The DISCuSS model: Creating connections between community and curriculum – A new lens for curricular development in support of social accountability

Goez, Helly; Lai, Hollis; Rodger, Joanne; Brett-MacLean, Pamela; Barber, Paul

doi:10.1080/0142159x.2020.1779919

Cited by 21 publications

(22 citation statements)

References 30 publications

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“…Community‐engaged pedagogy and structural competency are emerging paradigms in medical education, bringing longstanding principles from community‐based participatory research and social accountability into health professions education 3,5‐7 . Our pilot successfully introduced these frameworks at an AHC beginning to cultivate long‐needed institutional infrastructure to diversify the student body and better engage proximate communities.…”

Section: Discussionmentioning

confidence: 99%

“…Cultural competency training and classroom‐based teaching modalities alone are inadequate to robustly address health inequities 2,5 . To address these shortcomings, structural competency advocates propose fostering a critical understanding of intersections between race, class, clinical presentation and systemic aetiologies of health inequity 3,5–8 …”

Section: Introductionmentioning

confidence: 99%

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Building structural competency through community engagement

Khazanchi

Keeler

Strong

et al. 2021

The Clinical Teacher

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Context The importance of addressing the social determinants of health (SDOH) in medical education has been ubiquitously recognised. However, current pedagogical approaches are often limited by inadequate or ahistorical exploration of the fundamental causes of health inequity. Community‐engaged pedagogy and structural competency frameworks advocate for progressing from passive SDOH education to directly discussing systemic aetiologies of health inequity through reciprocal partnership with marginalised communities. Herein, we describe the development and exploratory evaluation of a community‐engaged structural competency curriculum implemented in 2019 at the University of Nebraska Medical Center. Our curriculum explored the downstream impacts of sociopolitical structures on local health inequities. We engaged university, health system and community stakeholders throughout curriculum development, implementation and evaluation. Curricular components included didactic lectures, reflective writing assignments and a community‐based, stakeholder‐led experience in North Omaha. Methods We used inductive thematic analysis to explore free‐text responses to a post‐curriculum survey. Results Eighteen community stakeholders, eleven multidisciplinary UNMC facilitators, and all 132 first‐year medical students were involved in the curriculum pilot, with 93% and 55.1% of students and faculty/community facilitators, respectively, responding to the post‐session evaluation. Analysis revealed themes including widespread desire for community‐engaged teaching, appreciation for the hyperlocal focus of curricular content and recognition of the importance of creating space for lived experiences of community members. Discussion Co‐created by a university‐community coalition, our pilot findings highlight the crucial role of community‐engaged pedagogy in promoting critical understanding of historic structural inequities and present‐day health disparities. Our communities can and should be reciprocal partners in training the physicians of tomorrow.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Building structural competency through community engagement

Khazanchi

Keeler

Strong

et al. 2021

The Clinical Teacher

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“…An important aspect of social accountability of the healthcare professions is to recognise disparities in healthcare delivery and work towards ensuring health equity. The DIS-CuSS model (Diversity, Identify, Search, Create module with community engagement, Sustainability, Social accountability) is one approach to create a community-engaged iterative curriculum for students (Goez et al 2020), developed to specifically improve the care of marginalised populations. Community-centred and community-engaged pedagogical initiatives are needed in order to meet the healthcare needs of society and fulfil obligations of the social contract, by ensuring that the 'patient perspective' is incorporated into decision making.…”

Section: Values That Need To Be Emphasised Through Social Contractsmentioning

confidence: 99%

Healthcare systems and the sciences of health professional education

Hays

Ramani

Hassell

2020

Adv in Health Sci Educ

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Health professions education is that part of the education system which applies educational philosophy, theory, principles and practice in a complex relationship with busy clinical services, where education is not the primary role. While the goals are clear—to produce the health workforce that society needs to improve health outcomes—both education and healthcare systems continue to evolve concurrently amidst changes in knowledge, skills, population demographics and social contracts. In observing a significant anniversary of this journal, which sits at the junction of education and healthcare systems, it is appropriate to reflect on how the relationship is evolving. Health professions educators must listen to the voices of regulators, employers, students and patients when adapting to new service delivery models that emerge in response to pressures for change. The recent COVID-19 pandemic is one example of disruptive change, but other factors, such as population pressures and climate change, can also drive innovations that result in lasting change. Emerging technology may act as either a servant of change or a disruptor. There is a pressing need for interdisciplinary research that develops a theory and evidence base to strengthen sustainability of change.

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“…A highly effective CLE and organizational culture embraces diversity by also supporting and protecting its team members with policies and practices that mitigate harassments, macroaggressions, and microaggressions through zero tolerance, team development, and training. 5 As a diverse faculty and team are essential to train, mentor, and retain a diverse group of residents, organizations should also provide the resources to support the residency programs and departments in efforts to recruit and retain a diverse workforce.…”

mentioning

confidence: 99%

“…GME programs are socially accountable to the communities they serve, which requires direct community engagement and integrated, collaborative curricula responsive to the unique health care needs of the diverse patient populations being served. 5 The Community Health Needs Assessments is a valuable tool to integrate into program curricula making it tangible and applicable in education, practice, and quality improvement. Individuals, programs, and institutions must seek to understand local history, social and structural determinants of health, and directly involve community partners in designing a socially accountable, community-engaged diversity, equity, and inclusion curriculum.…”

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confidence: 99%

How Do We Move the Needle?:

Elliott

2021

Fam Med

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Diversity, equity, and inclusion are core values in medical education; however, the concepts as currently incorporated into educational models and requirements are limited, just scratching the surface of the actual need and aim. Fostering diversity recognizes and values individual and group differences such as race/ethnicity, socioeconomic status, education, age, gender, sexual orientation, gender identity and expression, disability status, religion, location, language, country of origin, familial status, and other personal experiences. Inclusion builds upon diversity by ensuring a culture of belonging, respect, value, and engagement for all. The lens of diversity requires inward reflection on who we are as a care team of residents, faculty, and clinical staff, as well as outward analysis and perspective on who, how, and what care we provide. From this viewpoint, we consider our alignment in our communities and embrace our differences in the role of achieving health equity-the highest level of health for all people. Inclusive excellence provides an active, substantive context in which diversity, equity, and inclusion integrates into institutional and programmatic mission, culture, operations, education, engagement, and quality improvement activities.The Accreditation Council for Graduate Medical Education (ACGME) Family Medicine Requirements state sponsoring institutions (SIs) and programs must implement policies, procedures, and practices focused on systematic recruitment and retention of a diverse and inclusive workforce of residents, fellows, faculty, and staff; ensure residents demonstrate

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The DISCuSS model: Creating connections between community and curriculum – A new lens for curricular development in support of social accountability

Cited by 21 publications

References 30 publications

Building structural competency through community engagement

Building structural competency through community engagement

Healthcare systems and the sciences of health professional education

How Do We Move the Needle?:

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