By: Rinki Goswami (@rinki91)
“Hope you’re doing well and staying safe!” Every. Single. Email, video conference — even television commercials have some version of this phrase paired with ‘these unprecedented times.”
These times truly are unprecedented – none of us have lived through a global pandemic before. We have had many smaller versions of this crisis to prepare: H1N1 in 2008/2009, Ebola in 2014/2015, and Zika in 2016, all of which offered the opportunity to learn and improve before ‘THE BIG ONE”. While after-action reports and tabletop exercises helped deconstruct where we could do better, one of the largest barriers to successful public health remains untouched – the professional silo.
We are seeing large professional gaps in the response to the COVID-19 pandemic.
In the Unites States, and elsewhere, health policy is disconnected from public health recommendations, which do not take into account the situation on the ground inside hospitals, all of which are completely separated from the average citizen at home.
This is not how it was supposed to be. Public health agencies hire dual degree employees to attempt to minimize the disconnect. Health care facilities have public health or infection control experts. Consultants abound, but the issue remains, as opportunities for overlap in actual work are eliminated. Public health recommendations often do not take into account the most recent standards of care or limitations on the ground. And all of this occurs without addressing the business aspect, which has long overstepped its role in healthcare.
In January 2020, I had the unique opportunity to work at the United States Centers for Disease Control and Prevention (CDC) through the Epidemiology Elective Program (EEP). Initially, I worked in blood disorders and then quickly moved to the Emergency Operations Center as the novel coronavirus swept through China, Italy, cruise ships, and then landed on our shores. As we stepped back into our clinical roles, we could see the gaps in understanding of the medical field regarding public health recommendations and vice versa. We decided, although we were students, we could take action.
Enter the creation of Bridging Medical Gaps Collaboration – an organization focused on eliminating the silos in public health, medicine, and business.
- Our mission: Developing a space for medicine, public health, and business to work collaboratively.
- Our vision: We envision deploying the information revolution to empower global public health and medicine to address the problems of today and tomorrow.
While these are lofty goals, we have broken achieving them into four main methods:
- Project implementation.
We use communication by developing educational content (articles, podcasts, discussion forums) that addresses shared projects and raises awareness of mutual challenges in the field.
Part of building our network involves developing student chapters to bridge the collaboration gap early and create grassroots efforts to address health challenges at the local level, organizing a virtual conference, student elective, and a mentor/mentee program to connect those working at this intersection. We are also advocating (and educating) via letter writing and phone campaigns, and writing regulation comments for shared policy goals. Lastly, we are connecting with other organizations to develop and share resources.
Students are ESSENTIAL to the success of our mission. By engaging and teaching trainees about interprofessional collaboration early, we can ensure that, whether interested or not, students will at least be familiar with various roles in public health. As they enter their professional environments they will bring and share that knowledge with current employers. Although much of medical interprofessional education focuses on the essential roles of NPs, PAs, pharmacists, and nurses it still leaves out large swaths of teams working to keep the public healthy
Students have a unique position of working in the community and addressing needs at a truly local level. However, recent student bodies are composed of trainees which may not represent the communities they are serving. Using student chapters allows trainees to integrate into their community, learn local culture and challenges, and become a fresh vision for solutions. By pulling in learners, we teach them the tools of advocacy, public health, and policy – which they can harness and bring change locally – which is the intent of the student chapters. They will bring BMGC into a local. By emphasizing the importance of the intersection early and practicing advocacy while training, trainees will be prepared to engage early in their careers with the tools they received from their chapters.
Medical students rarely learn about food deserts or how food insecurity (and their policy solutions) affects their patients. They never learn about the difference between insurance-friendly medications and medications that will be denied every time. The complexities of insurance coverage and the resources available for patients without the ability to pay for their care are ignored. Learners are often unaware of available resources and processes and implicit bias is planted early. In the US, for example, the challenges of fair housing and homelessness are overlooked except to disparage homeless patients as noncompliant. We do not learn which vaccines and medications the health department will provide free of charge, or what additional resources are available to assist our patients in lifestyle changes.
We do not learn which diseases are reportable or why. We do not learn how to collect data and observe trends in disease processes (which is especially important with emerging infectious diseases).
I once asked an ED doctor during the height of MERS whether our Saudi Arabian patients merit a further workup due to their travel history, and he asked me ‘what is MERS?’. During the Ebola epidemic I requested that emergency physicians associations join our biosafety forum since they are the first workers to address patients on the front lines, and a public health official asked, ‘Why? What do they bring to the table?” These critical issues are treated simply as ‘beyond our role’ and simultaneously present THE largest barriers to providing appropriate care for our patients and communities.
To reach students we have created a student chapter initiative, contacting universities across the country and proposing students create a chapter of BMGC on their own campuses. They have access to our board and our resources (as they are compiled) and can lead education and advocacy campaigns that address local health issues. They are also required to intermittently produce content and report on pending projects to ensure success. We have also developed a mentor/mentee program to connect working professionals at the intersection of medicine and public health with students so that those earlier in their career can see where they can get involved and move forward with both interests.
We are also developing ‘Social Determinants of Health: A Global Curriculum for a Global Challenge’ – a virtual student curriculum in partnership with the University of Cincinnati social determinants of health curriculum. The goal is to partner with other domestic and international partners to teach all levels of students through the professions about the intricacies of social determinants of health, as well as methods to address them, and how to get involved with local organizations for fieldwork and advocacy drives.
The curriculum will be made available online (free-of-charge) to domestic and international students as we strive to address the student debt burden and reach students interested in public health in clinical settings globally.
Students will also have opportunities to connect with other curriculum registrants during the annual conference, with the intent to share their experiences and potentially develop collaborative, long-term projects.
The curriculum will address barriers by creating an interprofessional opportunity for students to learn about evolving issues with respect to social determinants of health.
The initial online curriculum will focus on:
- OneHealth (intersection of human, animal, and planetary health – https://www.cdc.gov/onehealth/index.html)
- Food insecurity
- Improving health care access for immigrant and refugee populations
- Policy and advocacy in healthcare
- Mental health
- Implicit bias in health care
The objectives of Social Determinants of Health – A Global Curriculum for a Global Challenge include:
- Use data to better understand how public health and medicine training improves health outcomes for patients and learning for trainees
- Advocate for policy changes to improve health-related outcomes for communities
- Allow learners to create content for interdisciplinary health-related professionals on public health topics
- Form connections with health-related organizations and lead/participate with ongoing community health projects
- Create networking opportunities with professionals and students in the field
For the pilot program, students will be recruited from existing BMGC student chapters, academic partners, and speaker institutions to trial the program. Feedback will be collected and after improvements are applied, the course will be regularly updated and expanded.
There will be avenues for regular feedback and student demographic data will be collected.
Students who face language/internet barriers will be identified, with long-term plans to translate core information into relevant and requested languages. This goal is to understand the curriculum’s impact and reach, as well as region-specific student interests and concerns.
Since our foundation in April 2020, we have published thirty pieces reaching a wide audience (over 700 followers on social media). We have featured guest writers on our website as well as our own board members, writing about a wide range of topics from the theoretical (the financial impact of the pandemic) to the practical (where to access contraceptives if insurance companies stop providing coverage). BMGC distributes a monthly newsletter (www.bridgingmedicalgaps.org) to subscribers and has just released a podcast (https://www.bridgingmedicalgaps.org/podcast and https://open.spotify.com/show/0ba5iQyfVyX3IWWWIsqeWE?si=HZHidPbBScipip63-XrYZQ) . We have also developed partnerships with several organizations doing community health work across the United States and established multiple student chapters with more in the works. We have also had three successful advocacy campaigns – including our role in an interdisciplinary team that met with the mayor of Dayton, Ohio to declare racism a public health crisis.
These are very exciting milestones for an organization that is hardly six months old. In the next 5 years we would like to:
- Host an in-person conference
- Hire at least one full-time employee
- Partner with five or more organizations
- Further our curriculum integration
- Establish a global presence!
- Secure a sustainable funding source
We would like everyone in our audience to share their experiences at this intersection with us – through a partnership, writing a guest piece, or even sharing our message out with others. By expanding student chapters and creating a course for learners, we have the opportunity to bridge the professional gaps early to create more effective professionals for the future. With a focus on growth, we can accomplish our lofty mission and vision within our career lifetime and leave the field better than when we started.
About the author:
Rinki Goswami, MD MS, is founder and president of the Bridging Medical Gaps Collaboration. She is an internal medicine resident at the University of Cincinnati originally from Dayton. She also serves on the Trainee Advisory Committee for the Consortium of Universities for Global Health. These experiences enhanced her passion for public and global health. Her research in medical school was focused on refugee health. Her hobbies include hiking, music, and her two cats.
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