The Role of Residency Training in Ensuring Health Equity

By Utibe Essien, MD

I was the only one: I confirmed it with the organizers. Out of the 120 internal medicine residents in my program, out of more than 250 internal medicine residents at the combined Harvard-affiliated hospitals in the area, and out of thousands of resident trainees in the Boston area, I was the only resident attending the 3rd Annual Health Equity and Leadership (HEAL) conference, “Challenging Racial Injustice through Community Health,” hosted by the Harvard School of Public Health in February.

The HEAL Conference was founded in 2012 by members of the Harvard School of Public Health, the Harvard Kennedy School of Public Policy, and Harvard Medical School to bring together students, faculty and administrators across Harvard University and other non-Harvard community members for inclusive conversation and joint action on health equity issues. However, one group seemed to be missing: those who were providing a majority of patient care, namely the residents. While many of my co-residents were in the ICU placing central lines, performing spinal taps in the emergency room, or prescribing pain medications in clinic, I had the opportunity to take part in an incredibly meaningful dialogue on the effects of social determinants on health.

Experts on the impact of homelessness, legal status, incarceration, and race on health care inspired the hundreds of attendees at the conference to believe that health equity is not an impossible feat. From the opening session on “Race, Criminal Justice, and Health” to Dr. Paul Farmer’s keynote on how health inequality spans borders and  oceans, into nations considered less of a world than ours is, I too was motivated. Yet I could not help but wonder, where were my co-residents? Where were those who are on the front lines of patient care every day? Shouldn’t they be hearing this?

Nearly ten years ago, Dr. Weissman and his colleagues revealed that residents do not feel well prepared in cross-cultural care, yet they were nowhere to be found at HEAL. Perhaps these issues are being addressed in other venues? Not at Mass General, where we have had only one noon conference on unconscious bias and a single ambulatory lecture on cultural competence.

One of reasons residents felt unprepared was a lack of mentors to model cross-cultural care, and as I scanned the room to see Dr. Joan Reede, a local and national leader  in addressing health disparities, as well as many other leaders, I realized this was exactly where my co-residents and I needed to be. We are promising to improve the health and well-being of the diverse communities we serve; yet often it seems as though we do not prioritize our patients’ social determinants. Conferences like these should not be limited to the future of medicine; let’s make sure those who are caring are caring about what matters.

Essien UtibeUtibe Essien, MD, is a second-year resident at Massachusetts General Hospital. He can be reached at uessien@partners.org

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