Embedding Health Equity in Policy, Practice and Participation Symposium

EQUITY POLICY IN THE TEACHING OF MEDICINE Dr. J-M Ferdinand Thursday, October 12, 2017

Declaration I have nothing to declare

Outline Objectives Case presentations Definitions Why is Equity Policy Important in the Teaching of Medicine? How to Teach Equity Policy in Medicine (recommendations from the Experts) Teaching Methods Questions

Objectives Understand the importance of Equity Policy in the Teaching of Medicine Identify opportunities to integrate Equity Policy in your workplace, and to partner with your local Institutions of Medicine to promote Teaching of Equity Policy Review examples of Teaching Methods included in the McGill Social Pediatrics rotation

David 16 year old boy referred to clinic for a simple surgical procedure. Arrived with his mother Otherwise healthy Doing well in school, plays sports, extracurricular activities, good friends Plans to finish high school, then go on to college Asks appropriate questions related to the procedure

Micheal 16 year old boy referred to clinic for a simple surgical procedure. Arrived with his mother Asthma since the age of 4 years. Stopped using his medications for 2 years. Undervaccinated. Sexually active. Socially drinks alcohol and smokes. Dropped out of school last year. Has no specific goals Has no questions related to the procedure

Gerald 16 year old boy referred to clinic for a simple surgical procedure. Arrived alone. His mother remained in the waiting room, at his request Appearance: apprehensive, make-up, long hair coiled in a bun Otherwise healthy “Challenges” at school. “Difficulty” with sports and extracurricular activities Plans to be a hair stylist Hesitantly asks appropriate questions related to procedure

Case Presentations-Questions What is the role of the Health Care Provider in each clinical encounter? How can we optimize the health of each patient? How can we provide culturally safe training for diverse students?

Definitions Health Equity (1) Social Determinants of Health (2)-WHO The absence of preventable or remediable health differences among groups of people Achieved when a person reaches their full health potential Social Determinants of Health (2)-WHO The conditions in which people are born, grow, live, work and age. Factors (3) SES, education, housing, employment, social support, food security, health service, early childhood, Aboriginal status, disability, etc

CANADA’S SOCIAL DETERMINANTS OF HEALTH

Why is Equity Policy Important in the Teaching of Medicine? Improve patient outcomes by eliminating health inequities Reduce healthcare costs Social accountability of medical schools (WHO) Accreditation Changing population demographics

Change Institutional Policy How to Teach Equity Policy in Medicine (recommendations from the Experts) PART 1 Change Institutional Policy Ownership Strategic plans: academic programs, research, admission, employment, promotion Create a safe learning environment Adapt the Curriculum Patient centered Learning outcomes and Content Unconscious bias Integrate across the entire curriculum Variety of settings and methods of Teaching

4. Assess, Re-evaluate and Keep Up to Date How to Teach Equity Policy in Medicine (recommendations from the Experts) PART 2 3. Faculty Development Compulsory training and assessment Multidisciplinary 4. Assess, Re-evaluate and Keep Up to Date Evidence based tools Include Satisfaction surveys of students, Faculty , patients and families Maintain evidence based practice by regular exchanges with other Medical Schools, Accreditation bodies, Research Institutions, etc.

Teaching Methods McGill Social Pediatrics Rotation Lectures (interactive)- Child Maltreatment Academic clinical setting (Hospitals, Medical School)- Complex Care, Multicultural clinic Discussion groups- Health Literacy, Ethics Role playing- Gender Identity Simulation- Mental Health Disorders Community- Harm Reduction Outreach van Projects- YMCA (new refugees)

Case Presentations-Questions What is the role of the Health Care Provider in each clinical encounter? Help patient achieve their health potential. How can we optimize the health of each patient? Determine, then address their needs in a patient centered environment How can we provide culturally safe training for diverse students? Start by changing institutional policy

References World Health Organization (2008) Closing the gap in a generation: Health equity through action on the social determinants of health: Executive Summary. Available at: http://apps.who.int/iris/bitstream/10665/69832/1/WHO_IER_CSDH_08.1_eng.pdf Public Health Agency of Canada (N.D.) The Social Determinants of Health: An Overview of the Implications for Policy and the Role of the Health Sector. Available at: http://www.phac-aspc.gc.ca/ph-sp/oi-ar/pdf/01_overview_e.pdf Keon, Wilbert J. & Lucie Pépin (2008) Population Health Policy: Issues and Options. Available at: http://www.parl.gc.ca/Content/SEN/Committee/392/soci/rep/rep10apr08-e.pdf https://www.cma.ca/En/Pages/health-equity.aspx Dogra, Nisha, et al (2009) Twelve Tips for Teaching Diversity and Embedding it in the Medical Curriculum. Med Teach. 31(11): 990-993. Achieving Health Equity: How Academic Medicine is Addressing the Social Determinants of Health. Available at: http://www.aamc.org/download/460392/datasdoharticles.pdf

QUESTIONS?

Accreditation of undergraduate medical education is undertaken jointly between the Committee on Accreditation of Canadian Medical Schools (CACMS) in Canada and the Liaison Committee on Medical Education (LCME) in the U.S. LCME Standards for Accreditation of Medical Education Programs Leading to the MD Degree Published March 2016. For the 2017-18 academic year (Effective July 1, 2017) 7.2 Organ Systems/Life Cycle/Primary Care/Prevention/Wellness/Symptoms/Signs/ Differential Diagnosis, Treatment Planning, Impact of Behavioral and Social Factors The faculty of a medical school ensure that the medical curriculum includes content and clinical experiences related to each organ system; each phase of the human life cycle; continuity of care; and preventive, acute, chronic, rehabilitative, end-of-life, and primary care in order to prepare students to: • Recognize wellness, determinants of health, and opportunities for health promotion and disease prevention • Recognize and interpret symptoms and signs of disease • Develop differential diagnoses and treatment plans • Recognize the potential health-related impact on patients of behavioral and socioeconomic factors • Assist patients in addressing health-related issues involving all organ systems 7.6 Cultural Competence and Health Care Disparities The faculty of a medical school ensure that the medical curriculum provides opportunities for medical students to learn to recognize and appropriately address gender and cultural biases in themselves, in others, and in the health care delivery process. The medical curriculum includes instruction regarding the following: • The manner in which people of diverse cultures and belief systems perceive health and illness and respond to various symptoms, diseases, and treatments • The basic principles of culturally competent health care • The recognition and development of solutions for health care disparities • The importance of meeting the health care needs of medically underserved populations • The development of core professional attributes (e.g., altruism, accountability) needed to provide effective care in a multidimensional and diverse society 7.9 Interprofessional Collaborative Skills The faculty of a medical school ensure that the core curriculum of the medical education program prepares medical students to function collaboratively on health care teams that include health professionals from other disciplines as they provide coordinated services to patients. These curricular experiences include practitioners and/or students from the other health professions.