1. Embedding Health Equity in Policy, Practice and Participation Symposium

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

3. Declaration
I have nothing to declare

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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?

10. 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

11. CANADA’S SOCIAL DETERMINANTS OF HEALTH

12. 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

13. 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

14. 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.

15. 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)

16. 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

17. 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:
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:
Keon, Wilbert J. & Lucie Pépin (2008) Population Health Policy: Issues and Options. Available at:
Dogra, Nisha, et al (2009) Twelve Tips for Teaching Diversity and Embedding it in the Medical Curriculum. Med Teach. 31(11):
Achieving Health Equity: How Academic Medicine is Addressing the Social Determinants of Health. Available at:

18. QUESTIONS?

19. 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 For the 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.