Between studying for exams, preparing for simulated patient encounters and cramming for national board exams, a growing group of students at DMU are leading changes in medical education. They are building on DMU’s legacy of diversity and inclusion. They are learning to recognize, discuss and intervene in the structural social, political and economic forces that shape disease distribution, access and quality of care, and biases within the health care system. This structural competency education, modeled on the successful Diversity Health Series, takes place as the Seeking Justice Series, student-organized lectures and events that occur throughout the academic year.
In accordance with its mission and values, DMU supports and promotes diversity and inclusion. The Office of Multicultural Affairs puts on a wide variety of educational events and programs. The Diversity Health Series (DHS) program, for example, started as a small group of participants gathered for lunch-time education and discussion; the series was so influential in forming competent and compassionate medical professionals that it has been instituted into the core curricula of the podiatric, osteopathic and physical therapy programs. The physician assistant, health care administration and public health programs also utilize aspects of the series.
Leading entities that evaluate medical education have increasingly recognized that educating medical students about culture and its implications for health and health care delivery leads to better health care. That helps confront bias and disparities that exist throughout our health care system. The American Association of Colleges of Osteopathic Medicine, for example, lists cultural competency as one of its core competencies.
Many argue that cultural competency education has its limits. After all, many variables beyond and within culture influence health: race, ethnicity, social class, religion, sexual orientation, gender identity and physical ability. The social determinants of health have also emerged as important ways of thinking about and stratifying risk of illness and wellness among different populations, as well as informing public health interventions. Structure, then, is what interfaces with, informs our understanding of, and underlies both cultural formation and social determinants of health.
Cultural competency/humility education has tended to focus on cross-cultural expressions of health and illness, and it enables communication and treatment that reduces stigma and is more appropriate for the patient. Structural competency education, by contrast, examines the forces that influence health above individual interactions. It focuses more on what the patient or community experiences before and after the exam room. And it includes a broader armamentarium of conceptual frameworks with which to understand how symptoms, diseases and attitudes present to the clinic.
The student-led Seeking Justice Series (SJS) encourages a broad variety of topics for discussion. Students typically select topics that are both informative and relevant to the practice of medicine. An example would be to watch several news clips about the burgeoning opioid epidemic followed by a discussion led by a faculty member familiar with the issue. Students learn about the complex nature of issues that exist beyond the medical realities of pain, addiction, overdose and so on. For example, they would learn that financial contributions coming largely from pharmaceutical companies and groups they fund pushed for a drastic change in opioid prescribing practices. They would perhaps discuss the ethical responsibilities that physicians have to prevent such harm to patients. They may discuss the racial differences apparent in the treatment of addiction. Students may then discuss how they as clinicians can engage at various levels, from clinical to community to national political campaigns, to produce change.
In summary, justice is increasingly integral to the practice of medicine. Research continues to shed light on the complexity of social issues and how they influence health. Our health care system faces a growing burden of chronic disease rooted in lifestyle, cultural formation and social determinants. The growing movement for structural competency promises new advancements in the care of patients and their communities that address stigma, bias and disparities – and the forces that produce them – in new ways. DMU students, with help of University leaders, are helping lead this momentous change in medical education.
James Miller, D.O.’19, is co-founder of the Seeking Justice Series with Luke Botting, D.O.’18. He is “eternally grateful” to the students and faculty who founded and continue to build the series. He plans to match into a psychiatry residency. He can be reached at James.C.Miller@DMU.edu.