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PREVENTATIVE
MEDICINE

Prevention through Health Equity

Training at the Long School of Medicine

By Garrett Kneese and Samantha Driscoll

A s medical education continues to advance beyond Flexnerian nationwide at the undergraduate (UME) and graduate medical educa-
Reaching back to the educational framework, there are now efforts
practices (Flexner, 1910), so does the focus of these educa-
tional methods to include the charges of today’s physicians.
of other health professions as well to work towards not only providing
One of these charges, highlighted by the disparate impacts of the tion levels leveraging this lens to empower medical trainees and those
COVID-19 pandemic (Kim et al, 2020) and based in the historical higher quality health services based on a socially-derived understanding
segregations of our American society (NCRC, 2020), is the inequities of their patient, but also advocating for and working towards reductions
within the social determinants of health (SDoH). in the disparate outcomes that unequal distributions of negative social
“As the United States contends with the effects of the COVID 19 determinants can cause. Much of this education at the UME level is
pandemic, health inequity, and a long overdue reckoning of institu- course-based in pre-clinical years, and occasionally integrated at an elec-
tional racism, transforming primary care is essential to meet the mo- tive-only level during fourth-year coursework. Ultimately, we conclude
ment…” – V.J. Dzau, National Academy of Medicine alongside most other global and national health organizations that so-
Over the last decade SDoH literature has expanded enormously, be- cioeconomics and health behaviors as influences by social determinants
ginning at a measurement and identification stage (ie what social fac- are the primary driving factors that can be modified for prevention of
tors determine health, and how might we calculate, quantify and disease across populations (Hood et al, 2016).
measure them?), and continuing onward to where we are today with At UT Health San Antonio, the Department of Family and Com-
respect to implication and intervention (ie what do these determinants munity Medicine’s undergraduate medical education division, led by
tells us about our communities and what can medical society do to re- Dr. Nehman Andry, has been hard at work in the post-pandemic setting
spond within this newfound lens?). to bring SDoH education to all medical students at the university in
hopes of facing the challenge of health disparities head-
on. The teams for this article’s highlighted programs
comprise of clinical faculty, students, community health
workers (promotores) and consultants with the Ameri-
can Board of Family Medicine. With help from several
leaders in the department, they have facilitated both lon-
gitudinal and interventional programs at the third-year
medical student level to improve SDoH clinical compe-
tencies in all students and inspire them to advocate for
the communities they serve from a foundational under-
standing of health equity.
With additional time available due to limited clinical
scheduling for the third-year family medicine clerkship
in intra-pandemic education, an impetus to leverage that
time for a novel educational experience arose. The idea
to create a longitudinal experience over the 6-week ro-
tation framed the pairing of medical students with both
a promotore (community health worker, or CHW)
from the Department, and a patient well-established
with the promotore for an interactive SDoH commu-
nity-clinical journey.

Modified figure from Family Medicine Team Care Session, February 2022. (Kneese et al, 2022)

22 SAN ANTONIO MEDICINE • June 2022