To the Editor:
The graduating medical students poised to serve the U.S. health care system, including ourselves, are no strangers to social turmoil. Our classmates sought to balance academics with a desire to demonstrate solidarity with disempowered populations in the wake of events, like Charlottesville and the humanitarian crisis on the southern border. With the emergence of the COVID-19 pandemic, we are seeing once again that medical education and the outside world do not exist independently of each other.
As we witnessed inequities and unrest, we looked for examples of how these struggles applied to medical education. In response to Charlottesville, our student body petitioned administrators, leading to the establishment of a Health Equity Task Force. This faculty–student partnership resisted assumptions that essential, biological differences better explain racial and ethnic health disparities than social factors. When concerns of human rights violations of migrants were widely publicized, students volunteered with and spoke on behalf of organizations providing care on the border. These events provided opportunities to develop clear examples of what we thought it meant to embody physician advocacy. As we graduate amidst the COVID-19 pandemic, we anticipate that physician advocates will have a crucial role to play.
A social justice perspective helps us anticipate disparities and bolster a skill set for ameliorating them. We find ourselves asking familiar questions about vulnerable groups in what is commonly called an “unprecedented” time. Who among us is marginally employed and likely to lose health insurance, to have their poorly managed chronic disease further exacerbated, to delay seeking treatment or fear doing so altogether? The answers to these questions do not come out of thin air, but rather, from an approach to system change that can be taught and nurtured over the 4-year medical school curriculum.
The COVID-19 pandemic reveals to us what already needs to occur in medicine. There are critical gaps in resources needed to protect both ourselves as providers and the most vulnerable among us. Advocacy is how we organize for that healthier, more equitable future. What if social justice and advocacy were core competencies that all physicians were expected to achieve before entering our workforce? What if these ideas were not relegated to opt in extracurricular activities but rather were formalized longitudinally into our medical education curricula? Though not an easy task to integrate a social justice and advocacy framework into a medical education curriculum, it is crucial that medical schools adapt to these changing times.
Acknowledgments: The authors would like to thank Greg Ogrinc, MD, MS, and Stephanie White, MD, for their continued support, mentorship, and guidance over the years.
Melissa Cantave
Fourth-year medical student, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; ORCID: http://orcid.org/0000-0001-8964-888X.
Jacob Perlson
Fourth-year medical student, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, and MPH candidate, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; ORCID: http://orcid.org/0000-0001-8003-219X.
Chad Lewis
Third-year medical student, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; ORCID: http://orcid.org/0000-0002-5940-9543.
Brianna Byers
Fourth-year medical student, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; ORCID: http://orcid.org/0000-0001-9462-2924.
Footnotes
Disclosures: None reported.