Health Equity and Social Justice at the Saint Joseph Hospital Family Medicine Residency
We recognize that our patient population is at risk for poor health outcomes secondary to inequities in our health care system. We also recognize the opportunity to address health equity as a core part of our residency curriculum. Included in this is our program’s approach to teaching and practicing anti-racism, our intention to promote and become a more diverse and inclusive community, and our work in leadership and advocacy. We are actively addressing this on a number of fronts through the following actions:
- We have established a Social Justice Work Group with engaged representation from resident and attending physicians and other residency program and clinic associates.
- Our ideal residency is one that is committed to caring for our unique patient population and to addressing health disparities. We realize that having physicians from diverse backgrounds helps address implicit bias inherent in healthcare. To this end we commit to increasing the diversity of our residency program, including our attending physicians, our resident physicians, and our associates. We are taking a data driven approach to this work and are actively monitoring our progress.
- We have developed a Spanish language training curriculum to help resident physicians (and others) acquire Spanish language skills during their residency training.
- We have a didactic curriculum that includes subject matter related to health equity and social justice. We are continuously evaluating this curriculum to ensure that it is meeting the needs of our patients, our resident physicians, and other providers and staff.
- We are constantly working to ensure that all staff and providers are educated in delivering culturally competent and inclusive care to do whatever we can to ensure that our clinic is a welcoming and safe place for all patients to receive care.
- We provide advocacy opportunities for resident physicians to learn advocacy and leadership skills during their training that will help them address health equity and inclusion in their careers. We are working to ensure that these opportunities meet resident physician needs.
Our work in the realm of social justice and health equity encompasses five broad categories. These are:
- Population and patient panel management, with a particular focus on addressing health disparities
- Advocacy and Leadership
- Community Engagement through PGY3 community medicine longitudinal experience
- Addressing Diversity and Inclusion within our residency program and in the clinic, and
Our work within each of these areas is further described below. We also partner with and are active members in our institution’s GME Diversity, which explores ways to promote equity, diversity, and inclusion at the broader GME wide level within Saint Joseph Hospital.
Population and Patient Panel Management, with a particular focus on addressing health disparities
- Introduction to basic concept of population health and panel management
- Learning how to run a report on your patient panel through Epic and how to do so to identify different patient groups (ie patients with hypertension, diabetes, etc)
- We are continuing to developing tools to address the following future goals:
- Identifying and addressing disparities in care among various patient groups on panels (ie African Americans, Latinx patients, older adults, etc)
- Identifying ways to improve the quality of care that we deliver to patient populations typically at higher risk of poor outcome secondary to social determinants of health (e.g. maternal and infant mortality, mortality in general-hypertension, A1c)
Advocacy and Leadership
- We partner with the Colorado Academy of Family Physicians in theirDoc of the Day Program to provide medical services and learn advocacy two days each month during the legislative session.
- We partner with both the Colorado Academy of Family Physicians and the Colorado Association of Family Medicine Residencies to advocate for our patients and our specialty.
- Advocacy for local neighborhood support through local business investment (ie use of local caterers for our noon conference meals)
- Future possible areas of advocacy that we are exploring include the following:
- Advocacy for increased support of hospital and clinic associates through increased pay and benefits
- Enhanced advocacy for increased local neighborhood support through local business investment and other initiatives (ie recruitment for jobs and contracts)
- Increased partnership with The Center for Health Progress to advocate for health care reform to address health equity and justice
- Advocacy through partnership with the Colorado Immigrant Rights Coalition
- Advocacy through White Coats for Black Lives
- Community Medicine is a longitudinal rotation primarily during the third year of residency.
- During PGY1, residents have protected time to orient themselves to the community we serve. Highly motivated residents may find time to establish and continue a partnership into PGY2 with a community organization of their choice.
- Third year residents have approximately one half day per month blocked to work with one of our community partners. In 2020-21, our partners include:
- Patient and Family Advisory Council (work with our clinic’s patient advisory board to learn how we can continue to best serve our patients and the community)
- Urban Peak Youth Shelter Clinic (work with one of our faculty providing clinical care to homeless teens and young adults).
- Career Coach Mentoring at Manual High School (mentor 10th or 11th grade students from disadvantaged backgrounds at a neighborhood high school who are interested in health careers).
- Metro Caring (participate in projects serving clients at a local hunger prevention organization).
- Senior Support Services (work with faculty to provide medical care at a day center serving homeless older adults).
- Laradon Hall (work with faculty providing medical care at a care center serving intellectually and developmentally delayed children and adults)
Addressing Diversity and Inclusion within our residency program and in the clinic
- Resident recruitment
- Includes recruitment through national groups such as AMSA, SNMA, LMSA
- Recruit residents who have experience with friends/peers who are URM- this includes more diverse experiences than solely volunteering
- Faculty recruitment
- Increasing diversity among other clinic associates beyond resident and faculty physicians
- Implicit/unconscious bias training for resident and faculty physicians
- Working to increase the “pipeline” of URM in health careers through the health career mentoring program at Manual High School
- Areas of ongoing and future work include the following:
- Continue working with GME Diversity Council to explore opportunities to offer training for all staff on Equity, Inclusion and Diversity
- Work with the GME Diversity Council to improve inclusiveness of the training environment by exploring opportunities to match practicing physician “mentors” with resident physicians from similar backgrounds.
- Explore other opportunities for additional pipeline development (local middle schools and undergraduate institutions - such as pre-med student shadowing opportunities)
Curriculum (including the Spanish Language Training Curriculum)
- We continue to build out our curricular opportunities in the realm of health equity. This includes teaching in the following areas:
- Anti-racism and anti-sexism in medicine
- Care Management and Community Health Workers
- Care for the LGBTQ+ community
- Immigrant care curriculum
- Public Health curriculum
- Global Health curriculum
- Climate change and its effects on health
- We have an ongoing Spanish language improvement project designed to increase Spanish proficiency in order to improve patient care and interactions for our large Spanish-speaking population, which offers:
- Monthly 90 minute multilevel Medical Spanish classes
- Three day pre-orientation intensive medical Spanish course for new interns
- Spanish language acquisition and immersion. Residents may apply for funding to take a two week medical Spanish immersion in Guatemala or Costa Rica. During COVID we are exploring opportunities for possible local immersion opportunities in Denver and surrounding communities.
- Opportunities for conversational practice in the outpatient and inpatient setting to improve Spanish speaking skills.