The practice of evidence-based medicine and lifelong learning are core tenets of medicine. Through courses, conferences, and lectures, physicians have regularly turned to their colleagues for continuing education. For decades, this reliance on physician-to-physician teaching has been a fitting choice for the subjects at hand, which usually related to clinical practice. In recent years, there has been widespread development of diversity, equity, and inclusion (DEI) initiatives. Holding to previous patterns, these DEI initiatives have often been designed and led by physicians. While the perspective of physicians is invaluable, it raises the question of whether this is the most evidence-based choice of teacher. Arguably, the predominance of physicians as the teachers of advocacy and equity in medical education results in a lack of interaction with the true experts in DEI, community organizers, and activists.
Activists in this case refer to individuals whose job is advocacy and community organizing. Health equity instruction from these individuals offers unique insights and perspectives that are often absent from medical education. These insights should be embraced as valuable. That is not to say that physicians cannot have expertise in advocacy. Advocacy is a mandated or debated requirement of Canadian and American medical education, respectively with many recent successes. Yet this advocacy is always a compliment to the primary job of a physician, to practice medicine.
Health activists are often embedded within the marginalized communities they represent. As medicine continues to struggle with diversity in its workforce, creating channels for experts from underrepresented or marginalized backgrounds to educate physicians is a step toward addressing underlying issues. Platforming activists in medical education also ensures that learners and staff from diverse backgrounds are not consistently called upon to fill these roles. Activists can instead facilitate building effective strategies for bridging cultural barriers, engaging with local stakeholders, building sustainable relationships, and empowering communities.
Superficially, the lack of exposure to activists and non-physician community organizers may reflect the logistical constraints of accessing these experts and integrating them into medical education. It also likely underscores a longstanding disengagement between universities and hospitals with local communities. In fact, in some cases, these institutions can be either harmful to surrounding communities or have a workforce that lacks diversity similar to their patient population. Without these partnerships, trainees may suffer from a lack of knowledge of issues faced by local communities or will not be equipped to partner with them when they become attendings.
The lack of activist exposure during medical training may also reflect the lingering emphasis on research-based activities relative to community engagement. The most traditionally competitive medical schools, residency programs, and fellowships traditionally recruit applicants with more research, relative to community engagement, experience. Increased awareness about the rigors of community engagement is only one aspect of increasing the acceptance of this work as valuable and shifting how the subject is approached in medical education. This may also shift attitudes needed to promote partnerships between activists, community organizations, and residency programs.
There are many approaches to building bridges between physicians and activists. Engaging with institutional offices that have existing networks with the community, researching community leadership, and working towards exploring and establishing those relationships are examples. Ideally, relationships are longitudinal and bidirectional, recognize structural biases, and respect the importance and power of lived experiences.
Ultimately, the journey towards health equity requires a shift in perspective. Physicians should actively seek knowledge and guidance from non-physician activists. Learning from activists can enhance and cultivate cultural sensitivity, challenge biases, and contribute to systemic change. Activists are uniquely positioned within the communities they serve; they understand the issues they face and have dedicated careers to addressing the needs of these communities. Building networks with these groups and exposing residents and even attendings to them will help facilitate future collaborations and challenge the ways that research is often presented as the only tangible source of extracurricular activity in medicine. Ultimately, activists and physicians have distinct yet overlapping roles and collaboration between the two groups can be powerful in promoting health equity.
Betty Yibrehu is a general surgery resident.