COVID-19 Necessitates a Commitment to Social Mission in Medical Education.

Abstract

To the Editor: A recent commentary in The Wall Street Journal calls for a medical curriculum overhaul prioritizing statistics, emergency medicine, and ventilator management. 1 Author Stanley Goldfarb asserts the dwindling emphasis on these topics is the result of expanded education on social issues. Medical students, he argues, need improved training in disaster preparedness and less training in social determinants of health. We were dismayed by the following statement: “Above all, the medical profession should abandon the fantasy that physicians can be trained to solve the problems of poverty, food insecurity and racism.” This remark illustrates a myopic view of the unfair ways health care systems treat underserved communities. It also proposes an antiquated conception of public health as separate from social determinants of health. To divorce emergency medical response and public health from social determinants of health during the COVID-19 pandemic is to risk catastrophe. Hurricanes Katrina and Maria, for example, demonstrated the consequences of failure to incorporate social context into disaster planning. Unfortunately, we are now witnessing a COVID-19 response marred by racism and disparity for people of color. 2 While investment in pandemic preparedness is essential, addressing social issues is not detrimental to other parts of medical education. Characterizing social issues in medicine as curriculum creep is inaccurate. Few medical schools have implemented meaningful curricular elements related to social determinants of health. 3 The irony of Goldfarb’s commentary is that it may illuminate critical underinvestment by schools in social mission. We believe it is time to “abandon the fantasy that” our commitment to our patients is confined to the 4 walls of a clinic or hospital room. It is not enough for doctors to simply prescribe pills from the ivory tower without engaging in the things that truly impact much of patients’ health. Public health experts and physicians are well positioned to address social determinants of health like “poverty, food insecurity and racism.” Advisory committees of the Health Resources and Services Administration and the National Academy of Medicine already recognize the importance of social determinants of health in medical education. 4,5 The work of the Beyond Flexner Alliance (the organization with whose recommendations Goldfarb takes issue) reminds us why we entered the health field: to reduce disparities and achieve health equity. Teaching social determinants in medical education ensures physicians are included in vital health equity conversations and are capable of guiding community-oriented disaster response during COVID-19 and future crises. We call on curriculum leaders to resist reactionary temptation to undo or delay advances in social issues in medical education in the name of pandemic preparedness. Such a calculus is a false dilemma; these issues are inextricably linked. Addressing the social determinants of health is an extraordinary task, but some dreams are worth fighting for.