School of Medicine Undergraduate Medical Education

Health Equity, Social Justice, & Anti-Racism Thread

Health Equity, Social Justice, Anti-Racism (HESJAR) Thread Curriculum

Course Description

All graduating medical students need to be competent in communicating with and advocating for patients, families and colleagues of diverse backgrounds. Physicians must be able to identify how conscious and unconscious biases can affect patient care, to explain how all aspects of diversity (including race, ethnicity, language facility, age, sex and gender identity, sexual orientation, differential abilities and disabilities, and faith practice) intersect with health outcomes, to commit to anti-racism, and to challenge themselves to learn from others while developing skills as effective cross-cultural communicators and advocates for high-quality patient care for every community.

This thread is designed to help students attain UCR Competency Objective 14 – conduct empathic and effective conversations with patients, families and colleagues of diverse backgrounds to promote health equity, social justice and anti-racism.

The goal of HESJAR is to help medical students learn to:

  • Increase health equity.
  • Advance health-related social justice.
  • Reduce the misuse of race within health care.

In order to move toward this goal, all graduating medical students will need to:

  • Develop skills in in identifying and addressing inequities within health care-related Systems, Cultures, and Structures (SCS).
  • Develop the skills and commitment to better understand, communicate with, and advocate for patients, families, and colleagues of diverse intersectional backgrounds.
  • Demonstrate the use of the Health Equity Framework (HEF) to support and interact with patients, families, and colleagues.

The HESJAR thread will coordinate, complement and build on relevant themes and topics existent in other SOM curricula/designated emphases such as Public Health and Social Medicine, Medical Humanities, Street Medicine, Correctional Medicine, LACE and Community Health. 

Course Contacts

Adwoa Osei – HESJAR Thread Co-Director
adwoa.osei@medsch.ucr.edu

Carlos Cortes – HESJAR Thread Co-Director
carlos.cortes@ucr.edu

HESJAR Ten Learning Outcomes

By the end of this thread students will:

  1. Communicate bidirectionally with members of all constituent societal groups to prioritize fair opportunities for every patient and family member to attain their full health potential (health equity).
    PCRS 4.1,4.2,4.6, 4.7, 5.1,5.2, 5.4,5.5,6.4 AAMC EPA 7,9,12,13,14
    1. Demonstrate respect, humility, and effectiveness when communicating with and advocating for patients, families, and colleagues of diverse backgrounds.
    2. Constructively use group generalizations as clues to individuals within the health care process while avoiding group-based assumptions and stereotyping.
    3. Demonstrate a recognition of cultural strengths and resources and an ability to incorporate them into conversations with patients and family members.
  2. Identify when and how racial factors affecting health care systems and patient management plans must be actively addressed for equitable health care outcomes (anti-racism).
    PCRS 2.4, 2.5, 3.3, 3.2, 4.1, 4.2, 4.6, 4.7, 5.1, 5.2, 5.4, 5.5, 6.4, 8.10 AAMC EPA 7,9,12,13,14
    1. Identify inequities within health care-related Systems, Cultures, and Structures(SCS).
    2. Identify and effectively address racial factors affecting health care systems, patient management plans, and health care outcomes.
    3. Describe how multiple intersectional aspects of diversity (such as race, ethnicity, culture, birth sex, age, faith practice, sexual orientation, language facility, differential abilities and disabilities, gender identity, and immigration status) may interact with the health care process and affect health outcomes.
    4. Apply the Health Equity Framework (HEF) in analyzing health care and medical education processes.
  3. Serve and advocate for patients from all backgrounds by recognizing their common humanity as well as the unique intersectional differences that reflect the various societal groups to which they belong (social justice).
    PCRS 2.4,2.5,3.2, 3.3, 4.1,4.2,4.6,4.7,5.1,5.2,5.4, 5.5,6.4, 8.10 AAMC EPA 7,9,12,13,14
    1. Recognize both the common humanity of all people and the unique intersectional differences that reflect the various societal groups to which individuals belong.
    2. Explain how factors such as privilege, bias, and intergroup misunderstanding can contribute to health inequities and identify strategies for addressing these challenges.
    3. Prescribe actions that can reduce these systemic, cultural, and structural obstacles to health equity, social justice, and racial equality.

Duration

Year Modules Health Equity Action Series OSCES
MS1 8 hours 8 hours N/A
MS2 6 hours 8 hours N/A
MS3 2 hours 8 hours 2 hours
MS4 4 hours 8 hours N/A

Delivery/Education Method

  • Lecture/Large Group
  • Online Module or Video
  • Small Group/Team-Based/Case-Based Learning Modules
  • Invited Speaker Presentations

Requirements

Students will complete:

  1. A minimum of four (4) hours per year of HESJAR related instructional and case-based learning modules (total 20 hours by the end of fourth year)
  2. Attend a minimum of four (4) monthly, one-hour Health Equity Action Series presentations. 
  3. Complete assigned pre-didactic material prior to each learning session and actively participate in discussions/case-based sessions/interactive group modules. 
  4. Submit a Group Advocacy Project (GAP) by end of fourth year to National Collaboration For Education To Address the SDOH.

Group Advocacy Projects

Group Advocacy Projects (GAP) should include one or more of the following: 

  1. Engaging in co-curricular leadership activities in an organization dedicated to bringing diversity to medicine.
  2. A project that addresses one of the social determinants of health for patients.
  3. Creating new curricular content (selective, elective, lunchtime talks, book clubs, journal club) that focuses on Health Equity or Social Justice or Anti-Racism in medical education or patient care.
  4. A PIP/ QIP that is dedicated to addressing health inequities in medicine.
  5. Five reflective short essays (2-3 paragraphs) on any HESJAR related/theme topic.
  6. One longer (3-4 pages) topic essay or patient encounter reflection doing a deeper dive on any HESJAR related material during the clinical years.
  7. Creation of an Advocacy Lab that addresses inequities, bias or disparities in clinical or research medicine/medical education. 
  8. Other group advocacy projects that address the learning outcomes and skills of HESJAR thread. These would need to be approved by thread director(s). 

 

Course Details

Health Equity Action Series

Monthly one-hour, invited speaker series addressing current thoughts and ideas in Health Equity, anti-racism and social justice during the academic year (AY). All students are required to attend a minimum of four hours of the series, each AY. 

HESJAR Themed OSCEs

Students in third year complete formative OSCEs formulated with HESJAR principles as a requirement of the Community Based Experience rotation.

Required HESJAR Modules

Year and Theme Module (Adapted from NCEAS and AAFP)

MS1

Structural Competency/
SDoH and Anti-Racism

Module I - 2 hours
Making America Healthier for All: What Each of Us Can Do  

Module II - 2 hours
Shifting the Paradigm Toward Social Accountability

Module III - 2 hours
Identifying and Addressing Patients' Social and Economic Needs in the Context of Clinical Care

Module IV - 2 hours
Racism, Sexism, and Privilege

MS2

Vulnerable Populations and
Trauma Informed care

Module V - 2 hours
People with Disabilities (Developmental, Sensory and Intellectual)

Module VI - 2 hours
Immigrant Populations in a Nation of Changing Policy

Module VII –2 hours
Screening for Toxic Stress Response and Buffering Factors: A Case-based Trauma Informed Approach to Health Equity.  

MS3

Economics/Policy/High Value Care 

 Module VIII - 2 hours
Community Vital Signs: Achieving Equity through Primary Care Means Checking More than Blood Pressure

MS4

HESJAR Roadmap 

Module IX - 2 hours
ACA Opened the Door for Payment Reform and Practice Transformation to Address Social Determinants of Health, Now What?

Module X - 2 hours
Access to Primary Care is Not Enough: A Health Equity Road Map

Assessment

Students’ assessments will consist of 

  • Completion of thread requirements.
  • Completion of Cultural Sensitivity/HESJAR themed OSCEs using the Health Equity Framework. 
  • Clinical summative assessments of students during clerkships.

 

Thread Policy

Students who complete more than 40 hours by end of fourth year obtain a certificate in HESJAR at graduation.

Students who do not complete these requirements will need to complete a set of alternative requirements and may be referred to the dean of education.

Recommended Reading Materials/Books

Expected Skills to be Developed Through Thread

  • Describe key principles of health equity and develop a detailed personal learning plan.
  • Consistently demonstrate respect for others by listening to and acknowledging divergent points of view.
  • Say other people’s names accurately, promptly correcting own and others’ errors.
  • Skillfully share appropriate information about one’s own professional or personal Background.
  • Proactively address cultural and socioeconomic issues with skill and sensitivity.
  • Effectively incorporate cultural strengths and culturally based resources into conversations with patients and family members.
  • Independently identify health disparities among disenfranchised societal groups, analyze root causes and develop ideas to address health disparities.
  • Identify how bias and systemic racism influence medical education and health care and develop anti-racist actions that can be taken to address these challenges.
  • Actively promote anti-racism by identifying and describing the difference between conscious and unconscious bias and how this can influence health care.
  • Speak up when appropriate to advocate for both patients and colleagues in order to counteract systemic racism and support equitable outcomes for all.

Sources