Christiana Care Health System, Newark-Wilmington, DE “A-HA!” Advancing Health Advocacy Through Resident Education

Arlene Smalls; Renee Kottenhahn; Michael Maguire; Loretta Consiglio-Ward; David Paul

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PROJECT MANAGEMENT PLAN – Advancing Health Advocacy (A-HA), A Health Equity Educational Curriculum

Vision Statement	Physicians in training are exceptionally positioned to establish a new culture of medicine with an appreciation for diversity and the social determinants of health. Effective interdisciplinary partnerships are necessary to create sustainable, system-based changes that impact the populations we serve. Our vision is to leverage the current educational infrastructure to create a longitudinal, collaborative learning curriculum that addresses topics of diversity and healthcare disparities and resonates across all medical specialties. We aim to help our learners become competent, mindful, and compassionate clinicians who are engaged in their local community (ie, health advocates) via a curriculum that provides the opportunity for insightful (“A-HA!”) experiences.
Team Objectives	Our project assumptions were as follows: Integrate a structured poverty simulation event into the Christiana Care Health System (CCHS) resident orientation that will introduce participants to the concepts of poverty and highlight both hospital-based and community resources Use the validated pre- and postsimulation survey and consider the creation of other measures such as the Attitude Toward Poverty Scale, the Understanding Others Scale, the Critical Thinking Scale, or customized surveys and word mapping Repeat collection of the measures longitudinally during residency training (simulation surveys, resident surveys) Allow for feedback from residency program directors and establish faculty champions to act as healthy equity journal club mentors who work actively with a resident team member Substitute a relevant, specialty-specific health equity article into the existent, mandatory residency specialty CCHS journal clubs A key goal was to strengthen and create community partners to allow resident work within our community. Two long-term goals were to compile the identified resource tools into an accessible CCHS repository and to create a pathway toward a CCHS Certificate in Diversity and Health Equity based on resident participation and leadership in multiple venues for community and health advocacy.
Success Factors	The poverty simulation event was extremely well received by the inaugural resident trainee class and deemed the highlight of the weeklong orientation by Academic Affairs. The simulation will be included within resident orientation longitudinally. After publication in the CCHS internal magazine FOCUS, the poverty simulation received interest across the health system. resulting in requests to repeat the exercise with leadership to better integrate health equity into our clinical operations and strategies. CCHS set aside time for our health system managers and directors to experience the poverty simulation. Early data analysis suggests that the poverty simulation activity did impact resident trainees’ attitudes and knowledge regarding health equity topics. A manuscript describing the poverty simulation experience with new residents and interns was accepted for publication in the Journal of Graduate Medical Education.
Barriers	The largest barrier encountered was that team members found it difficult to meet with any regularity because of schedule conflicts and the lack of protected time for clinical faculty and residents serving in lead positions. We worked to overcome this challenge by capitalizing on each other’s commitment with frequent handoff of key tasks between team members. We leveraged each other’s strengths and professional networks and maintained momentum via early morning and late night phone meetings/email and text communication.
Lessons Learned	The single most important piece of advice to provide another team embarking on a similar initiative is that team members need to understand early the magnitude of the time commitment necessary for successful project completion. We recommend recruiting a diverse and actively engaged group of core team members who have an identified, institutional commitment to health equity and resident education early in the project. It is important to recognize that the hospital administrative partners who are key to project execution may have competing priorities that make it difficult to establish their commitment to NI V activities.