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Social Equity and Inclusion

Historical and structural forms of social oppression based on identity, including racism, sexism, homophobia, transphobia, xenophobia, classism, ableism, and discrimination based on religion or education, have a profound effect on the health of individuals and communities. Despite our commitment to do no harm, medicine has often perpetuated and benefited from social inequities, exploiting vulnerable populations and patients on numerous occasions. While this is a longstanding historical pattern, the inequities persist to this day and are in some instances expanding.

UMass residents, students, faculty, nurses, social workers, police, administrators, and  more gather for a socially-distanced Black Lives Matter protest on our University Campus that was co-organized by WFMR PGY-2 Laurel Banach.

The Worcester Family Medicine Residency (WFMR) is working to address structural oppression within our own program, within medicine, and within our society. We believe this is not just an extension of our mission to promote health and wellbeing in our communities, but an essential component of that work. We have established two standing task forces with resident and faculty members to further this work: the Anti-Racism and Systemic Inequalities in Medicine Task Force and Diversity in Recruitment Task Force. In addition to this work at the central residency level, each of our health centers is working on these issues in multiple ways. 

The patient population served at our Family Health Center of Worcester (FHCW/Queen St.) site is highly diverse and medically underserved; 53% of our patients are Latinx, 18% are Black, 9% are API, and 21% are multiracial. We provide services in 55 languages for the 46% of our patients best served in a language other than English. Three-quarters of our patients are living under the federal poverty level and 94% live under 200% FPL. Our residents participate in a two-year Vulnerable Populations Workshop curriculum. We also provide residents with opportunities to address inequality in their clinical work through our HIV and viral hepatitis program, refugee and asylum clinic, Homeless Outreach and Advocacy Program, gender affirmation clinic, Office Based Addiction Treatment program, direct transfer of care of patients following incarceration, and more. 

FHCW Global Health Fellow Raulo Colón-Mulero and PGY-2s Judy Wang and Becca  Gwaltney alongside family medicine resident colleagues from ELWA Hospital in Liberia.

Our Hahnemann Family Health Center residents are involved in reproductive justice work and receive training in medical and surgical abortions. The site is also committed to practice transformation and quality improvement with a lens on health equity and access. Residents interface with medical students, fellows, and residents from other specialties in the clinical setting and are working to reinvigorate health center-based didactics to focus on social justice.

At Barre Family Health Center, residents work with an underserved rural community. They provide compassionate care for patients living with chronic pain and substance use disorders. A nearby behavioral facility affords the opportunity to care for a number of trans teens, including by providing puberty blockade in the primary care setting. They also offer medical abortions and plans are underway to launch an asylum clinic. 

These efforts are ongoing and we as individuals and as a residency program are committed to doing the daily work to mitigate harm and build a better system. This is going to be a long and difficult road to acknowledge the painful history and persistent inequalities facing our communities. We acknowledge that we have not and may never arrive at our destination. We believe we have a responsibility as physicians to combat discrimination, prejudice, and structural inequality, as well as to celebrate the diversity of human experience.

                                                Our PD, Ginny Van Duyne, MD, at the Worcester Pride Parade.  

Anti-Racism and Systemic Inequalities in Medicine Task Force
This task force brings together residents and faculty from across our department, including primary care physicians, FM obstetrical providers, hospitalists, behavioral health providers, sociologists, and admissions staff. Our central focus is on actively combatting racism as well as identity-based discrimination that leads to structural forms of inequality. 

One of our roles is to coordinate and collaborate with the Department of Family Medicine and Community Health, the Graduate Medical Education department, the University of Massachusetts Medical School, and the UMass Memorial Health Care system in their ongoing efforts to fight racism and systemic inequalities, including through multidisciplinary efforts like the UMass Memorial Maternity Center Anti-Racism Task Force.

We are also working to incorporate broad changes into our didactics curriculum and faculty development, with the underlying goal of denouncing race-based medicine as well as holding the medical field accountable for historically prejudicial policies and practices. This includes materials to help faculty determine if their presentations reflect diverse patient populations and use fully inclusive language. Didactic facilitators will be asked to include material on how the topic area interacts with social inequalities, such as the role of environmental racism in asthma, food insecurity and its relationship to diabetes, the controversy over measuring kidney function differently based on race, the pervasiveness of exclusive training in white skin tones for dermatology topics, disparities in treatment and diagnosis of mental health conditions based on race and gender, the fraught history of the gender dysphoria diagnosis, etc.

Finally, we are committed to establishing competency milestones to ensure the residents we graduate have the knowledge and tools to address systemic inequalities in their current and future practice. 

Meet Our Anti-Racism and Systemic Inequalities in Medicine Leadership Council

The Physician as Leader rotation occurs in each year of residency. PAL-1 offers time for interns to learn more about the diverse community of Worcester. 

Diversity in Recruitment Task Force
The DIR-TF is committed to fostering an environment of acceptance, support, and representation of diverse perspectives. Our work is an attempt to bridge the gap between the providers we train and the populations we serve. Over the past several years, we have worked to integrate a holistic review of all applicants that acknowledges that physicians who experience social inequalities on a daily basis face unique challenges in their educational journey. 

In addition to academic and clinical strengths, we actively pursue applicants who bring diverse perspectives through their lived experiences. This includes race, ethnicity/culture, gender identity, sexual identity, religion, refugee or immigrant experience, socioeconomic status, first generation college student status, personal or family hardship, disability/differently-abled experience, and life experience in underserved urban or rural communities. We are also looking for residents who have demonstrated a strong commitment to anti-racism work or advocacy to combat inequality in support of people of all identities.

The task force is co-chaired by WFMR Associate Director of Admissions Mike Smith and Chief Resident Jordan Howard-Young. This year, more than half of all residents are members of the task force alongside numerous faculty and central residency staff. We are working to improve outreach to applicants who experience social inequalities, and to counteract bias in our interview selection, application review, interview questioning, and ranking processes.