynamic shift towards becoming increasingly more diverse. According to the 2010 Census, the nearly 10% rise in the U.S. population in the previous decade was largely due to increases in the number of individuals who reported their race as non-white and those who reported ethnicity as Hispanic or Latino. By 2042 it is estimated that minorities will become the majority proportion of the population. Despite the impressive growth in population diversity, minorities continue to make up a disproportionately small percentage of medical school applicants, matriculants, and physicians relative to the general U.S. population. Among the 79,070 students enrolled in U.S. medical schools in 2010, 7% self identified as Black or African American, while 8% self-identified as Hispanic or Latino.
 
During a March 4th 2011 House Labor-Health and Human Services-Education Appropriations Subcommittee hearing, the Secretary of Health and Human Services, Kathleen Sebelius, specifically testified to the need for workforce diversity programs in recruiting and training individuals to address health disparities. This urgent call can and should be addressed by not only advancing innovative underrepresented minority recruitment initiatives but also through specific clinical and research education strategies.
 
Given the rapid rate of scientific advances in diagnostic and therapeutic modalities, the training of a diverse healthcare workforce to address health disparities should incorporate programs to develop and enhance skills in molecular epidemiology. Over the past two decades, while significant advances in medical diagnostic and therapeutic innovations have been made in infectious disease, cardiovascular health, and oncology, significant inequities remain in health outcomes according to factors such as race and ethnicity, sexual and gender orientation, income, and education. Having an understanding of these inequities and being equipped to address modifiable determinants of health disparities provides the physician-in-training with the necessary foundation to effectively practice medicine in the 21st century.

Diversity as a Driver of Health Equity
Marc A. Nivet, EdD, Association of American Medical Colleges

Academic medicine is beginning to reach consensus that diversity and inclusion, when appropriately managed, are core to, not separate from, the pursuit of excellence. While there is a noticeable increase in commitment to diversity and inclusion efforts, we have yet to see widespread evidence of effective, integrated initiatives across the three mission areas connected to meaningful metrics and accountability. We need to better empower leaders to bring the value of diversity and inclusion to bear for their institutions and the communities they serve.
 
This presentation will (i) introduce Diversity 3.0, a framework for animating diversity to improve the health of all, (ii) explore the link between a culture of inclusion and excellence in medical education, patient care and discovery, and (iii) advocate for the urgency of an evidence-based approach to diversity work.

Improving Quality and Achieving Equity through Cross-cultural Education
Joseph R. Betancourt, MD, MPH, Massachusetts General Hospital, The Disparities Solutions Center

The Institute of Medicine Report "Unequal Treatment" recommended a broad set of activities to address racial and ethnic disparities in healthcare—among these was cultural competence training for all healthcare professionals. The field of cross-cultural education has grown significantly since this time, and continues to define itself as a discipline. For over twelve years, Dr. Betancourt has been involved in cross-cultural education for medical students, residents, practicing clinicians and front-line healthcare staff. Through e-learning, his programs have been used to train over 100,000 health care professionals across the country. In this presentation, Dr. Betancourt will provide key perspectives and lessons learned on how the field has evolved, including a discussion of key principles, learning objectives, teaching methods, and new innovations.

Health Disparities and Social Justice: A Call to Action for Academic Health Centers
Claire Pomeroy, MD, MBA, University of California Davis Health System

The U.S. healthcare system faces unprecedented challenge and change. Despite spending about twice as much per capita as any other nation, the nation's health outcomes are inferior to those of many other countries and reflect unconscionable disparities on the basis of race, ethnicity, socioeconomic status, geography, and immigration status. The Patient Protection and Affordable Care Act will increase access for many previously uninsured citizens and will reform insurance payments. But, it will unfortunately leave the systems for delivering healthcare largely untouched. It is our responsibility to find innovative approaches that fundamentally transform healthcare.
 
To truly improve health, we must ask new questions; incentivize new behaviors; and develop new models of health care, discovery, and education. New models must focus on prevention and wellness, and address the "upstream" drivers of health — especially the social determinants of health, like poverty reduction, educational opportunities, and safe neighborhoods. To do this, we must embrace interprofessional approaches to healthcare and expanded interdisciplinary approaches to research. We must work across sectors that have traditionally functioned in isolated silos. Academic health centers must be at the forefront of this change — as we train the next generation of thought-leaders, provide patient care, perform research, and help shape health policies.

Potential Alignment of Health Disparities Curricula to Enhanced Minority Recruitment for Careers in Academic Medicine
Mekbib Gemeda, MA, New York University Langone Medical Center

Diversity at academic medical centers has not progressed much over the past two decades. The number of underrepresented minority faculty at U.S. medical schools—African American, Hispanic, Native American—has remained locked at 3%, 4.2% and 0.3% respectively. A number of reasons have been identified for the dearth of underrepresented minorities at academic medical centers, including a subpar k-16 education system that has failed to prepare and engage underrepresented minorities to pursue careers in science related fields. Further up the pipeline, other barriers emerge to discourage minority academicians from reaching their potential. A study commissioned by the National Institutes of Health (NIH) in 2011 identified gaps in NIH funding success rates for black researchers. The lack of professional development and promotion opportunities for underrepresented minority faculty within academia has also been well demonstrated.
 
While these challenges remain significant, there are a few factors that have the potential to boost the training and retention of a diverse academic workforce. First, the initiative by the NIH to advance translational research to expedite the translation of discoveries at the bench to clinical interventions in the community promises greater impact on addressing health disparities. Second, new initiatives to integrate population health and health disparities in the core medical curriculum offer the opportunity to expose, engage and retain trainees interested in working with underserved communities as academic physicians. Both these initiatives resonate with underrepresented minority students and professionals who tend to be driven by an interest to serve underserved communities.
 
The brief presentation will explore barriers to recruitment and retention of underrepresented minorities into academic medicine and discuss the potential of a medical curriculum focused on population health and health disparities to attract and retain a more diverse workforce in academic medicine.

Educating Students to Deliver Comprehensive LGBT Patient Care
Mitchell R. Lunn, MD, Brigham and Women's Hospital, Harvard Medical School

Lesbian, gay, bisexual, and transgender (LGBT) people face specific health and healthcare disparities, and they are more likely than their heterosexual and cisgender counterparts to encounter barriers accessing appropriate medical care. Social stigma further exacerbates health risks. This talk will explore the current state of LGBT-related medical education including how medical education is quantified, which topics are currently covered in medical schools, and the barriers as well as various suggested strategies to increase or improve the quantity and quality of LGBT-related medical education. Recent government reports, recommendations for improved uniform data collection and a national LGBT health research agenda, and several novel endeavors by various individuals and organizations to improve awareness of and education in LGBT health will be discussed.

* Additional abstracts coming soon.

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