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PREVENTATIVE
MEDICINE

mary care access, health disparities in San Antonio, com-
munity engagement practices, etc. that are foundational
to family medicine practice. This year’s spring session was
inter-professionally designed and delivered by three fac-
ulty and one medical student to capitalize on the momen-
tum of the clerkship curriculum previously described,
acting as either a capstone workshop session for those
who had already completed the clerkship, or as an educa-
tional primer for those yet to enter the clerkship that year.
Based in competencies of place and equity, a patients cir-
cle of support, establishing trust between doctor and pa-
tient, and addressing societal challenges to these concepts,
this case-based workshop follows the story of a patient in
small-group format to bring SDoH-oriented tools to stu-
dents in a competency-driven and practical manner. Be-
Health Disparities 6-Week Curriculum Overview as Developed for 2021-2022 Clerkship Students ginning with a review of San Antonio’s own history of
housing segregation that have led to measurable health
Over the course of the rotation, students spend time each week getting inequities between neighborhoods of the city, students then learn how
to know their patient on a more socially-derived level via independent to work with patients experiencing these disparities in a relationally-
investigation using both electronic health records and geospatial social centered way through empathic communicative and psychosocial in-
determinant data tools such as the American Board of Family Medicine’s tervention tools that build trust with patients sometimes considered
Population Health Assessment Engine (PHATE) (Bambekova et al, forgotten by medical society.
2020), direct meetings with their partnered promotore, guided visits to
the patient’s community, and ultimately a personal meeting with the pa-
tient in their own home. While innovative tools, such as the ABFM’s
PHATE, allow for neighborhood-specific understandings of patients’
social vulnerabilities, it also directly links providers to zip code-specific
resources and services designed to rectify these vulnerabilities (such as
travel vouchers, food assistance programs and other social services). Then,
by placing students physically into the environment of their patient, we
extract them from the medical education bubble that could possibly de-
tach them from the realities often faced by many of their most vulnerable
BATHE Clinical Communication Technique as presented in the Family Medicine Team Care
patients. Finally, these experiences culminate with a report to their peers
Session, February 2022
in the form of an artistic rendition that encapsulates what they’ve learned
and the relationships they’ve built along the way (see next column, top). While implementing these psychologically-driven approaches, stu-
Altogether, this student-patient-promotore engagement experience dents also learn to establish a circle of care for their patient along the
provides a holistic look at health disparities as SDoH are implicated way, possibly consisting of behavioral psychologists, nutritionists, psy-
right here in the San Antonio advanced primary care environment. Ad- chotropic specialists and social work to name a few of what are entailed
ditionally, it highlighted the importance of an interprofessional team in an advanced primary care model. These competencies are finally
to fully address complex issues and lower the barriers to care for our framed by the ethical and moral challenges posed by our medical-in-
patients by leveraging the skills and trust built by promotores and other dustrial complex, charging students to recognize the moral determi-
ancillary service team members. nants of health (Berwick, 2020) in practice and community presence.
The Long School of Medicine’s Team Care curriculum is a longitu- A final charge to students is made to go beyond the recognition of and
dinal experience over the third medical school year that focuses on attempt to resolve in clinical practice the disparities in SDoH that their
themes that span across all specialties (UTHSA LSOM, 2022). The patients face, through recognizing the necessity to look upstream at
Family and Community Medicine Department is charged with one the structures and systems in place that lead to these disparities at-large.
session each spring, which has often focused on topics surrounding pri- Measuring the outcomes of these educational interventions is tan-
continued on page 24
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