Students Reflect on First-of-its-Kind Health Equity Program

Brie Howerton, OMS IV, Lake Erie College of Osteopathic Medicine – Bradenton Campus

Ashton Glover Gatewood, OMS III, Oklahoma State University Center for Health Sciences College of Osteopathic Medicine – Tahlequah Campus

Torhiana Haydel, OMS III, Edward Via College of Osteopathic Medicine – Louisiana Campus

The answers below have been edited for brevity and clarity.

Ashton: It is essential because our patients don't exist in little snow globes isolated from the world around them. If we consider one of America’s most common diagnoses, childhood obesity, and we advise a family to increase physical activity and healthy foods, we have to consider what a family can do if there are no sidewalks in their community, if it isn't safe to go outside and play in the evenings or if they live in a food desert and the only place to buy food is at a gas station. We have to understand our patients’ environments, because what we may perceive as non-compliance or lack of motivation to follow a treatment plan might instead be related to health disparities they are trying to overcome. The same is true for patients who have the burden of managing a chronic disease or who are understanding and learning how to work through a cancer diagnosis while also worrying about how to put food on the table or how to pay their electric bill. It's going to be a lot harder for these patients to absorb their health information and make it to their appointments.

Torhiana: It is essential for future DOs to learn about health equity and health disparities because we'll see a wide variety of patients. When you see patients from diverse backgrounds, ethnicities and experiences, you need to be able to provide that same standard of care to everyone despite their economic status or what's going on in their life beyond medicine. As someone who wants to take care of the underserved community as a primary care doctor, I believe that knowing where my patients come from, what they believe in and what might have shaped their viewpoints on medicine and their treatment is vital to making sure that the community I serve is in better shape than the way that I left it. My ultimate goal is to make sure that the information I learned in this course will provide me with a foundational skill set so when I encounter patients, I’ll be able to meet and exceed their needs when it comes to patient care and satisfaction.

Q: What advice would you give to third-year osteopathic medical students who are interested in the Academic Recognition Program but are concerned about balancing it with their other coursework?

Brie: I was able to start and stop this program when I wanted to, and I made it a priority to work on the modules for one to two hours every couple of days. On the weekends, I’d find more time to work through all the material and review what I learned throughout the week to ensure I was prepared to take the quiz at the end. As long as you have good time management skills, this program is important to prioritize in addition to your schoolwork.

Ashton: I'm currently in my third year. I just started my rotations, and the timing was perfect because the Academic Recognition Program added to my clinical learning. It complemented my understanding of cardiovascular disease and psychiatry because it helped me learn about social and environmental factors. This knowledge and perspective will be another tool that I can use when I’m putting together treatment plans and could also help set students apart on rounds or even in applications to residency. Completing the Academic Recognition Program allowed me to use a different part of my brain to think about public health problems. Through completing the Academic Recognition Program, I was studying and working towards my school goals while also getting a little bit of a break, doing something different that still helped advance my knowledge.

Q: What does the osteopathic approach of whole person care mean to you, and does it play a role in how you approach learning about health disparities and health equity?

Torhiana: The whole person approach is why I decided to go to a DO school. I love the tenets of osteopathic medicine, the philosophy that the body is composed of mind, body and spirit and the understanding that healthcare goes beyond disease. This is essential to patient treatment and longevity because DOs are not only asking, “Does this patient have a common cold, or do they have COVID-19?” We look at what could have caused this patient to become ill. Is it their environment? Is it transportation? Is it the foods they’re eating? It goes beyond the disease and is about the whole person. DOs look at all the compounding factors that lead to different healthcare presentations. This perspective helps us determine the best treatment plans with our patients so they can hopefully get better.

Brie: Being an osteopathic physician means getting to the root cause of what's wrong with my patients and helping them overcome those barriers. It’s understanding that health disparities and health equity affect patient health. As Ashton mentioned earlier, I can tell a patient every single day, “Please stop smoking, please eat more vegetables, please go work out,” but if there are boundaries and barriers that prevent patients from doing these things that I’m not aware of, then they may not trust me as much. They may think to themselves, “Why would I not take my medicine if I could afford it,” you know? It puts a barrier between you and the patient. Building trust is crucial to any patient-physician relationship but is especially so in an osteopathic approach to holistic patient care.

Ashton: I think of the osteopathic tenets where we know that the body is a unit. We’re trained to consider the mental, physical and spiritual aspects of a person. When we view the body this way, we're not merely working toward an absence of illness, but also the pursuit of health. We have to consider health disparities and health equity in that equation. Like Brie was saying, it may be that patients want to reach their health goals but there's something they don't know how to talk to you about because you haven't built that rapport up yet. The Academic Recognition Program helps complement what we're already taught at our osteopathic programs and will help build that bridge between where your patient is, and the health goals you share as their physician.

Q: What do you hope to achieve with the knowledge you'll gain from this program?

Ashton: Each patient comes from a unique background with their own perspectives on their disease, illness and health goals. It's easy to fall back on paternalistic medicine and wanting things for your patient, but the knowledge gained from this program will help make students better physicians who can be true partners in care.

Torhiana: Just by participating in the pilot version of the program I was able to learn more about the history of U.S. healthcare. Sometimes patients have a preconceived notion about physicians. It's vital for us to understand where that is coming from, so we know how to assess and handle it better. We need to make sure that we're treating everyone the same because history has shown it has been otherwise. As a third-year student who is rotating in hospitals for the first time, as I meet patients with different disease presentations from what I thought I knew from book work, I'll be able to relate what I've learned through this program to be a better medical student and future physician.

Brie: I want to be the best osteopathic physician I can be. I really liked the program’s rural health module. I plan to practice in a rural area where there are many barriers to good health. Programs like this one are important to knowing how to fully treat your patients so they can be successful in their own lives. There is a quote, and I think this is from Dr. Still, that says anyone can spot and treat disease, but it takes a special kind of person to treat and find health in patients. To me, the Academic Recognition Program helps fulfil that goal.

AACOM encourages all third-year osteopathic medical students to register for the Academic Recognition Program.