‘I can’t breathe” are three words that transformed our lives in 2020 and continues to be in the forefront of our nation in 2021. While it was largely representative of an acute event, there is a long history of oppression represented in these words. I am not a historian but in my quest to educate myself on the current events, it is clear to me structural and systemic issue exist that perpetuate inequities that manifest in many ways including health and health outcomes. I also discovered that in 2002, one year after the publication of the Institute of Medicine (IOM) (now called the National Academy of Medicine) called Crossing the Quality Chasm: A New Health System for the 21st Century, was another landmark report called Unequal Treatment: Confronting Racial and Ethnic Disparities in Healthcare. The report explores how persons of color experience the health care environment and highlights how disparities in treatment may arise in health care systems. While this can be attributed, somewhat, to patients’ and providers’ attitudes, expectations, and behavior, suggested solutions are directed to addressing structural/system issues that perpetuate inequities. Recall that the Crossing the quality chasm report also details how safety is a system property that needs to be supported by structures that enable individuals to do the right thing which often means functioning in teams.
I was attending the Nexus summit and was riveted by a plenary speaker, Dr. Denise Rodgers, who’s talk was titled: Diversity, Disparity and Health Care Teams and she mentioned an article by Peter Cahn, How interprofessional collaborative practice can dismantle racism, was provocative in several ways. He proposed new verbiage for the four domains found in the IPEC competencies:
- Values/ethics: Health professionals should affirm their ethical obligation to band together with colleagues from across the professions to advocate for the repeal of policies that adversely affect the health of minoritized populations.
- Roles/responsibilities: Health professionals should reflect critically on their own racial position and how it establishes power imbalances between members of the team and with patients and families.
- Interprofessional communication: Health professionals should enhance perspective taking and analysis of identity-making through small-group discussion of fictional texts and films.
- Teams/teamwork: Health professionals should form meaningful partnerships with local organizations that lead to sustained immersion in low-resource communities.
He ends the article with a challenge for us (IPE-er’s): to reimagine these domains and associated competencies to be inclusive of diversity, inclusion and health equity. The additional challenge was to teach our students structural competence—the lack of inter professional education and practice and health equities are born from structural barriers coupled with individual bias.
I began to read more and more about structural competence, “a term used in American health professional education to describe the ability of health care providers and trainees to appreciate how symptoms, clinical problems, diseases and attitudes toward patients, populations and health systems are influenced by ‘upstream’ social determinants of health”. The more I read, the more passionate I became about addressing these issues with our learners. I convened a team, Interprofessional of course, who shared this same passion. We had previously conducted pilot work focused on IPE in the Clinical Learning Environment (CLE) (see previous blog) to teach medical and nursing students about discharge planning and teamwork competencies. We asked ourselves, “why not change the view into the room just a bit and leverage the environment, learning in teams, to include explicit attention to structural barriers to health equity and its impact on what they may encounter on discharge?” We worked tirelessly to put together a proposal, secure buy in from leadership from health care and academia, map clinical schedules, develop a curriculum outline and build a coalition to support the work. Despite our efforts to secure a funder, we have fallen short and are back to the drawing board.
The look back on my career in IPE over these three blog posts has helped remind me how things take twists and turns; there is no straight path despite our efforts. What started as a literature search on communication has end, today, with my determination to leverage IPE to teach structural competence, a concept that applies to both IPECP and racism leading to significant impact on health outcomes. The next generation of health care workers deserves to understand these barriers to practice and will be one of the most important history lessons, they will ever have….
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