Societal Themes

Theme Description

How can HMS best prepare medical students to care for older adults and for patients of any age facing serious illness? COVID-19 has shed light on the urgency of this training physicians in all specialties need to be able to communicate effectively and compassionately about serious illness, goals of care, and end of life with patients of all ages and across illness trajectory.

Possible scenarios:

• A July intern is paged to the hospital bedside of a woman who could be his grandmother, confused and pulling out her lines in a post-operative delirium; is he able to collaborate with her hospital team to provide her compassionate evidence-based care?
• A newly-graduated HMS alumna sits across a clinic room from a young man her own age as he approaches the end of a long road battling a terminal illness; does she have the skills to ask what matters to him in the time that remains, to align his care with his goals and values?

In the Aging and End-of-Life Care theme medical students learn the Geriatrics 5Ms for caring for older adults (Mind, Mobility, Medication, Multicomplexity, and what Matters Most) and about the principles and practice of palliative care, including serious illness communication. The curriculum integrates geriatrics and palliative care education for HMS students based on published learning objectives, aligning with the Age Friendly Health Systems Initiative and the Massachusetts Serious Illness Coalition’s Medical Schools Collaborative for Palliative Care education.

Highlights include:

• Goals of Care workshop
• Palliative Care Pocketcard
• Longitudinal OSCE with an aging patient
• Geriatric 5Ms Pocketcard
• Immersive half-day experiences for first-year students with a Geriatric Home Visit
• Palliative Care Clinical Immersion

Faculty Directors:

Theme Description

Climate change is among the greatest public health threats that the world has ever faced — it is a vast threat to public health and health equity. Physicians are called to practice medicine to improve people's health by preventing and treating diseases. However, increasingly, physicians are recognizing the ways that climate change is impacting their clinical care of patients and want to be a part of the solution.

The burning of fossil fuels is tied to catastrophic events driven by climate change, which in turn have adverse effects on food security, access to clean water, and morbidity and mortality from natural disasters, heat-related diseases, air pollution, and mental health. At Harvard Medical School, we are teaching medical students how climate change is impacting the health of their patients and the practice of medicine. Education plays a critical role in climate solutions. The curricular theme’s philosophy is that no matter what passion brings you into medicine, climate change and its impacts on health play an important role in the medicine each doctor practices. Studies have shown that doctors are the most trusted voice in climate communication.

The Climate Change, Environment and Health curricular theme is led by a working group consisting of faculty from across HMS and Harvard's affiliated hospitals as well as passionate HMS students from the Students for Environmental Awareness in Medicine (SEAM). Faculty from the working group provide expertise in curricular content development, and the curricular theme working group supports course directors in developing the Climate Change, Environment and Health curriculum. Students are very active in developing curricular content, and any student is welcomed to join these efforts.

The Climate Change, Environment and Health curricular theme has five areas of focus:

1. Define the pathophysiological mechanisms by which climate change, air pollution, and ecological degradation impact human health.
2. Apply knowledge of climate impacts on human health to the clinical care of patients, including prevention, diagnosis, and risk reduction counseling.
3. Analyze the historical and structural causes of climate change, air pollution, and ecological degradation, and describe the ways in which it creates and exacerbates health inequity.
4. Describe the ways in which the healthcare system contributes to climate change and how healthcare delivery is vulnerable to climate-related events.
5. Explore roles health professionals and institutions can play in climate solutions.

The curricular theme also provides mentorship and career counseling and coordinates research experiences, projects, and internships.

Faculty Director:

Gaurab Basu, MD, MPH - gbasu@challiance.org

Theme Description

Medical educators face a moral imperative to ensure that future physicians possess the knowledge, skills, attitudes, and behaviors to provide equitable care for diverse patients. Yet, parts of medicine are still anchored in racism and other systems of oppression that continue to this day.

Additionally, the mistreatment of patients — from the Tuskegee experiment to forced sterilization campaigns; separate but equal laws; and other abuses on smaller, more personal or community scales — has resulted in mistrust in the health care system among marginalized groups. Over twenty years ago, Unequal Treatment, a landmark publication from the National Academy of Medicine, outlined the prevalence and impact of health disparities in medicine. Even today, documentation of health inequities—disparities that are systemic, unjust, and preventable—is pervasive throughout the medical literature, and no specialty or field is immune.

These inequities in heath and health care are driven by underlying systems of oppression that shape the social determinants of health and lead to increased disease burden, higher costs of care, poorer quality-of-life, and ultimately shorter lifespans for marginalized patient populations.

The goal of the Health Equity and Anti-racism theme is to ensure that each course and clerkship addresses health equity issues, provides social context to the ways in which inequities manifest in patient populations, and teaches students how to dismantle systems of oppression and build more equitable health systems for all.

Health Equity and Anti-racism competencies and learning objectives will ensure that students continue to grow in their journey toward advancing health equity in clinical care. With faculty, student, and community experts, this theme aims to develop an innovative health equity curriculum that transforms how medicine is conceptualized and practiced as a means for achieving justice in health for all.

Faculty Directors:

Rose L. Molina, MD, MPH
Daniele Ölveczky, MD - dolveczk@bidmc.harvard.edu

Theme Description

Regardless of specialty or setting, healthcare increasingly requires interprofessional collaboration to best promote and restore the health of patients and populations. The Interprofessional Education societal theme prepares students to become effective collaborators in the interprofessional delivery of healthcare.

Curricular offerings focus on developing the core competencies of interprofessional care, as defined by the Interprofessional Education Collaborative (IPEC):

• Embracing shared values and ethics
• Understanding the roles and responsibilities for collaborative practice across the spectrum of healthcare professionals
• Engaging in effective interprofessional communication
• Promoting teamwork for team-based care

Competencies are built through a curriculum that emphasizes facilitating student contact with diverse health professionals and, importantly, the patients who are at the center of interprofessional care.

Students are introduced to the IPEC core competencies starting with the Introduction to the Profession course, where they are prompted to explore the implications of joining not only the physician and dental communities, but the broader community of healthcare professionals. Through subsequent courses, students engage in activities including interviewing patients and simulations of interprofessional care. During the PCE they engage in precepted explorations of how other professionals contribute to the care of patients and elicit feedback from these professionals on how to support such collaboration.

Curricular innovations from the IPE theme have been featured at multiple national meetings and in the literature. Current efforts are underway to embed formalized assessment of the core competencies into the Clinical Capstone course, create a portfolio of interprofessional reflections over the continuum of medical school, and to allow students to participate in creating or assessing interprofessional education activities during their electives.

Faculty Directors:

Susan E. Farrell, MD
Jennifer Kesselheim, MD - jennifer_kesselheim@dfci.harvard.edu
Kelsey Miller, MD, EdM - kelsey.miller@childrens.harvard.edu

Theme Description

The field of sexual and gender minority (SGM) health continues to experience explosive growth, from basic sciences to clinical innovation to systems- and policy-level implementation. HMS students can and want to be change agents to ensure equitable access to culturally-responsive care for all.

At HMS, instruction in SGM health clinical skills is in high demand. Each year, 15–20% of incoming HMS medical students are LGBTQIA+, with a strong passion and expectation for SGM health engagement. On a national level, SGM health rights are under grave and direct threat, with bans on access to basic health care for LGBTQIA+ (lesbian, gay, bisexual, transgender, queer, intersex, asexual, and all sexual and gender minorities) communities in motion across dozens of US states and countries.

The Sexual and Gender Minority Health Equity Initiative integrates SGM health content throughout the core curriculum and cultivates an educational climate conducive for engaging students and faculty in SGM health education.

The initiative employs innovative strategies to:

• Comprehensively review existing SGM health curricular content and climate
• Integrate content across courses and clerkships
• Lead with LGBTQIA+ community engagement
• Adopt an intersectional approach that centers racial equity
• Cultivate safe, affirming educational environments for LGBTQIA+ and non-LGBTQIA+ students, faculty, and staff
• Better prepare all graduating students to care for SGM patients;
• Enhance faculty knowledge, skills, attitudes, and confidence teaching SGM health
• Evaluate effectiveness and impact of SGM health curricular innovations
• Prioritize sustainability of curricular innovations
• Publicly share and disseminate SGM health curricular products and tools

Key outcomes of the initiative have focused on five key areas:

1. Development of nine SGM health competencies
2. Stakeholder engagement (HMS students and faculty, national SGM health experts, and LGBTQIA+ community members
3. Student life and educational climate (increased LGBTQIA+ student matriculants, enhanced mentorship and support)
4. Curriculum development and refinement (authentic LGBTQIA+ standardized patient experiences, clerkship toolkit design, ad hoc consultation for faculty)
5. Faculty development (multimedia curriculum on content and process to teach SGM health)

The SGM curriculum will better equip HMS students and faculty to provide culturally responsive care to LGBTQIA+ patients. Through the sustainable integration of knowledge, skills, and attitudes related to sexual orientation, gender identity, and sex development, the Sexual and Gender Minority Initiative aims to optimize the health and wellbeing of all.

Faculty Directors:

John L. Dalrymple, MD
Alex Keuroghlian, MD, MPH
Jennifer Potter, MD

Theme Description

There is an urgent need for comprehensive medical student curricula on addiction and pain management. The rapid rise of opioid prescribing, opioid addiction, and opioid-related overdose deaths constitute a public health crisis that has focused attention on the critical issues of preventing harmful substance use, diagnosis and treatment of substance use disorders, safe opioid prescribing for pain syndromes, and evidence-based diagnosis and treatment of pain syndromes.

Federal and state governments have appropriately prioritized these issues and have taken regulatory and policy actions supported by fiscal appropriations underlining the urgency of corrective action. A large part of this effort includes the urgent need to adequately train physicians, and other health care providers, to demonstrate competence in addressing these issues in their patients, in care delivery systems, and to assist in the development of effective public health policies and population health management strategies for the US.

Implementation

Curricular elements of the Substance Use and Pain (SUP) theme integration began with the addition of dedicated content to the pre-clerkship courses Mind, Brain and Behavior (MBB) and Transition to the Principal Clinical Experience (TPCE). In the post-PCE phase, a buprenorphine waiver training was added to the Clinical Capstone course. A variety of Principal Clinical Experience (PCE) clerkship-related modules have been implemented and work is underway to further develop clerkship-level curriculum. A “map” of the core, foundational, and advanced curriculum elements that still need to be integrated into the current 4-year curriculum has been developed.

These changes to the curriculum will ensure that we prepare clinicians to provide competent and confident care through understanding the role that hazardous substance use, substance use disorders (SUD), and pain play in human health across the lifespan. The framework ensures an understanding of the importance of pain management in the setting of co-occurring substance use disorder and the ongoing opioid crisis.

All medical students will achieve a basic level of competence in understanding, preventing, screening, and diagnosing pain and substance use syndromes, and formulating a comprehensive treatment plan. They will learn best practices for prescribing medications safely and effectively, recognizing both the importance and dangers of opioid therapies in pain management; as such, they will learn safe opioid prescribing as well as alternative pain management therapies. Students will also gain the knowledge, skills, and attitudes essential to effective behavioral, psychosocial and pharmacologic treatments of SUD.

Faculty Directors:

Theme Description

Trauma is defined as “an event, series of events, or set of circumstances that is experienced by an individual as physically or emotionally harmful or life threatening and that has lasting adverse effects on the individual's functioning and mental, physical, social, emotional, or spiritual well-being.” Because trauma is ubiquitous across the life course and may be associated with a wide spectrum of adverse health consequences, medical schools must teach students to conduct all patient interactions in a trauma-informed manner and respond effectively when patients present with trauma-related signs and symptoms. Educators must also consider how educational content should be sequenced and how trauma-informed competencies should be assessed.

Simultaneously, there is growing consensus that medical educators need to apply a trauma-informed lens to the learning environment—the context in which medical education takes place. Trauma-informed techniques can assist in identifying and dismantling the structural factors that contribute to our students’ academic underperformance, professionalism issues, mental health problems, and burnout—harms that can arise from students’ personal histories of trauma and from traditional medical education norms and practices. As a community of educators, we are called to guide the creation of effective institutional policies and supports to help students navigate the challenges of medical training.

Integration of the Trauma-Informed Care (TIC) theme began with the creation of TIC competencies and implementation of trauma-informed instructional content in the Pathways and HST preclerkship phase of the curriculum, as well as in several PCE clerkships. Advanced content and assessments for the post-PCE phase are now under development. Alongside student-facing materials, trauma-informed faculty development modules are being disseminated to assist faculty in building a learning environment that optimally supports students in navigating the challenges of undergraduate medical education.

These trauma-informed enhancements to the content and process of medical education will ensure that our students graduate with the ability to provide universal, high-quality, trauma-informed care to their future patients while having the opportunity to grow professionally and personally in a nurturing and supportive environment.

Faculty Directors: