Beginning next year, Dell Medical School students will have a greater focus on health equity in their studies.
The medical school at the University of Texas is adding an eighth focus of study, which it calls a core competency, to the curriculum. It joins the other core competencies: leadership and innovation; patient care; medical knowledge; communication; practiced-based learning and improvement; systems-based practice; and professionalism.
Under the health equity core competency, students will learn about the historical context of discrimination, how to recognize structural and social determinations of health, and structures of oppression within medicine. They also will learn how to identify their own biases and privileges; how to build relationships with a diverse group of people; and how to work with community-based partnerships. They will be taught how to advocate for inclusion and intervene when they see barriers, discrimination, biases and microaggressions.
Dr. Beth Nelson, associate dean of undergraduate medical education, said the school began looking at how to teach health equity when it opened in 2016, with a milestone in 2018 when it hired an associate dean of health equity.
Some of the health equity content was already in existing courses, but after the spring of 2020, when social justice issues were at the forefront and COVID-19 illustrated the disparities of health outcomes among people of color, the school began to think about how it could better teach health equity, Nelson said.
Working with an advisory group that included students, the school decided to make it a core competency “as an important metric, to be able to embrace what it means to be a physician that graduates from where we are,” Nelson said.
Nelson sees health equity teachings as permeating the work the school already does. For example, in the third year, students take a problem-solving course in which a group of three to five students work with a community resource to solve a small problem. Now, they will be asked to consider health equity in the problem they choose and the way they solve it.
“The students coming to Dell are really hungry for this kind of knowledge and hungry for an environment that embraces it,” Nelson said. “They are very aware of these kinds of problems and have a commitment to see social changes.”
Health equity is part of a shift currently happening in medicine from just looking at the patient to considering how that patient fits into a broader population, Nelson said: “Decisions made for the individual have consequences more broadly.”
Part of this work means Dell Medical School is looking at its own diversity. The faculty is 54.5% male and 64.5% white. Asians make up 19%, African Americans 4.8% and Hispanics 9.4% of its faculty. Faculty who are considered “underrepresented in medicine,” those who self-report as African American, Hispanic, American Indian or Hawaiian/Pacific Islander, make up 14.2%.
“Nobody at Dell feels like we are where we need to be,” Nelson said. “We’re really trying to work on strategies to improve that.”
In the student population, the incoming class is 58% female and 30% underrepresented in medicine, which has increased 10% from the previous year.
With building health equity curriculum and increasing the diversity of faculty and students, Nelson said, “We are just at the beginning of a long journey. We’ve got a lot of momentum.”