Health Equity Track

Introduction

The United States of America (USA) has the highest per capita spending on health care, with nearly 30% of the budget, or $765 billion, wasted annually. Despite the large budget and availability of medical resources, the USA ranks 24th out of 188th nations in health measures such infant mortality, vaccination rate, violence, smoking and preventable diseases and is ranked behind many less developed countries including Malta, Slovenia, Antigua and Barbuda.

Gaps in health equity, both clinical and non-clinical, play a major role in these statistics. Nearly 20% of someone’s health is based on the clinical care they receive, while the other 80% is a product of their environment collectively termed as the social determinants of health (SDH, or SDOH for the CDC’s acronym). The World Health Organization (WHO) defines SDOH as “the conditions in which people are born, grow, live, work and age. These circumstances are shaped by the distribution of money, power and resources at global, national and local levels.” Examples of SDOH barriers patients may face are challenges within their physical environment, barriers within their social economic status and certain modifiable behaviors such as exercise and diet. Social, environmental and political factors such as barriers to a safe living environment, access to clean water, healthy air, food insecurities, issues with health literacy, or being uninsured can lead to worsened overall health. There are also certain vulnerable populations (e.g., immigrants, homeless patients, seriously mentally ill patients) who have additional barriers to care which reduce their quality and quantity of life.

The Society of General Internal Medicine Health Disparities Task Force recommends that learners in medicine:

  1. Examine and understand attitudes, such as mistrust, subconscious bias, and stereotyping, which practitioners and patients may bring to clinical encounters.
  2. Gain knowledge of the existence and magnitude of health disparities, including the multifactorial causes of health disparities and the many solutions required to diminish or eliminate them.
  3. Acquire the skills to effectively communicate and negotiate across cultures, languages, and literacy levels, including the use of key tools to improve communication.

The University of Connecticut Internal Medicine Program’s Health Equity Track is a three-year longitudinal curriculum integrated within the main residency curriculum designed specifically for residents who envision working towards eliminating disparities in healthcare and recognizing root causes of health inequities. By the end of this track, residents will receive the training necessary to address the diversity, health equity and inclusion (DEI) issues within their community.

A focus on achieving equity in healthcare is consistent with our GME program and the Capital Area Health Consortium’s member institutions’ missions:

  • UConn GME program: Our commitment to DEI relates to our community of faculty, residents, and staff as well as the patients we serve. We value diversity, equity and inclusion in all aspects of health care including providing excellent patient care, within our academic and professional communities, and in research. Our faculty and residency programs recognize the important role diversity plays in creating a culture of collaboration and teamwork. To that end, our strategic effort and goals are as follows:
    • Recruitment and retention of a diverse work force;
    • Institutional and GME policies that are consistent across all of our affiliated hospital communities that allows for identification of best practices and identifying, reporting, and correcting mistreatment;
    • Professional development and education of our GME community on cultural and structural competence;
    • Patient care that demonstrates a commitment to our diverse communities with focused efforts in research, quality improvement, and institutional population health initiatives;
    • Commitment to leadership in diversity, equity, and inclusion through program development;
    • We strive to foster a safe and supportive environment in graduate medical education.

See more on GME's Commitment to Diversity, Equity, and Inclusion page.​

UConn Health DEI statement: Our commitment to DEI relates to our community of faculty, residents, and staff as well as the patients we serve. We value diversity, equity and inclusion in all aspects of health care including providing excellent patient care, within our academic and professional communities, and in research.

Hartford Healthcare DEI statement: We commit to the fair treatment, access, opportunity and advancement for all. We value the uniqueness of each person and embrace diverse backgrounds, opinions and experiences. We foster intellectual, racial, social and cultural diversity and treat everyone with dignity and respect. Our customers, patients and colleagues experience Hartford HealthCare’s culture of belonging.

Saint Francis Hospital/Trinity New England DEI statement: Our diversity, equity, and inclusion initiatives align closely with the core values of Trinity Health of New England: to care for self, colleagues, and those we serve. In this, patient satisfaction, diverse sourcing, community engagement and workforce training and education is of the upmost importance to us. We value the individuality provided by those we encounter that continues to enhance the experience of patients and colleagues. In such a personal environment, we understand that appreciation of someone’s differences help stimulate an enjoyable healing space. In acknowledging the diverse population, we serve, we look forward to providing more resources, tools and information to the many different members of our communities. Be it differences in gender, race, age, national or ethnic origin, sexual orientation, physical or mental disability, education, veteran status, citizenship, genetic makeup, or any other characteristic; we understand that we all have differences that make us who we are. We also recognize the importance of us coming together as a cohesive unit to provide the best care for everyone’s personal needs. Your needs and values are important to us, as, “when everyone is included, everyone wins”.

Mission Statement

The mission of the Health Equity Track is to train and prepare the next generation of clinicians committed to caring for disadvantaged and vulnerable populations, and to promote health equity for all. To accomplish this, we focus on a curriculum centralized around developing knowledge, attitudes, and skill-sets needed to address these health inequities in the clinical setting and promote DEI-informed care and leadership. Ultimately, we hope that all participants will develop the skills and experience necessary to become experts on medical and social conditions common to our vulnerable populations.

Goal

By the end of this track, residents will be leaders within our Internal Medicine Program in promoting care consistent with Task Force recommendations, and be able to:

  • Define and describe terms such as weathering, bias, structural racism, social, environmental and political determinants of health, diversity, health equity, inclusion, and trauma-informed care.
  • Assess root causes of health inequity in the communities we serve, and work with community members to promote positive paths forward.
  • Identify bias, microaggresssions, attitudes and behaviors that worsen disparities or detract from DEI in the health care setting, and develop effective responses to mitigate these.
  • Assess patients for health care inequities, access available resources, and construct plans to address these in the clinical setting and beyond.
  • Forge partnerships with community stakeholders and advocacy organizations critical to health equity and anti-racism efforts.
  • Engage in community-based activism through listening sessions, legislative advocacy, scholarship, research, teaching and volunteerism related to health care equity.

Curriculum

The Health Equity Track offers a broad longitudinal three-year curriculum to provide the knowledge and skills necessary to better take care of our patients. The curriculum will focus on both vulnerable and under-served populations in addition to specific Diversity, Equity & Inclusion topics.

Track welcome/kick-off event:  DEI session with UConn Health’s Dr. Jeffery Hines, Associate Vice President and Chief Diversity Officer

Monthly Meetings: our monthly meetings are track-member facilitated. Meetings may include member-led presentations on topics of interest, such as assessing disparities in renal care, or other opportunities such as listening sessions with a Hartford-based men’s health support group, volunteer activities with the Greater Hartford Urban League, faith-based community health events, assessing medical debt by neighborhood, disparity mapping via PolicyMap and other data/informatics with Health Disparities Institute statistician, meeting with experts on optimizing care for those with disabilities, speaker events, local advocacy and health events, anti-racism activism, partnerships with UConn Law Legal Aid Clinic, medical school Urban Service Track partnerships, Walk with a Doc events, advocacy and listening events on fighting worst impacts of climate change on vulnerable populations, LGBTQIA+-informed care, or other ideas track residents propose, develop and lead.

ACGME Curriculum:  Track members each complete 12 modules from the ACGME EquityMatters series over the course of three years (4 modules per year, each are ~1-2 hours).  Module topics prepare residents for DEI-informed leadership and mentorship across their careers:

  1. Trauma-informed Cultures and History of Race in Medicine
  2. Building Safe and Courageous Spaces in GME and Steps Leaders Can Take to Increase Diversity, Enhance Inclusion, and Achieve Equity
  3. Patient Safety, Value and Healthcare Equity: Measurement Matters & Using a Structured Approach to Recruit Diverse Residents, Fellows and Faculty
  4. Exposing Inequities and Operationalizing Racial Justice; and Whiteness: Power and Privilege in the Context of U.S. Racism
  5. Naming Racism and Moving to Action
  6. Gender Equity
  7. Sexual and Gender Minorities
  8. Black Experience in Medical Education; American Indian and Alaskan Natives in Medicine
  9. Asian, Pacific Islander and API American Experience; Latino, Hispanic or of Spanish Origin Experience
  10. Remaining Inclusive of and Supporting Non-Traditionally-Aged Learners and Disability Inclusion
  11. First-Generation and Low-Income Trainees in Medicine & Geography - The Impact of Place
  12. Creating an Inclusive Environment for Muslim and Sikh Trainees, together with 13: Health Disparities in Correctional Medicine and the Justice Involved Population (both are shorter modules)

Bi-weekly Health Equity Curriculum contribution: Track members deliver two to three topic teaching topics each year, via our bi-weekly Health Equity Curriculum emails, for the benefit of the entire Internal Medicine residency program and faculty. Each work introduces a clinically relevant key health equity topic, and teaches how to address it, including resources and partnerships available within our community. The resources and partnerships presented will also be posted to our UConn IM blog for the benefit of our entire program, and be added to our topic bank. Track residents will also share with faculty and colleagues at clinic and hospital sites how to capture social and environmental determinants of health via effective medical coding.

Community Engagement

Health Equity track residents will join annual community engagement events. Track members should plan to attend at least one event per academic year (or more, clinical schedule permitting). For the upcoming 2022-2023 year:

Fall: Meal delivery and listening event with homeless clients in Hartford.

Winter: In conjunction with first year medical students, a community stakeholder panel in the North Hartford Promise Zone to understand the life expectancy gap this community faces and paths forward to close the gap.

Spring: In conjunction with first year medical students: a community health advocacy fair featuring many area partner agencies and nonprofits involve in fighting disparities; resource gathering and networking.

Summer: Community event on environmental justice and climate action efforts in Hartford and beyond.

Legislative Advocacy/Political determinants of health

Winter/Spring: track members will monitor health-related bills, and engage in letter-writing and testifying for at least one relevant equity topic annually, whether at the state or national level, or beyond. Alternatively, track members may research, propose and submit a bill of their own to the CT legislature to meet this requirement. We will also have the opportunity to work throughout the year in collaboration the UConn Health Disparities Institute, led by Dr. Linda Barry, Interim Director.

Clinical Care

The health equity track will prepare each resident to better address their patient populations, with focus on both under-served and vulnerable populations. Each resident will have their continuity clinic at either UConn Farmington campus, Brownstone (Hartford Hospital) or the Gengras clinic (Saint Francis Hospital). UConn John Dempsey Hospital is the official hospital for the state of Connecticut and sees a high volume of Medicaid (Husky) patients. The Brownstone and Gengras clinics are located in inner city Hartford and take care of a predominantly Medicaid population. At each site, track members are asked to help students, fellow colleagues, and faculty assess for, address, and code for environmental and social determinants impacting health, as well offer other suggestions for optimizing DEI in care delivery on site.

In addition, each resident has the option of completing a Federally Qualified Health Center (FQHC) rotation during the ambulatory elective block. This rotation allows learners to experience the care provided by FQHCs, but also rotate with experts who have specific expertise on one or more health equity issues. There are also opportunities to do specific health equity rotations in a given field (e.g., incarceration medicine, undocumented immigrant care, environmental medicine) upon request.

Diversity, Equity, and Inclusion Project

Track members interested in honors or honors with distinction level engagement will complete a DEI project within our local community that applies the topics and skills learned in our track. Most resident choose projects that involve teaching, scholarship such as research, advocacy, volunteerism, or quality improvement. Here is a list of some of the projects completed by our residents:

  • Designed an outpatient HIV/AIDs and substance use rotation.
  • Teacher for a longitudinal health system science curriculum for second year medical students (VITAL).
  • Developed an online Health Equity curriculum for medical students in Guatemala.
  • Participating in QI projects at their local resident clinics (e.g., diabetes management, HPV vaccine).
  • Volunteering in our local community.
  • Research project with a faculty member focused on health equity.

Mentorship

Each resident is asked to meet with our health equity track director every 6 months to ensure they are progressing within their program goals. Each resident is also asked to mentor colleagues on DEI topics throughout their careers here and beyond.

Certification

In summary, for successful completion across three years, all track members:

  • Join annual welcome / kick-off sessions
  • Join monthly meetings, co-leading at least one per year
  • Attend at least one health equity community engagement session per year
  • Contribute 2-3 teaching/resource pieces per year to bi-weekly Health Disparities (HE) curriculum (with resources also added to the UConn IM blog)
  • Complete 4 ACGME EquityMatters modules per year
  • Contribute legislative advocacy activities annually (letter-writing, testimony, or equity-related bill proposal)
  • Complete biannual mentorship meetings

Members interested in pursuing Honors level in the track successfully complete the above each year, plus:  

PGY1
Propose, develop and begin a DEI-related research, community advocacy, or QI project.

PGY2
Continue DEI project, summarize progress.

PGY3
Complete DEI project; successfully present at Grand Rounds, Annual research day, QI session, and/or submit to regional/national meetings or publications.

In addition, Honors level members demonstrate consistent engagement, leadership and mentorship within the track.

Members interested in pursuing Honors with Highest Distinction level in the track successfully complete all of the above, plus:

Complete an elective rotation at a FHQC (or equivalent experience tailored to member’s interest), accomplishing and presenting a separate site-specific DEI-focused project during the rotation, or,

Ally with a DEI advocacy partner over the course of three years to complete and present a sustained DEI-focused project complementing that organization’s mission, or,

Partner with a local family or community group in need, meeting at least monthly and demonstrating sustained commitment to emotional support and health care navigation over the three years, and present annually to track members (whilst preserving HIPAA protection) on DEI barriers to care encountered, track member support provided, including resources and services found to meet needs, or,

Publication on DEI topic, or a piece of policy and/or legislative advocacy successfully achieved.

In addition, Honors with Highest Distinction level members demonstrate consistent engagement, leadership and mentorship within the track.

Additional Information

For more information regarding the Health Equity Track within UConn’s Internal Medicine Residency Program, please contact the Health Equity Track Director, Kirsten Ek, M.D., at ek@uchc.edu, or General Internal Medicine Fellow Jasmin Hundal, M.D., or Chief Medical Resident Leanne Brown, M.D.

References

Institute of Medicine. The Healthcare Imperative: Lowering Costs and Improving Outcomes: Workshop Series Summary. Washington (DC): National Academies Press (U.S.); 2010.

GBD 2016 SDG Collaborators. Measuring progress and projecting attainment on the basis of past trends of the health-related Sustainable Development Goals in 188 countries: an analysis from the Global Burden of Disease Study 2016. Global Health Metrics | Volume 390, Issue 10100, P1423-1459, September 16, 217.

Bradley, E. H., B. R. Elkins, J. Herrin, and B. Elbel. 2011. Health and social services expenditures: Associations with health outcomes. BMJ Quality and Safety in Health Care20(10):826-831.

WHO (World Health Organization). 2012. What are the social determinants of health? (accessed June 8, 2020).

Smith WR, Betancourt JR, Wynia MK, Bussey-Jones J, Stone VE, Phillips CO, Fernandez A, Jacobs E, Bowles J. Recommendations for teaching about racial and ethnic disparities in health and health care. Ann Intern Med. 2007 Nov 6;147(9):654-65. doi: 10.7326/0003-4819-147-9-200711060-00010. PMID: 17975188.

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