By: Nikki Barrington
The COVID-19 pandemic laid bare undeniable health disparities in the United States, with a third of COVID-19 deaths occurring in Black patients, and significantly higher hospitalization rates occurring in patients of color relative to white patients. While important to understand, these raw numbers fail to acknowledge the humanity of the lives behind them, as well as the grief and resilience of the loved ones left to grapple with such tragedy.
When Dr. Magdala Cherry’s father, Mario Cherry, was diagnosed and hospitalized with COVID-19, even her position as a physician could not overcome these disparities, and Mr. Cherry died following a fall in his hospital bathroom after a failure to monitor his oxygen levels. In sharing her story, Dr. Cherry asked, “Can we step back and stop looking at these case numbers, at these fatalities and call them lives, lives we could not afford to lose? We failed them.”
These failures are steeped in centuries of systemic racism; as such, health curricula across professions must embrace anti-racist medical education to change the very fabric of our profession. Medical student and content creator Joel Bervell has worked to shed light on racism in medical education, including medical myths that continue to undermine the health of Black patients and communities to this day. For instance, a 2016 study found that 40% of first- and second-year medical students believed that Black skin was thicker and less sensitive to pain than white skin. Student doctor Bervell’s content also illuminates the dearth of dark-skinned bodies in medical illustrations, in particular dermatologic presentations of illness on dark-colored skin, making students and providers ill-equipped to diagnose patients of color accurately and efficiently. Furthermore, algorithms used to assess kidney function in healthcare institutions are often adjusted for race, making it more difficult for Black patients to become eligible for kidney transplants. Such adjustments to these algorithms continue to be included in health professions curricula, perpetuating treatment biases of which many students and providers may not be aware.
Young physicians and medical students such as Dr. Cherry and student doctor Bervell, along with their colleagues across healthcare professions, are determined to implement education and policy changes to improve outcomes for their marginalized patients. It is well-documented that interprofessional education and collaboration in health care settings leads to better outcomes for patients, reduces medical errors, and improves patient and provider satisfaction, but can the incorporation of health disparities education in these efforts lead to greater health equity?
A group at Samuel Merritt University in Oakland, California sought to answer this question by implementing a model for interprofessional learning specifically designed to reduce health disparities. In this program, teams of health science students worked to solve health disparities impacting local communities of color, with the teams ultimately participating in a mock city council meeting to advocate for funding proposals to address a variety of systemic issues. Similarly, a program at the University of Arkansas sought to combine interprofessional education and cultural competency training. In doing so, they found significant improvements in measures of both interpersonal learning and cultural competence. However, experts in the field advocate for more than cultural competence, instead emphasizing the importance of education around structural vulnerability in both interprofessional education and among interprofessional teams.
An assessment of structural vulnerability can be used to better understand how a patient’s illness is connected to factors including access to housing, transportation, nutrition, and safety, as well as employment opportunities and education. Such assessments help shift providers’ perspectives away from the idea of health as an individual responsibility – and therefore an individual failure in the event of illness – and toward the mindset that health is a product of a much broader structure in which marginalized groups are at a disadvantage. In practice, an interprofessional structural competency curriculum focusing on the impact of socioeconomic factors on health outcomes implemented among students, residents, and clinicians was found to shift clinical providers’ perspectives on their patients. In addition to reframing the way providers think about patients and making them more aware of their own biases, such interventions highlight the importance of interprofessional collaboration among all helping professions, including social workers, case managers, attorneys, and more, in addressing health disparities and providing an adequate support network for patients.
While these educational efforts and programs are key to establishing a foundation for systemic change, the question of their direct impact on health disparities remains. A review of health-inequity focused interprofessional education programs found improvements in patient health, including enhanced nutritional status, decreased hospital readmission rates, and fewer emergency department visits. Some articles included the review further reported improvements in specific health metrics including blood pressure, HbA1C, and triglyceride levels. In addition to these direct measures, health-inequity focused interprofessional education linked marginalized communities to outside resources, a vital component to ensuring the sustainability of such efforts over time.
Health disparities focused interprofessional education undoubtedly improves cultural competence, shifts perspectives on patients, and directly impacts health disparities via improved patient and community health outcomes. However, for these educational and curricular efforts to be effective, they must be translated into practice, including the elimination of racist medical protocols stemming from decades of abuse of marginalized communities in medical research and practice, and continuing interprofessional education emphasizing health disparities, structural competency, and collaboration both within and outside of healthcare and public health.
A discussion of interprofessional education and collaboration’s role in anti-racism efforts would be incomplete without an acknowledgement that white and non-marginalized providers and trainees such as myself must not remain complacent in addressing racially driven health disparities. We must listen to and amplify the voices of people of color across professions, recognize the justified distrust that patients may have of a healthcare system that has disproportionately damaged individuals and communities of color, and actively work to educate ourselves on medical racism, critical race theory, structural vulnerability, and health disparities. Engaging in this work will not only bring us closer to fulfilling our oaths as medical providers but will also provide a framework to address the disparities that led to the disproportionate loss of patients like Mario Cherry and so many others prior to and in the wake of COVID-19.
Hearst, MO & LL Dutton. The future deserves better – seeking health equity through interprofessional education, cultural humility and understanding structural context. Journal of Interprofessional Care. 2021: 35:sup1, 1-2.
Click here to learn more about the #NOTJUSTABLACKBODY campaign, dedicated to honoring the Black lives that were cut short from the injustice and racism surrounding the COVID-19 virus.
About the Author: Nikki Barrington, MPH is an MD-PhD student at Rosalind Franklin University of Medicine and Science. She received her BS from the University of California, Santa Barbara, and her MPH from the University of California, Davis. She is currently completing her PhD in neuroscience studying neuroinflammation in traumatic brain injury and plans to specialize in neurosurgery. She is co-founder and Director of Operations for the National Association for Interprofessional
Health Mentorship, Education, and Service (NAIHMES), whose mission is to promote health equity by training future health care providers to address the social determinants of health utilizing an interprofessional framework.
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