Social Justice and Health Equity in Medical Education

Raghav Goyal '21, Christina Dawson '21, Sam Epstein '21
uvmmedicine bloggers Raghav Goyal ’21, Christina Dawson ’21, Sam Epstein ’21

“[The] suppression of women health workers and the rise to dominance of male professionals was not a ‘natural’ process, resulting automatically from changes in medical science, nor was it the result of women’s failure to take on healing work. It was an active takeover by male professionals. And it was not science that enabled men to win out: The critical battles took place long before the development of modern scientific technology.”Barbara Ehrenreich and Deirdre English

Barbara Ehrenreich and Deirdre English’s 1975 book, Witches, Midwives, and Healers, was the first text that the Larner College of Medicine’s Social Justice Coalition discussed in October of 2017. This excerpt sets up our charge—despite its authoritative and evidence-based veneer, the underpinnings of medicine are highly political, social, and temporal. Medicine sits in a larger context, and the Social Justice Coalition’s overarching aim is to foster critical analysis of that context within the confines of medical education. What began as an informal reading group became an effort to engage the broader community, with a goal to bring the conversations out of the student lounge and into the classroom.

Health disparities along racial, ethnic, class, and gender lines (to name a few) are well-documented. Yet medical education has not historically explicitly addressed these inequities. The Social Justice Coalition seeks to change that — our goal is to foster critical self-inquiry among students and physicians so that we may be better equipped to build equitable and preventative systems of health.

The first-year course, Attacks and Defenses, served as a starting point for our efforts. We mapped different social themes—such as housing, access to clean water, and pharmaceutical pricing—to each week in the course in cooperation with the course director, and then worked with faculty to adjust relevant Professionalism, Communication and Reflection (PCR) sessions to match. Our hope was to use PCR as an anchor for conversations that started in class, both expanding the conversations happening in class and giving them a dedicated space to flourish. This structure has gone live for the Class of 2022.

We received largely positive feedback from this format, and we worked with individual course directors as well as school administration to develop and implement this model. Recognizing that curricular change is an iterative process, we are now working to evaluate and adjust as needed.

Our curriculum work, while deeply important, cannot stand on its own – social medicine must not simply be taught, it must be practiced. One of our core goals is to empower underrepresented minorities in medicine, and to support these students both academically and socially. We are working closely with the College’s Teaching Academy to analyze admissions and academic success data in the hopes of identifying intervention points.

We have also been closely working with the College’s Office of Diversity and Inclusion and the Student National Medical Association to create a wellness space for students, faculty, and staff of color.

Our overarching mission is to create a climate of conversation, and encourage critical self-reflection as students, faculty, staff, and as an institution. We hope to inspire conversations about class, gender, and race, and how each of these interact with biology and medicine to impact someone’s health.


Social Justice Coalition Vision and Mission

To develop the education and practice of social medicine at the Larner College of Medicine in order to prepare a cadre of physicians to better understand and more fully address the diverse hardships faced by our future patient populations.

It is our belief that today’s health burden in America — and globally — stems from structural divisions that segregate populations based on income and identity. By fostering critical inquiry about these issues now, we hope to better prepare ourselves to negotiate these barriers when we face them in our future practice as physicians.

The Social Justice Coalition serves as a platform for uniting the numerous voices in the Larner College of Medicine community that are advocating for more critical social dialogue in our training and establishing systems of justice and equity in the community. By pooling resources and finding commonalities between the efforts of different groups and individuals, we hope to encourage an atmosphere of critical social consciousness. In coalition, we seek to build sustainable curricular and extracurricular vehicles for making social justice and cultural competency a larger focus in the Larner College of Medicine community.

What are your thoughts about this topic?