When she was 5 years old, Reine Ibala and her family moved to the United States as refugees amid civil war in their native Republic of the Congo. Her father later developed hypertension and faced challenges as he navigated the U.S. health care system. His physician was dismissive, Ibala recalled, and failed to address the real, personal and cultural reasons behind her father’s misgivings about his treatment plan. With a discordant patient-physician relationship and lack of shared decision-making about what treatment plan would be best, he ultimately died from a dissected aorta.
“Being a good physician isn’t just delivering scientifically and clinically excellent medicine,” said Ibala, 27, now a third-year medical student at Weill Cornell Medicine. “It’s about being able to meet patients where they are, understanding where they are coming from and knowing when to follow their lead.”
That experience, along with her upbringing as a Black woman and immigrant in the United States, was formative for her, she said. It engrained in her the importance of social justice and health equity – values that underpin her aspiring medical career. The 2020 murder of George Floyd and the resulting national reckoning on race, along with the disproportional impact of COVID-19 on communities of color, further galvanized her, driving her participation in a newly established committee at Weill Cornell Medicine devoted to advancing those principles through the prism of medical education.
Convened in summer 2020 by Dr. Yoon Kang, senior associate dean for education, the Anti-Racism Curriculum Committee was charged with reinvigorating Weill Cornell Medical College’s curriculum to ensure that medical students gained a firm understanding of how social, economic and policy factors influence health outcomes. These social determinants of health, which co-chair Dr. Joy Howell calls the “social impediments to health,” have been recognized by the Centers of Disease Control and Prevention and the World Health Organization to be more important than genetics or ancestry, health behaviors, and even access to care and the quality of that care.
“We need to impress upon the next generation of health care workers the power that societal factors have on population health, as well as an individual’s health, so that they can become well-rounded, comprehensive physicians,” said Howell, who is also assistant dean for diversity and student life at Weill Cornell Medicine. “If you are just coming up with a medication to treat high blood pressure and not attending to the context in which this patient lives, I question your ability to effectively control that patient’s blood pressure.”
Comprising Weill Cornell Medicine administrators, faculty, students and staff, the Anti-Racism Curriculum Committee met throughout 2020-21 and quickly identified the need to encapsulate social justice and health equity in a new medical college foundational learning objective.
The goal, said committee co-chair Dr. Joseph Safdieh, was to develop a framework in which social determinants of health, including racism, are taught longitudinally, across all four years of medical school, rather than in a single course.
“If we segmented it into an individual course, the concepts then just exist on their own,” said Safdieh, who is also the Gertrude Feil Associate Dean for Curricular Affairs, the Louis and Rachel Rudin Foundation Education Scholar and a professor of neurology at Weill Cornell Medicine. “The students learn it and then move on. We want to show them that understanding social determinants of health is relevant in heart disease, lung disease, kidney disease, brain disease, in all different organ systems. This isn’t a unique problem in medicine, or surgery, or neurology or OBGYN. It’s a pervasive societal problem that impacts every patient’s experience.”