Tufts University’s new medical school curriculum highlights disparities in population health and health.
On their first day of class, the new cohort of medical students at Tufts University School of Medicine didn’t dive into biochemistry or physiology. Instead, they began their education by focusing on how social factors, such as housing instability, health care costs, and racism, affect health outcomes and create inequalities.
âOur job as physicians is not simply to treat one patient in front of us at this time,â says Amy Lee, associate professor and vice president of academic affairs in the Department of Family Medicine. âOur job is to have an impact on the health of populations in general, to bring better health to our society. It is therefore important that our students understand that there are things they can do, from the individual level for patients to advocacy at the community level, to advocacy at the political level.
Tufts’ new medical curriculum, rolled out to incoming students in 2019, strives to center these historically neglected aspects of healthcare. Students begin their education with a three-week course in the social determinants of health, how the US health insurance system works, professionalism, and ethics in medicine. As they tackle anatomy, cell biology, and other fundamental scientific topics, these larger themes are woven into the curriculum.
âAll of these things have a huge impact on health, but sometimes they don’t get talked about a lot in typical medical school programs,â says Lee. âIt’s a much more systematic way of ensuring that all of our students truly understand some of the major health issues facing American patients today. “
Traditionally, medical education began with the hard sciences. Medical students need a thorough understanding of the body’s systems, as well as how things can go wrong and what treatments are available. The programs are structured to break down this monumental amount of information into manageable chunks.
This structure is invaluable, says Richard Glickman-Simon, assistant professor of public health and community medicine, who helped develop the new program and directs several of the courses. But that doesn’t leave much room for looking at patient issues from a community or population perspective.
“He tends to focus on a problem like being an inconvenience or something wrong at the molecular or cellular level,” says Glickman-Simon. âYou really can’t serve patients by just focusing on what their molecules are doing. It is very powerful, but it is insufficient. You may miss the big picture.
The COVID-19 pandemic served as a poignant reminder of why these topics are essential for a doctor’s education. While anyone could catch and spread the virus, communities of color in the United States have suffered disproportionately high rates of illness and death. These disparities have been linked to a number of factors, including living conditions induced by discriminatory housing policies, the body’s physiological response to prolonged stress caused by racism, and systemic inequalities in access to health care. Persistent problems in the U.S. healthcare system have also hampered the country’s ability to respond to the pandemic and disrupted the rollout of tests and vaccines.
In the new curriculum, Tufts students use the pandemic as a setting to discuss the lack of public health infrastructure in the United States, the roots of vaccine reluctance, and the history of medical racism in the country. This knowledge will help future physicians address the specific concerns of each patient and effectively advocate for the needs of their community.
âIt was a really helpful setting to know that Tufts was prioritizing the social determinants of health inequity – looking at racism in medicine, misogyny in medicine and many of those larger threads that we then carry on. to be followed throughout medical school, âexplains Emma Noyes. , MG20 (MBS), M24. “There is still a lot of work to be done to make sure we cover all of this material comprehensively and effectively, but I felt like they were really trying to make it a priority for us from day one. . “
As students delve into the more traditional aspects of medical education, they take a parallel course, aptly named Threads, which weaves the social determinants of health and other important aspects of patient care into the rest of the program. While students study neuroscience, for example, they chat with a group of advocates for the Threads course to discuss how physicians might better meet needs and build trust with patients with neurodevelopmental differences. When students learn about diseases of the reproductive system, they have a Threads section on why black mothers in the United States are much more likely to die from pregnancy-related complications than white mothers.
âI feel like Tufts is really training doctors to look at the big picture and treat the patient like a human rather than a disease,â Noyes said. âUnderstanding the pathophysiology is very important, but it is equally important to understand what prevents your patient from coming to the appointment to see you, which prevents them from maximizing their care and maximizing their overall health. . “
The redesign also includes a new mentoring structure for medical students. Students are each assigned a physician coach, someone working in the field who will help the students grow during their four years of training. Coaches encourage discussion of key concepts students have studied in Threads and their other courses and help them take on leadership roles in the areas they are most passionate about. Coaches do not assess or rate students; they help them find their strengths and develop a professional identity, says Lee.
âIt really gives our students a whole new kind of support to become the kind of doctors they want to be,â Lee said. âOur expectations of what it means to be a doctor have grown. Physicians have important roles in society beyond just caring for an individual patient, and we want our students to be fully prepared for these kinds of leadership and advocacy roles.