Students volunteering at the Midnight Mission in Los Angeles.

 

A commitment to social justice is built into the DNA of the Keck School of Medicine, and providing medical students with dedicated content and training in Health Justice has been in the planning since 2018. The coronavirus pandemic and recent outrage over police brutality have made such instruction even more relevant and urgent.

The new KSOM curriculum will be known as the Physician-Citizen-Scholar curriculum, to be implemented in the Fall of 2021 with the class of 2025. The curriculum’s emphasis on Health Justice reflects the special role and responsibilities of physicians as citizens in our society.

Building on the more than 100-yearlong history of caring for the underserved patients of Los Angeles County at the LAC+USC Medical Center, the focus on Health Justice in the medical school curriculum demonstrates KSOM’s deep commitment to equity, justice and structural transformation to ameliorate health disparities. It also recognizes that physicians trained in Health Justice will be best-positioned to be at the forefront of social change.

Even more important today

The pandemic has hit people of color much harder than whites: There are about 15 fatalities per 100,000 white Los Angeles County residents, half the fatality rate of Black, Latino and Pacific Islander residents.

After George Floyd was killed by a police officer in Minneapolis on May 25, setting off protests around the country, Keck School Dean Laura Mosqueda, MD, wrote in a message that the death of Floyd and others “are symptoms of the same inequalities that contribute to poorer health for people of color in the United States.”

“We were inspired by Dr. Mosqueda saying to me, to us, that she wants the Keck School of Medicine to be known for social justice,” said Donna Elliott, MD, EdD, vice dean for medical education and chair of the Department of Medical Education. She added that inequalities seen during the pandemic, and those unjust deaths, are not new experiences for the Black community.

“This isn’t an a-ha moment in our history,” she said. “This is just a moment where a light has been shined on what’s been happening for decades.”

Long in the works

Elliott and Ron Ben-Ari, MD, associate dean for curriculum, started planning for a Health Justice themed curriculum as far back as September 2018.

“What’s remarkable is this confluence of events,” Ben-Ari said. “The pandemic laid bare the health disparities in our community. We were already having a national conversation about worse outcomes in people of color and poor communities from the pandemic. Then on top of that, the public broadcasting of the killing of George Floyd further laid bare the systemic racism and police brutality in our society.”

The goal of the Health Justice Curriculum is to condition students to look beyond diagnosing a patient’s illness and to dig deeper.

“It’s taking a step back to look at the root cause of why patients have certain health risks,” Elliott said, “and then arming students with that knowledge to help them build skills to help them advocate for their patients. A large focus of our curriculum is advocacy, to allow students to engage with communities in a way where they’re not bystanders.”

The program will include mentoring from faculty, content on health policy, population health, public health, and structural competency. Students will participate in community engagement experiences and will work in clinical venues in the surrounding neighborhoods so they can see first-hand the obstacles to care faced by patients in the community. At graduation, all students will receive a certificate in Health Justice.

Better physicians

How can knowledge of health justice make someone a better doctor?

“We have always taught students to seek to understand their patients,” Ben-Ari said. “And the reality is that, as it’s being revealed in this moment, even though people think they understand, there is a huge disparity between knowing someone’s medical history and having an understanding of the historical scope and the structural elements that actually influence their current circumstances and their care.”