Time for Social Justice: One Residency Program’s Response to a Call for Action

Three years ago, when we began our family medicine residency, we aspired to become physicians who are not only adept at managing our patients’ chronic medical conditions but also serve as their advocates. We chose family medicine because of the emphasis that it places on incorporating social determinants of health into chronic disease management and feel proud to be training to care for patients as their primary care doctors.

The last several months of our residency, however, were upended by the COVID-19 pandemic and further exacerbated by persistent police brutality and racism that led to the most recent series of protests in our city of Philadelphia. Both of these situations further exposed the inequities that impact the well-being of our patients. This acute and chronic trauma that communities of color disproportionately experience is just as much a determinant of health as food and housing insecurity.

In Philadelphia, where we trained and intend to practice, most people identify as People of Color: 42% of Philadelphians identify as African-American, 14.5% as Hispanic or Latino, and 7% as Asian. We see this diversity in our patient population both at our residency practice and at community sites where we trained. Despite this, when we reflect upon our training, there is a noticeable void of antiracist introspection, dialogue, and action.

With such unequivocal evidence that police brutality and this pandemic disproportionately affect the patients we serve, we feel it is our responsibility to initiate conversations with our colleagues and our patients to address this structural violence. In response to STFM President Tricia Elliott’s call to action,¹ we proposed a number of structural changes to our program, which follow. As suggested by Guh and colleagues,² we believe that these interventions will need to target multiple aspects of our residency to lead to significant and lasting changes.

• Drawing from the work of Wu et al³ incorporating antioppression curriculum through quarterly workshops focused on developing skills for allyship into resident didactics
• Training residents to be competent in screening for structural and social determinants of health, including police brutality and other forms of structural racism
• Prioritizing recruitment and retainment of underrepresented minority residents and faculty members similar to the successful efforts of Boston Medical College as published by Wusu et al⁴
• Ensuring that time and resources from our department and program are allocated to community organizations to better understand and address our patients’ needs

We presented these proposals to our residency and feel proud to be members of a department where we are having these conversations and making changes to more explicitly address racism in health care. Despite all of the darkness that the pandemic and police brutality have exposed, we hope this serves as an impetus for other residents to ask of our colleagues, mentors, programs, and academic societies to work toward equity in medicine, starting with the education and diversification of residency programs.