New Mexico State University professors in anthropology and social work are collaborating with Memorial Medical Center on a project to train medical residents with an “upstream” focus on the circumstances that cause disease.

Mary Alice Scott, NMSU professor and medical anthropologist, and Ivan de la Rosa, NMSU social work professor, are working with Dr. John Andazola, the family medicine residency program director at Memorial Medical Center. The collaboration entails implementing a longitudinal curriculum in social medicine that is framed by a concept called “structural competency,” the capacity for health care professionals to recognize and respond to health and illness as the “downstream” consequences of broad social, political and economic structures.

“It has been said that a person's zip code has a greater impact on their health than does their genetic code,” Dr. Andazola said. “A person's behaviors and social environment have five times the impact on their health than does their genetics. Therefore, for physicians to be most effective in their communities they must understand the social constructs that cause illness and health disparities in the community.”

The researchers found is that there is a formal curriculum and a hidden curriculum. Doctors recognize health inequities and how poverty and racism contribute to poor health outcomes, but -646-5935how to address these issues is not taught within a clinical environment.

“As a social work educator in a land grant university, this opportunity really spoke to my drive to have a meaningful impact on my community,” said de la Rosa. “Dr. Andazola’s aims to train family physicians to be sensitive to and be better able to respond to the health and well-being needs of marginalized and vulnerable populations really resonated with me.”

“We are facilitating training residents in a couple of ways – first is through helping to guide the development of the specific curricular areas,” Scott said. “The second is to develop longitudinal experiences for residents that will include longer term, more intensive engagement with community organizations that are doing work to address structural issues in our communities. Those experiences may include both direct service and conducting research with these organizations.” 

In the program at Memorial Medical Center, each medical resident’s rotation is four weeks. Four rotations are now focused on health equity. One involves training in population health, which includes collaboration with community health agencies and examination of epidemiological data on health disparities in our community. The second focuses on care for marginalized populations, and the third on border health.

In their last year, the medical residents have a health policy rotation that shows them how a physician can engage in policy discussions and legislation. They meet with legislators, follow bills in legislative session, write letters and engage with professional organizations.

“There are two perspectives,” Scott said. “One is thinking about patients and structural issues that people face. The other is how to train physicians differently so they can help address these issues that impact health inequities.”

“Is not only important to teach physicians how to treat diabetes, but it is also important for them to ask why their patient has diabetes in the first place,” Dr. Andazola said. “If the physician can address the causes of diabetes in their community, then they can prevent many more people from ever getting diabetes.”

Scott and de la Rosa agree one key concept they hope medical residents take away from the program is they do not have to do it all themselves. Doctors can work with other health professionals like social workers and psychologists to address the complex medical and non-medical needs of their patients.

‘We are training medical residents to understand health system structure and policy, to be leaders within their health care organizations and to communicate with their elected officials about health policy issues that matter to them and to their patients,” Scott said. “That allows them to move outside of the clinic and hospital walls to engage in health care in a much broader way.”

Arthur Kaufman, leader in family medicine at the University of New Mexico, invited Scott and Andazola to co-author an article on social accountability in graduate medical education and the future of family medicine. The article is due to be published in Family Medicine.

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