Growing your own advocates – an experience in our residency program

Definition of advocacy: the act or process of supporting a cause or proposal : the act or process of advocating (see ADVOCATE entry 2) something¹

Among the updated ACGME milestones in Family Medicine² is a new sub-competency “Advocacy”. The target for graduation is set such that our graduates know how to use tools to affect policy change. As one of the faculty who has undertaken teaching in this milestone I applaud this vision even as I struggle with how to implement a curriculum around this vital skill set.

The murder of George Floyd and subsequent community uproar kicked off a tremendous amount of thinking and introspection in our program³. After the initial shock reaction, many of us recognized that our program strongly desired to take on anti-racism work here. We wanted to make sure we all understood the implications of this damaging social structure in our work and amongst each other. And work towards mitigating this influence.

A small focus group met. We realized that this work needed to include all of us: faculty, residents and the larger clinic staff. We agreed to subdivide the efforts into three areas of focus: training faculty, training residents, and training the wider clinic. A team of 5 senior residents took on the task of building a curriculum for the resident core conferences.

Various learning theories, both Bloom’s original and revised taxonomies⁴, and an untold number of references to the “learning pyramid” and active vs passive learning references all support the generally understood concept that being actively engaged in the learning process, and part of the creation of the learning process is a richer and more effective way of learning and retaining skills and information⁵.

To illustrate, I give this discussion over to the residents:

The Hennepin Healthcare Family Medicine residency program is the most diverse in the state of Minnesota, but is also located in a state with some of the worst social disparities in the country. After the murder of George Floyd, our residency cohort recognized – in a way that was in retrospect, too little too late – that we had to care for ourselves and each other first and foremost. How were our colleagues of color, residents and clinic staff, experiencing our institution and our social milieu? And how were we as a program falling short to provide appropriate support? What started as an online safe space, for sharing feelings related to both the pandemic and racial re-traumatization, grew into a dynamic advocacy group rooted in the belief that we are all in this together.

Early in the process we facilitated a healing circle for residents and faculty where we could share openly with each other things which had been hurting us and building up over time. It gave us an opportunity to be vulnerable with each other, learn how racism affects us each differently, and visualize how racism is embedded in each of our daily lives. Other activities we’ve facilitated have ranged from peer support sessions to collage sessions – plastering the windows of our clinic with hearts and signs reading “Black Lives Matter,” “Justice for George Floyd,” and “Todos Unidos – Una Familia”.

Perhaps our most difficult task was finding the resources to guide our work in creating an efficacious antiracist curriculum. We drew on resources within our department and from peer programs across the country to find up to date methods for facilitation and assessment.^6,7 To date, intentional antiracism group activities have included racial caucusing for residents and faculty, a baseline assessment workshop of our program’s status as an aspiring antiracist multicultural institution,⁸ and a clinic wide introduction to racial inequity in healthcare and mindfulness as an approach to health equity.^9,10 Curriculum currently in the process of being developed will utilize tools such as the Health Equity Curricular Toolkit from the American Academy of Family Physicians,^11,12 as well as the racial healing handbook worksheets by Anneliese Singh.¹³ The curriculum development process has revealed the absolute need for being intentional with antiracism training. Finally, we have begun including junior residents in this process to ensure long-term sustainability of antiracism training in the program after the founding members of our committee graduate this summer.

The last 8 months have been a learning journey for each of us both collectively and independently. We feel grateful to work alongside our inspiring colleagues, both resident peers and faculty alike. This process has only begun to show us how deeply racial inequality and health inequity are intertwined with each other. Though we are based out of the county hospital and pride ourselves in being a diverse program who serves the neediest of the neediest in our metro area, even we have a long road ahead of us as we work toward becoming a more antiracist program and healthcare system. We’re learning to amplify each other’s voices, to listen, and to lean on each other because we all need it some days. The true transformation we are working toward will come as we begin to shift from “advocacy” for marginalized communities or disenfranchised demographics to “living” embedded in the community with each other, each pulling at the oars of the same ship headed towards justice.

Thank you to our resident curriculum team: Drs. Maria Arciniegas, Simone Childs-Walker, Olaoluwa Lediju, Monique Pondy and Jia-Shuyan Su

-Susan Hasti M.D, Community of Practice Member

Dr. Hasti is faculty at Hennepin Healthcare Family Medicine Residency program and Assistant Professor at University of Minnesota Medical School. Areas of teaching focus include Social Determinants of Health and Health Equity, Centering pregnancy and Community Medicine.

Maria Arcienegas, MD, Simone Childs Walker, MD, Olaoluwa Lediju, MD, and Jia-Shuyan Su, MD

Drs. Arcienegas, Walker, Lediju, Su are third year residents at Hennepin Health Family Medicine residency program.

References:

1. https://www.merriam-webster.com/dictionary/advocacy
2. https://www.acgme.org/portals/0/pdfs/milestones/familymedicinemilestones.pdf
3. https://sdoheducation.org/community-hub/what-happens-when-a-pandemic-coincides-with-a-catastrophe-in-the-community-a-firsthand-account-of-events-in-minneapolis-following-the-death-of-george-floyd/
4. https://cft.vanderbilt.edu/guides-sub-pages/blooms-taxonomy/
5. https://journals.physiology.org/doi/full/10.1152/advan.00053.2006?url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=cr_pub%3Dpubmed&
6. https://resourcelibrary.stfm.org/HigherLogic/System/DownloadDocumentFile.ashx?DocumentFileKey=cf40991e-96e9-3e15-ef15-7be20cb04dc1&forceDialog=0
7. Equity in the Center. Awake to Woke to Work: Building a Race Equity Culture. ProInspire, 2018.
8. https://www.aesa.us/conferences/2013_ac_presentations/Continuum_AntiRacist.pdf
9. King, Ruth. Mindful of Race: Transforming Racism from the Inside Out. Sounds True Inc, 2018.
10. Svetaz, Maria Veronica, M.D. 1/13/21 Clinic Wide Presentation
11. https://www.aafp.org/family-physician/patient-care/the-everyone-project/health-equity-tools.html
12. https://www.aafp.org/dam/AAFP/documents/patient_care/everyone_project/health-equity-toolkit/hops19-he-guidebook.pdf
13. Singh, Anneliese. The Racial Healing Handbook: Practical Activities to Help You Challenge Privelege, Confront Systemic Racism, and Engage in Collective Healing. New Harbinger Publications, 2019.