CDIC Advocacy - Health Equity and Advocacy in the Internal Medicine Residency Program

We are committed to developing a nationally recognized training program that supports diverse teachers and learners, fosters a culture of self-reflection, and empowers residents to collectively address upstream drivers of health inequity.

We envision a healthcare system where all people receive quality, equitable, and compassionate care.

We believe that:

• Everyone deserves equitable healthcare.
  • All people should be able to access medical care via a universal, comprehensive healthcare system in a welcoming, safe, inclusive environment regardless of race, gender, sexual orientation, gender identity, economic status, disability, incarceration status, nationality, or primary language.
• A diverse physician workforce is essential.
  • In addition to diversity in our medical trainees and faculty, equity in leadership positions and compensation is essential to achieving just healthcare and medical education systems.
• Physicians should receive comprehensive education in all of the determinants of health.
  • Medical education should extend beyond pathophysiology. Physicians must receive comprehensive education in comparative health systems, social determinants of health, systemic racism, and other structural drivers of morbidity and mortality in order to advocate for the policy-level changes that will improve the health of our patients and society.
• We must hold ourselves and our institutions to the highest standards.
  • Unconscious bias leads to inequality in healthcare. We recognize the importance of cultivating a culture where we are expected to examine, identify, and address this bias within ourselves, our community, and the larger healthcare and medical education systems.
• This work is best done together.
  • Collaboration, collective action, and mutual support are essential components to achieving truly equitable healthcare and medical education systems. We will work with patients and community groups and always center our most vulnerable and marginalized patients in our advocacy efforts.

As physicians, we acknowledge that the long history of racism and systemic bias in medicine and medical education has lead to inequitable health care. These standards were co-created by Emory internal medicine residents and faculty to articulate our vision for the future of medicine within the systems in which we practice. These standards assess our current state, articulate our plans for the future, and lay out our aspirations as we work toward a more just and equitable healthcare system.

We are using these standards as a working document to initiate important conversations and hold us accountable for continued, deliberate structural change in our program and communities.

• Representation: Build population parity in the workforce by promoting recruitment and retention of diverse residents and faculty

• Support: Provide institutional support for residents and faculty, including discrimination reporting and creation of affinity groups

• Education: Create and maintain a robust health justice curriculum and evaluate the current curriculum for bias

• Patient Care: Protect our marginalized patient populations and work to ensure equitable treatment for all patients under our care

• Research: Ensure studies conducted at Emory define and justify any use of race and acknowledge racism, not race, as a cause of inequity

• A working group of residents, residency program leadership, and DOM leadership jointly developed a progress report on the initial 2021 health justice standards (coming soon)
• IM residents and faculty were invited to deliver a workshop at the annual, national SGIM meeting on steps health institutions can take to improve the care of incarcerated patients in the hospital
• Continued to prioritize and host monthly health equity noon conferences. Topics included “the relationship between policy and social determinants of health” and “introduction to advocacy” 
• Initiated a health equity case conference lecture series for residents, in which we analyze how different social determinants of health impact a patient’s illness trajectory. 
• Formed an initiative to help patients register to vote, find their local polling office, and vote in November, even if hospitalized
• Matched four RYSE clerkship participants into the 2024 class of the J. Willis Hurst Internal Medicine Residency Program

• Studied and published an analysis of the impact of our work, particularly the Health Justice Standards, on resident interest in advocacy as a career goal; we showed that our work was significantly correlated with increased resident interest in advocacy (publication here)
• Successfully advocated for protected time for residents in the Social Medicine Distinction to do CDIC-Advocacy-related work 
• Successfully advocated for more transparency about Department and Program diversity on the Emory website (link here)
• Residents continue to meet regularly with program leadership to discuss ongoing efforts to fulfill the Health Justice Standards

• Successfully advocated to the Emory Institutional Review Board (IRB) to include a new requirement that researchers define race and its use in Emory-based studies (manuscript describing this work accepted for publication in 2023)
• Successfully advocated for equal patient caps at all of our resident primary care clinic sites. Residents at the Grady primary care clinic previously had more patients scheduled per day than residents with Emory and Emory-Midtown clinics, but now all residents are scheduled for the same number of patients across all internal medicine resident primary care clinic sites
• Successfully advocated for equal patient caps between Emory and Grady wards. Grady and the VA wards teams previously capped at 18 patients while Emory and Emory-Midtown capped at 14 patients, but Grady has now moved all teams to a 14-patient cap
• Developed connections with community advocates including the Communities over Cages Coalition. Specifically, we have supported their ongoing efforts to decarcerate the overcrowded Fulton County Jail and to close the nearly empty Atlanta City Detention Center in order to repurpose it to the John Lewis Center for Equity and Freedom. We support the ongoing efforts of community organizers to stop the construction of a 90-million-dollar military police training facility in the South River Forest. We oppose the construction of a new costly Fulton County Jail and support community members asking for alternative investments in care. We have collectively given testimony dozens of times to the Atlanta City Council, published op-eds, joined local actions, and organized healthcare worker rallies around these campaigns
• Held rallies and published op-eds in support of Medicaid expansion in Georgia and continue to support these efforts
• Developed a relationship with and support the expansion of the Policing Alternatives and Diversion Program to address the unmet needs of those struggling with extreme poverty, substance use, and/or untreated mental health in Atlanta
• Our monthly Health Justice Curriculum was voted the best Grady-based curriculum by Emory IM residents

• Started a monthly, resident-run core Health Justice Curriculum (which has continued to the present - see topics here) for all Emory internal medicine residents in January of 2021 focusing on the history of racism and bias in medicine, intersectional oppression, non-biological drivers of disease, comparative health systems, and health justice strategies
• Obtained DOM approval to publish our Health Justice Standards on Emory’s website as part of the IM residency program’s official approach
• Our DOM continued to grow and support programs to recruit more diverse trainees (RYSE, MFAX, Diversity Recruitment Days)
• Held our first annual Health Equity Day in conjunction with the DOM DEI Council; this has continued annually
• Our DOM DEI Council started bystander/upstander and implicit bias training for all new residents
• Our DOM DEI Council successfully advocated for the removal of the eGFR race-based correction for non-Hispanic Black people in the Emory and Grady electronic medical records
• Held an event for CDIC-Advocacy residents and medical students to research and discuss candidates for the upcoming Atlanta mayoral elections

• Started CDIC-Advocacy
• Developed a Mission & Vision statement for review by the CDIC, residents, and DOM leadership
• Obtained “Doctor” badge buddies for each resident to make their roles clear and to avoid the misidentification of female and URiM residents’ roles on the team
• Developed voter registration guides for the upcoming national elections
• Printed and disseminated badges with QR codes linking to the voter registration website to our residents so that we could help patients in our clinics and hospitals get registered to vote