Training Physicians for the Future, Not the Past

Here are a few examples that have made this rather clear to us:

—Seeing patients with newly diagnosed diabetes, who cannot pick a pharmacy for prescriptions, because of difficulty acquiring affordable housing.

—Our patients have used the emergency room for primary care because of provider wait times, insurance issues and homelessness.

—On our pediatrics rotations, we have seen hardworking parents struggle to pay for expensive formula and quality childcare.

In those moments, we share the palpable frustrations of our patients. How do you tell a patient who wants help with their substance use, that we cannot refer them because of immigration status, insurance problems and overcrowding?

To confront these issues on a wider level, physician training with greater emphasis on social determinants of health is necessary to more fully help our patients. Broadly speaking, traditional medical institutions are starting to catch on.

The American Academy of Family Physicians has started recommending screening for five sociocultural needs: food insecurity, housing instability, utility needs, transportation needs and interpersonal violence. Those factors are particularly relevant in Philadelphia.

Recent data shows that the number of people living in hunger in 2018 increased 22 percent in the city.  Another challenge has been the rise of the opioid epidemic coupled with a lack of low-cost housing in our city. This shows how health and social needs go hand-in-hand.

Thankfully, these topics are discussed in our master’s program through advocacy, behavior and environment courses, despite the fact that they have been slow to enter conventional medical education.

Another systemic problem in medicine that we must address is the lack of diversity.

Seventy-five percent of providers, and more than half of all medical students are white, while the number of women is just now equaling the number of men in medical school.

This has been evident to us during our training in Philadelphia, where doctors often do not look like those they serve.

Why does this matter? Research has shown that if your doctor looks like you, you are more likely to have better communication and be more satisfied with your care.

We appreciate the steps that Jefferson, and others in Philadelphia, have taken to begin addressing these issues.

In 2017, the Sidney Kimmel Medical College introduced a case-based learning curriculum, which weaves sociocultural training into medical education through a curriculum called Health System Sciences developed by the American Medical Association.

The Jefferson College of Population Health continues to offer advanced study of these topics to medical students throughout the region, including those at the Philadelphia College of Osteopathic Medicine and Geisinger Commonwealth School of Medicine.

Our university also has taken strides to make the student body more reflective of the patients that these students serve, including the development of the eight-week STEP-UP Program to help underrepresented college students apply to medical school.

These are important changes and steps in the pressingly right direction, but we encourage all medical educators to think about how we can continually improve. We must not be satisfied with the small steps we have taken thus far.

Given our passion for public health, we have valued our MPH training at Jefferson. Much work remains to be done, and by utilizing the skills we have learned in our master’s program, we look forward to continually advocating for these changes.

David Klodowski and Jeremiah Davis have completed three years at Sidney Kimmel Medical College and are currently enrolled in the MPH program at Jefferson College of Population Health. They will graduate from medical school with the Class of 2021.