Student-Led Effort to Incorporate Social and Structural Determinants of Health into Undergraduate Medical Education: Civic Engagement, Advocacy, and Anti-Racism.

Abstract

Background: The recent wave of student and physician activism created a space to discuss racism in healthcare with a more critical lens. Students are interrogating the environment in which they will provide healthcare and the social and structural determinants of health—one being the lack of anti-racist education in undergraduate medical education (UME). Objective: The Black History Month Speaker Series (BHMSS) was formulated to highlight racism in healthcare. Participants learned about race and healthcare policy (RHP), maternal mortality (MM), racial health equity (RHE), voting barriers and civic engagement (CE), distrust of medical institutions among communities of color (D), and health disparities (HD). A list of national and local partner organizations was provided after the series to all participants with contact information and volunteer resources to encourage active community engagement and apply what they had learned. Methods: Students organized a five-lecturer series for February 2021. Pre-BHMSS and post- BHMSS Qualtrics surveys assessed overall knowledge and comfort measured on a 4-point scale (1=very uncomfortable/no knowledge and 4=very comfortable/knowledgeable). Two-tailed unpaired t-test was utilized. Results: The pre-BHMSS population (n=247) included primarily medical students (49%); post- BHMSS respondents (n=61) were majority female (80%) and Caucasian (63%). Post-BHMSS reported increased “knowledge” for RHP, MM, RHE, CE, D, and HD (μ difference=0.71 [95% CI=0.47, 0.95] p<0.001; 0.58 [0.32, 0.84] p<0.001; 0.49 [0.21, 0.77] p<0.001; 0.61 [0.20, 1.0] p<0.01; 0.64 [0.40, 0.87] p<0.001; 0.22 [0.057, 0.38] p<0.01). Post-BHMSS exhibited increased “comfort” addressing RHP, MM, RHE, CE, and D (0.55 [0.30, 0.80] p<0.001; 0.40 [0.14, 0.66] p<0.01; 0.46 [0.18, 0.74] p<0.01; 0.47 [0.053, 0.87] p<0.05; 0.35 [0.09, 0.61] p<0.01); however, there was no change in HD “comfort.” Conclusion: Comfort and knowledge significantly increased across nearly all topics, suggesting insufficient prior awareness and the urgent need for integration of anti-racism education in UME. BHMSS represents an innovative option for the incorporation of historical racial context that influences current medical practices and education. Knowledge acquired may foster valuable relationships between providers and patients and represents a potential solution to improved care for marginalized groups.