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House staff education includes focus on health equity

Sep. 30, 2021, 10:03 AM

 

by Nancy Humphrey

This summer’s annual orientation for new interns, residents and fellows included a bold new discussion about the history of racism in Nashville and at Vanderbilt University Medical Center as well as topics on health equity and anti-racism in medical practice.

“Health equity is appropriately in the forefront of medical education right now, and faculty members involved in this year’s graduate medical education orientation agreed that we had an opportunity to boldly expand the conversation with new doctors,” said Kyla Terhune, MD, MBA, vice president for Educational Affairs and associate dean for Graduate Medical Education.

“Our residents and fellows are recruited to Nashville based on Vanderbilt’s academic reputation and on Nashville’s reputation as a cosmopolitan city with a thriving country music scene — a fun place to live. But we don’t talk much about the more difficult aspects of the history of Nashville, which profoundly impact our patients and their health,” Terhune said. “We wanted to remind our house staff that this difficult history is more recent than they think, that it impacts neighborhoods and resources, and that some of our current patients remember a time in their own lifetime when they would have been segregated on a different ward when admitted to the hospital.”

The five-part program presented during orientation included:

  • An introduction to the history of Nashville and VUMC with a focus on Black history, presented by André Churchwell, MD, vice chancellor for Equity, Diversity and Inclusion at Vanderbilt University, Chief Diversity Officer for the University, Levi Watkins Jr. MD Professor of Medicine, and professor of Biomedical Engineering and Radiology and Radiologic Sciences.
  • Introduction to antiracism, health equity and VUMC’s institutional health equity efforts, led by Consuelo Wilkins, MD, MSCI, Senior Vice President for Health Equity and Inclusive Excellence at VUMC and Senior Associate Dean for Health Equity and Inclusive Excellence in the Vanderbilt University School of Medicine;
  • Seeds of Equity Training, led by Elisa Friedman and Carleigh Frazier from the Office of Health Equity.
  • Neighborhoods of Nashville, led by Tiffany Israel, LCSW.
  • Introduction to the institutional and community resources used to assess and address social determinants of health, including Shade Tree Clinic; Clinic for Transgender Health; Open Table Nashville; Second Harvest of Nashville; Tennessee Department of Health, VUMC Bridge Clinic; and Siloam Health.

It also included interactive sessions and a new online guide for assessing and addressing social determinants of health, developed by the Vanderbilt University Social Mission Committee for VUMC trainees, staff and faculty.

“With the wealth of expertise in health equity both within and outside of our institution, we felt it was critical to welcome new physicians to VUMC by grounding their practice in an orientation in health equity,” said Sophia Kostelanetz, a postdoctoral research fellow and co-leader of the Nashville Chapter of the Campaign Against Racism, who helped develop and implement the curriculum. “We hope this…reflects the values of our institution as well as empowers our trainees to know that they have the foundational knowledge and tools to advance health equity.”

Terhune said the orientation was well received by those who participated.

“Usually orientation is ‘here’s your parking sticker; do you have your immunizations; here are your scrubs;’ and filling out a lot of paperwork. This year’s orientation was a very unique way of covering not just the required aspects of orientation, but also ‘here are the people you’re going to be caring for and here are some things that impact them,’” Terhune said.

Rahul Shah, a first-year resident in internal medicine, said he believes the focus on health inequities and racism should be incorporated at every institution, in a way that’s patient-centered and specific to the state and town of the training program.

“Understanding the local history of racism in medicine and understanding the community are both critical to delivering the best care to patients inside the hospital and working to make sure we can promote their health outside of it,” he said.

“Our takeaway is that we as physicians have an ethical obligation to our patients to prioritize health equity in our practice of medicine, to combat the structural components of our health care system that bring harm to our patients of color. Such a large part of what promotes a patient’s health and well-being revolves around what happens outside the hospital — access to medications, physical therapy, home health, fresh and affordable food, mental health counseling, safe green spaces to exercise, and so on,” Shah said. “So, in addition to learning about the medicine during our training, we have a duty to learn about our community and its resources for underserved and marginalized patients, as well as work with our case managers and social workers to make sure our patients can access the resources they need outside the hospital.”

Anna Berry, a first-year internal medicine-pediatrics resident, said she believed one of the most important parts of the orientation was the exploration of Nashville’s and VUMC’s history of race relations.

“As trainees who often come from various parts of the country and world, we are often thrust in the midst of this cultural narrative and may not entirely understand the background of the very systems in which we participate,” she said. “By understanding the historical backdrop upon which we practice daily, we might be empowered to have a broader understanding of the complex web of relationships between the health systems and the disenfranchised populations in our own backyard.”

Berry said she hopes the information she gained during orientation will serve as a stepping stone to learn more. “Personally, it has motivated me to continue to learn more about the communities I serve, and I hope to engage in shared decision-making in a more culturally-humble, curious and empathetic manner.”

Terhune said that with the aid of an American Medical Association Reimagining Residency Grant, VUMC is working with the University of Mississippi to incorporate a similar training for its house staff next year.

“The patterns will be different in different cities with different histories, but there’s a lot you can do on an institutional level to impact an individual’s care they will receive.”

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