By Claudis Polk, O’Rese Knight, Neva Howard and Beat Steiner
We want to share with you an exciting and powerful innovation centered on social justice and aimed at narrowing persistent and severe health disparities in our state and in our country. UNC has long been recognized as a leader in social justice efforts, and we are confident that this newest initiative will continue that tradition.
In 1969, students started the Student Health Action Coalition (SHAC), the first student-run free clinic in the country. In 1974, UNC started the Medical Education Development (MED) program, designed to increase opportunities in the healthcare professions for individuals who demonstrate educational promise and commitment to a healthcare career but who have lacked opportunities in the past in moving toward their professional goals. There have been many other examples since.
Despite these efforts, terrible disparities persist, highlighted strongly by the current COVID-19 pandemic. Health structures predictably failed on a mass scale. Incremental change imposed on powerful systems designed to be exclusive have achieved their original intent: disproportional health for the privileged. Black and Brown communities and other marginalized groups are suffering unimaginably worse outcomes.
This trend has also been mirrored in our educational systems; despite increased representation of women, LGBQT+, and disabled students, leadership positions for under-represented minorities have remained stagnant. In fact, representation of African American men in medical school has decreased over the last thirty years.
To address these disparities within the healthcare system and within our education system, the UNC School of Medicine is rolling out a transformative new program, MED EXCEL (Medical Education Development Early eXperience in Clinical Education and Learning). Claudis Polk MA, the director of the Office of Scholastic Enrichment and Equity, is providing oversight of the program, with O’Rese Knight, MD, serving as director and Neva Howard, MD, serving as curriculum director. The program also has the strongest support at all levels of the medical school and at the highest levels in the University. MED EXCEL is recruiting its first class of students this winter and the program will formally launch in May 2021. MED EXCEL students will join the class of 2026 in the fall of 2022.
MED EXCEL will provide an intensive one-year clinical, academic and professional development curriculum with conditional acceptance to UNC School of Medicine upon successful completion of milestones. Conditional acceptance means that these students are guaranteed a spot in the medical school in the next year as long as they fulfill clearly established milestones. This conditional acceptance will help alleviate anxiety and allow these students to be valued members of our medical school community.
They will enter their first year of medical school well-prepared and well-positioned as leaders and role models. The curriculum of MED EXCEL leading to the entry into the SOM is designed to promote trust, belonging and inclusivity through the formation of deep relationships in a small-group, case-based learning community. The acquisition of content at the base of Bloom’s taxonomy will be achieved using a self-paced digital curriculum. Based on principles of cognitive load, spaced retrieval and interleaving, students learn content efficiently, and learning communities concentrate on application of concepts in an inclusive and authentic environment. Central to the program is engagement in population health projects servicing our immediate community in North Carolina.
MED EXCEL is designed to transform how we educate healthcare professionals. The transformation must start with the creation of leaders among the most critical and at-risk members of our community: under-represented minorities prior to matriculation. We will start with a small cohort of students and teachers fundamentally committed to change and a growth mindset. At this point, we anticipate recruiting nine students and have already recruited teachers to work with those students.
We believe that the MED EXCEL program will also help transform the overall medical school curriculum. We have proven that adding courses, modules or experiences to an already near-bursting curriculum does not work. During our significant work in remediation of medical students, we have come to realize that our system of education is biased deeply in our pedagogy of information transmission. This is not a new problem. In the words of Benjamin Bloom in 1984, “The normal curve is a distribution most appropriate to chance and random activity. Education is a purposeful activity and we seek to have students learn what we would teach. Therefore, if we are effective, the distribution of grades will be anything but a normal curve. In fact, a normal curve is evidence of our failure to teach.”
Our years of work in remediation of medical students was in fact basic teaching: the development of the student. Remediation is the heart of teaching and transformation. Bringing growth and transformation to the heart of the curriculum will benefit everyone, and disproportionally benefit students who have large opportunity gaps due to arbitrary circumstance.
We believe that we must promote a complete transformation of the educational environment towards equity, inclusion, innovation and adaptability using all evidence available. In order to transform racism and inequity at its roots, we must start small, designed to scale up. We will start with a small cohort of diverse individuals at the beginning of their learning curve, coached and mentored by diverse healthcare professionals also at the beginning of their learning curve as transformational educators, and use the cutting edge of learning science to create leaders of the future.
It is not enough to just add individuals from underrepresented in medicine (URM) backgrounds; we all must work as a group to transform pedagogy and curriculum to create adaptable, innovative, and diverse leaders devoted to the all-encompassing goal of respect, inclusion, equity and justice.
To learn more about the MED EXCEL program and how to offer support, please contact Jeanine Simmons, Senior Executive Director, Medical Education and Alumni Development, at firstname.lastname@example.org.