The power of interdependence: Linking health systems, communities, and health professions educational programs to better meet the needs of patients and populations.

Promoting optimal health outcomes for diverse patients and populations requires the acknowledgement and strengthening of interdependent relationships between health professions education programs, health systems, and the communities they serve. Educational programs must recognize their role as integral components of a larger system. Educators must strive to break down silos and synergize efforts to foster a health care workforce positioned for collaborative, equitable, community-oriented practice. Sharing interprofessional and interinstitutional strategies can foster wide propagation of educational innovation while accommodating local contexts. This paper outlines how member schools of the American Medical Association Accelerating Change in Medical Education Consortium leveraged interdependence to accomplish transformative innovations catalyzed by systems thinking and a community of innovation.

Caring for Vulnerable Communities in Miami Dade County during the COVID-19 Pandemic.

In response to the COVID-19 pandemic, the Herbert Wertheim College of Medicine's Neighborhood Health Education Learning Program (NeighborhoodHELP) initiated a longitudinal assessment and mitigation of social and health care challenges for a population of approximately 850 underserved households. Here, we describe the needs assessment, ensuing interventions, and lessons learned during this pandemic.

Developing the Community Engaged Physician: Medical Students Reflect on a Household Visit Curriculum.

INTRODUCTION:  To educate students about social determinants of health, our medical school assigns interprofessional student teams to work longitudinally with underserved households to identify and address their health and social needs. To cultivate reflective practice--an essential component to training competent professionals through service-learning programs--students are asked to recognize their emotional responses to patient encounters. This project used reflective essays to identify the emotional responses of medical students to the start of their household visit experience and to assess their observations in relation to social determinants of health. METHODS:  Thematic analysis was used to examine patterns in reflective essays provided by 99 medical students. Two independent reviewers read the essays and created initial codes, which were developed into a common codebook by consensus. Codes were categorized into themes, including observations of the social determinants and emotional reactions to household visits. RESULTS: Through the provision of household-centered care, medical students recognize the roles that social determinants play in the health of patients, households, and communities. Furthermore, they are able to identify household and community level interventions to address these identified needs. A variety of emotional responses to household visits were identified, ranging from frustration and sadness to empathy and humility.  Conclusions: Medical students undergo an emotional evolution even at the start of their household visit experience; highlighting that early patient care responsibilities play an important role in their development from pre-professional students to doctors-in-training. Additionally, student observations of the social determinants suggest that household visits can provide an opportunity for the application of knowledge about identifying and addressing these barriers to care.

Addressing the Social Determinants of Health in Undergraduate Medical Education Curricula: A Survey Report.

PURPOSE: Social determinants of health (SDH) are recognized as important factors that affect health and well-being. Medical schools are encouraged to incorporate the teaching of SDH. This study investigated the level of commitment to teaching SDH; learning objectives/goals regarding student knowledge, skills, and attitudes; location in the curriculum and teaching strategies; and perceived barriers to teaching SDH. METHODS: A team from the American Medical Association's Accelerating Change in Medical Education Consortium developed a 23-item inventory survey to document consortium school SDH curricula. The 32 consortium schools were invited to participate. RESULTS: Twenty-nine (94%) schools responded. Most respondents indicated the teaching of SDH was low priority (10, 34%) or high priority (12, 41%). Identified learning objectives/goals for student knowledge, skills, and attitudes regarding SDH were related to the importance of students developing the ability to identify and address SDH and recognizing SDH as being within the scope of physician practice. Curricular timing and teaching strategies suggested more SDH education opportunities were offered in the first and second undergraduate medical education years. Barriers to integrating SDH in curricula were identified: addressing SDH is outside the realm of physician responsibility, space in curriculum is limited, faculty lack knowledge and skills to teach material, and concepts are not adequately represented on certifying examinations. CONCLUSION: Despite the influence of SDH on individual and population health, programs do not routinely prioritize SDH education on par with basic or clinical sciences. The multitude of learning objectives and goals related to SDH can be achieved by increasing the priority level of SDH and employing better teaching strategies in all years. The discordance between stated objectives/goals and perceived barriers, as well as identification of the variety of strategies utilized to teach SDH during traditional "preclinical" years, indicates curricular areas in need of attention.

Socially Accountable Medical Education: An Innovative Approach at Florida International University Herbert Wertheim College of Medicine.

PROBLEM: Despite medical advances, health disparities persist, resulting in medicine's renewed emphasis on the social determinants of health and calls for reform in medical education. APPROACH: The Green Family Foundation Neighborhood Health Education Learning Program (NeighborhoodHELP) at Herbert Wertheim College of Medicine provides a platform for the school's community-focused mission. NeighborhoodHELP emphasizes social accountability and interprofessional education while providing evidence-based, patient- and household-centered care. NeighborhoodHELP is a required, longitudinal service-learning outreach program in which each medical student is assigned a household in a medically underserved community. Students, teamed with learners from other professional schools, provide social and clinical services to their household for three years. Here the authors describe the program's engagement approach, logistics, and educational goals and structure. OUTCOMES: During the first six years of NeighborhoodHELP (September 2010-August 2016), 1,470 interprofessional students conducted 7,452 visits to 848 households with, collectively, 2,252 members. From August 2012, when mobile health centers were added to the program, through August 2016, students saw a total of 1,021 household members through 7,207 mobile health center visits. Throughout this time, households received a variety of free health and social services (e.g., legal aid, tutoring). Compared with peers from other schools, graduating medical students reported more experience with clinical interprofessional education and health disparities. Surveyed residency program directors rated graduates highly for their cultural sensitivity, teamwork, and accountability. NEXT STEPS: Faculty and administrators are focusing on social accountability curriculum integration, systems for assessing and tracking relevant educational and household outcomes, and policy analysis.

Breast Health Disparities: A Primer for Medical Students.

INTRODUCTION: While breast cancer incidence rates have remained stable and mortality rates have declined for white women, breast cancer mortality has steadily increased for African American women since the 1950s. It has often been assumed that genetic risks linked to African ancestry are the cause for these disparities. However, a better understanding of the role of stress and social and environmental factors in health lends evidence to the social determinants behind the increasing gaps in breast health outcomes. This resource's goal is to raise awareness among undergraduate medical students about breast cancer disparities, particularly the late-stage diagnoses and the higher mortality rate for African American women. METHODS: Our educational session included a lecture on basic epidemiological data and information on breast cancer etiology followed by a case study, which was created with the founder of a local cancer support and resource center serving mainly African American women diagnosed with breast cancer. As part of the case exercise, we utilized concept mapping as a tool to apply learning. RESULTS: Pre-/postquizzes showed significant improvements in knowledge and confidence in working with patients. Narrative reflections from students indicated an improvement in targeting at-risk populations, educating patients about their risk and options, and understanding the complex role that socioeconomic factors may play in patient outcomes. DISCUSSION: By raising awareness and exposing medical students to the socioeconomic and cultural aspects of breast health, we hope to improve medical students' knowledge of risk factors and preventive strategies, as well as their abilities to guide patients through appropriate screening and follow-up.

Strategies for improving the Office of Minority Health.

The Office of Minority Health (OMH) was established in 1986 to improve and protect the health of racial and ethnic minority populations in the United States through the development of health policies and programs that will eliminate health disparities. Since its initial congressional mandate, it has produced multiple programs, campaigns, publications, and educational materials promoting the health of ethnic minorities. However, its continued existence is by no means assured. Recently, it faced harsh criticism regarding the success of its programs, and congressional leaders have introduced legislation designed to modify the office and its minority focus. In this report, we review 1) the accomplishments and inefficiencies of the current office and 2) provide recommendations to improve OMH's effectiveness in reducing health disparities and addressing health issues in minority populations.