Changing Health Care One Medical Student at a Time
Sarah Rosenberg-Scott had found satisfaction practicing family medicine, and, during the early months of the pandemic, caring for patients at Newton-Wellesley Hospital. Yet Rosenberg-Scott, M06, MPH06, an assistant professor at Tufts University School of Medicine, was also disturbed by the health disparities she saw in medicine, with people of color often having worse health outcomes than white patients.
The factors behind this situation—lack of insurance, money, time, transportation, access to nutritious food, or social support—are referred to as social determinants of health, and they create barriers for patients trying to follow medical advice and manage chronic conditions. She wanted to move beyond treating individual patients to help improve the medical system on a broader scale. She wanted to encourage physicians and health systems to provide more comprehensive care that would take social determinants of health into consideration rather than treating medical problems in isolation.
“I spent some time thinking, ‘Where can I make the most impact in changing the system?’” she said.
She decided to take a break from clinical practice so she could teach full-time. “I want to inspire students to change the health care system to be a more equitable experience for more people,” she said, “and I want to teach them to listen deeply to patients.”
She saw her opportunity in a relatively new course, called Perspectives in Medicine – Patients, Populations, and Systems. The course, which spans the first three years of medical school, is designed to engage students with concepts that fall outside the biology of health and disease but are integral to the practice of medicine.
The course, originally called Threads, was added to the curriculum in 2019. Rosenberg-Scott was already the content director for the segment on population health, which refers to strategies such as addressing social determinants of health or developing policies with the goal of improving the health of entire groups of people. Then, in 2022, she became the director for the entire course.
As course director, Rosenberg-Scott is making changes with the goal of transforming how students fundamentally approach medicine. She is putting an explicit focus on health equity and social justice as a framework to explore the disparate topics covered in the course. And she is changing the pedagogy of the course from a traditional model of expert-lecturer to one of collaborative learning among students, health care providers, and community members.
Bringing Other Voices into Medical Education
On any given day, the class might hear from patients, community members, nonprofit directors, and allied health professionals. A recent class about adaptive sports featured physical therapists, occupational therapists, and the director of adaptive sports at Franciscan Children’s Home in Brighton, Massachusetts, who uses a wheelchair. In a section on immigrant health, the class heard from immigrants and from community groups that support immigrants.
Rosenberg-Scott is also giving students a voice, seeking to follow their passions and fuel their fire. Students who come to her with ideas or questions about a particular topic are often asked to co-facilitate a class or even to develop a curriculum segment, for which they receive credits toward graduation.
Kali Sullivan, M25, with Rosenberg-Scott’s encouragement and in collaboration with public health faculty, got an Innovation in Education Intramural grant from Tufts to work with other students and faculty members to build a climate change module for the Perspectives class. As part of that experience, Sullivan has been teaching class sessions and leading discussion groups as well as building content related to the impact of climate change on health and the impacts of the health care system on the environment. “It’s been an invaluable experience,” she said, “and it’s possible because of the type of course Perspectives is and the type of leader that Dr. Rosenberg-Scott is.”
Theo Stein, M25, co-facilitated classes relating to trans health and caring for LGBTQ patients. They appreciated being able to learn and share information that wasn’t covered in other classes, while also having the opportunity to work with faculty to practice teaching skills.
In addition to collaborating with a faculty member, Stein also liked another professional development aspect of the course, which was hearing physicians share how they found their way in medicine. “In the first two years, we’re inundated with facts and memorizing and it can be hard to see the big picture of where we’re going,” Stein said. “It’s been really empowering to hear from doctors at different stages of their career and see all these different paths of people who are really passionate about patient care they are providing and research they are doing.”
An Integrated Curriculum
During the first two years, Perspectives classes typically take place weekly. In the third year, when students are rotating through clerkships in a variety of medical and clinical settings in and around Boston, they come back to campus for a week of Perspectives to spend time reflecting on their clinical experiences. (Students enrolled in the Maine Track program have a similar Perspectives week in Maine.)
The content and learning methods of Perspectives may contrast with the students’ more traditional classes, which involve lectures, lab practicals, and high-stakes exams, but the two approaches complement each other. Together, they provide students with the skills, knowledge, and experiences they need to practice medicine. “They have to learn the physiology and pharmacology; you need that knowledge to be a doctor,” Rosenberg-Scott said. “But we can teach them to listen deeply to patients, to work collaboratively in teams, and how to recognize and access the embodied knowledge of people who are not physicians.”
The content in Perspectives is linked to the biology-based and medical ethics curriculum through the lens of social justice and inclusivity. For example, when students are studying the biology and pathology of the gastrointestinal system in their other classes, they are learning about food insecurity and local food banks in Perspectives. When studying renal function, they look at the ethics of kidney transplants, Rosenberg-Scott said.
In either case, what students learn in Perspectives always applies to the realities of practicing medicine. “So much of what we discuss in Perspectives is very relevant in the clinical setting, like how to use iPad interpreters to speak with patients who prefer to use another language besides English, or having familiarity with social obstacles people may be facing outside clinic,” Stein said. “Now that I’m a third-year, those issues are coming up so frequently.”
Hope for the Future
Interacting with Tufts students in the Perspectives course fills Rosenberg-Scott with optimism. “The way they think of medicine is so new and so different from how medicine has been thought of traditionally,” she said. “That’s what gives me hope that the system might change.”
She’s not relying on hope, however. She wants to measure the impact of Perspectives. Are students satisfied with the course? What are they getting out of it? Will their experiences in the course change the way they practice medicine after they graduate? What do community members and patients feel about participating in the course? She’s tackling those questions in a yearlong fellowship at the Harvard Macy Institute, which seeks to improve medical education. If it turns out that her teaching methods and content choices are effective, it could lead to an even bigger impact if other medical schools are inspired to adopt some of her strategies.
“Students are coming in with so much knowledge already around inequities and social and structural determinants of health,” Rosenberg-Scott said. “Tufts is actively seeking students who feel that way. Now we are updating our curriculum and faculty development to support those students. I truly think we’re on the cutting edge of where medical education is going.”