The Yale School of Medicine (YSM) Office of Education (OoE) has established a new Thread for the four-year medical student curriculum—the Health Equity Thread (HET). This Thread is designed to equip our students with the knowledge and skills needed to understand and respond to the challenge of assuring a diverse, equitable, and inclusive health care system for patients and communities. When fully implemented, the HET will rigorously engage learners at all stages of the medical curriculum. The HET starts in the pre-clerkship period and extends into the advanced training period in years three and four.
The goal of the Thread is to train the next generation of physicians and physician-scientists to confront and surmount structural barriers to high quality health care for all patient populations and communities. Specifically, the HET’s vision is that YSM students will help shape and lead a more equitable health care system, reimagine health care to reduce disparate outcomes, work to dismantle systems and structures that perpetuate inequity, bring innovation to education, champion workforce diversity, and conduct research that addresses these issues.
In response to student demands in 2015 for the YSM curriculum to more comprehensively address health disparities, social determinants of health, and issues of social justice in health care access and delivery, the Educational Policy and Curriculum Committee (EPCC) formed a subcommittee on Diversity, Inclusion, and Social Justice to survey the curricular content and activities in these areas, to identify opportunities for development, to make recommendations, and to provide a template for implementation.
In March 2018, this subcommittee, chaired by Marcella Nunez-Smith, MD, MHS, associate professor of internal medicine, and Douglas Shenson, MD, MPH, MS, MA, associate professor of internal medicine and public health, made recommendations for “the development of a robust health equity curriculum at Yale School of Medicine.” Among the recommendations endorsed for implementation by the EPCC from this report was the creation of a Health Equity Thread to cover content and provide a critical understanding of the impact of social differences and structures on health and health care.
Following the endorsement of the EPCC for the formation of this thread, the Associate Dean for Curriculum in the OoE, Michael Schwartz, PhD, and Darin Latimore, MD, the Deputy Dean and Chief Diversity Officer, who also oversees the Office of Diversity, Inclusion, Community Engagement, and Equity (DICE), jointly implemented a search to identify leadership for the Health Equity Thread.
In January 2020, Beverley Sheares, MD, MS, associate professor of pediatrics, was named the leader of the HET, and Shenson, the deputy leader. The Offices of Education and DICE jointly support these positions and a senior administrative assistant in the OoE provides administrative support for the Thread.
Schwartz describes Sheares as “a terrific and inspiring leader” who “has done a tremendous job of leading this Thread” since January, adding that her plans going forward are “inspirational.” Sheares has spent much of her career tackling issues of equity in the workforce, clinical care, and research. Schwartz cites Shenson’s concurrent role as the leader of the Populations & Methods Thread, enabling him to bring extensive experience on how to incorporate thread content into the curriculum, as well as Shenson’s role with the earlier EPCC review and recommendations, as important elements in his partnership with Sheares. Shenson also has a longstanding commitment and record of work in health equity.
The HET curriculum will include educational content that enhances a critical understanding of the impact of social structures on health and health care, and social differences on the doctor-patient relationship. It will address issues of race, ethnicity, gender, sex, disability, and sexual orientation and gender identity, as well as the intersectionality of identities on access and delivery of care. The plan is to identify where health equity can be added to the curriculum from admissions to graduation, with the goal that by 2023, 50% of the curriculum incorporates a health equity perspective in a meaningful way.
Sheares and Shenson explain that consultation and collaboration are central to their approach. They will meet with faculty and together with faculty decide how to best weave equity content into a course, or consider whether it is best to develop a stand-alone session on a particular topic that does not have a natural home in the current curricular framework. Sheares states that not every course is designed in such way that health equity topics can fit. Nonetheless, the HET aims to be a resource for the many faculty who seek to increase the health equity content in their syllabi.
Sheares and Shenson, the HET team, importantly will provide coordination and differentiation of social justice topics across the curriculum, to mitigate repetition and enhance the methodical building of knowledge and skills. They will evaluate the effectiveness of the Thread in meeting its goals. There also will be student and faculty assessments and adjustments to the curriculum made in response to feedback. The evaluation process will be one way the HET team assesses the quality, effectiveness, and responsiveness of Thread content to stakeholders.
Sheares describes the HET’s contribution as a “dynamic process.” Latimore believes “that if we are successful in really infusing equity into the curriculum, then we will truly train and graduate the quality of physicians that are actually ready to deal with and tackle” the health care disparities facing our country.
The HET was introduced to medical education faculty leaders at the annual YSM Curriculum Retreat on October 8, 2020. The OoE organized the retreat and over 60 people participated including course, clerkship, sub-internship, and elective leaders, as well as educational leaders and staff. Sheares explains that the HET will be developed and implemented with input from faculty, students, staff, community members, and experts from across the university and beyond. She adds, “We are going to enhance medical education at Yale by taking this journey together and learning from each other.”