Growing up as an Indian American kid in the suburbs of Minnesota, a career in medicine was always in the back of Priya Sury’s mind. At first, she resisted the idea, instead studying Spanish and anthropology in college. But it was an introductory anthropology class project at Washington University that would eventually redirect her to medical school and beyond.
While interviewing Spanish-speaking people around St. Louis for her project, she got to learn about their life experiences. Through those conversations, people were saying what they needed and what sort of services they wanted. A theme kept coming up again and again – the want and need for better access to health care. In particular, the need for others who could really understand them, as well as people who could help do something about the conditions they were facing.
Combining her experiences with her studies of Latin American political figures who saw medicine as a manifestation of society, and with the help of undergraduate professors who combined the worlds of anthropology and medicine, the now Dr. Sury took her inspiration to medical school, Oxford and beyond.
Today, Dr. Sury is an emergency medicine physician at HealthPartners and an assistant professor of emergency medicine at the University of Minnesota. She is also the architect behind Community Health MPact, a new community-focused course for students at the University of Minnesota Medical School. In today’s Off the Charts, Dr. Sury talks more about the need for a renewed focus on the communities health care professionals serve in the study of medicine. Listen to the episode or read the transcript.
Science and data vs. the human experience
During the podcast, Dr. Jackson talks about how health care professionals are very driven by science and data. And rightfully so – they want to make sure that treatment plans, workups and investigations are clinically and medically appropriate as well as measurable. However, behind the numbers and the desire to fix them, there is a story. Addressing the story can change the numbers, but the drive for data can come at the expense of hearing that story from the patient.
Unfortunately, much of medical school involves an almost singular focus on science – one that’s introduced early and sustained heavily throughout. In a field that also attracts students that are primarily academic and also driven by statistics and proof, the bigger component of the human experience can be sidetracked, if not completely left out.
It's an omission that can set up major issues later as students become health care professionals. Without an additional focus on the experience of patients and the role of health care in serving its community, health inequities can continue and become even worse. So, when health equity and DEI conversations come up, especially in the wake of tragedies like the murder of George Floyd, they feel more of an addition instead of being what they truly are – an intrinsic part of practicing medicine.
The course: Community Health MPact
Like many medical students, Dr. Haley went to a medical school in the heart of a large city. And also like many, including Dr. Sury, there were few discussions on diversity or equitable care, if any. For these reasons and more, Dr. Sury and her colleagues have “created the course that I so desperately wanted as a medical student and what I felt was missing at the time.”
This new course, Community Health MPact, will be required for all medical students at the University of Minnesota. All students choose one of five pathways: urban and community health, rural health, immigrant and refugee health, 2SLGBTQIA health and Indigenous health. The course runs two hours a week for five weeks throughout the course of two years.
Each pathway highlights the people of each community, including their specific health care needs and issues accessing care. As Dr. Sury describes, “we really want to meaningfully center community and voices of the people who we’re serving.” Instead of relying on readings and materials, Dr. Sury is working with advocates for putting community voices front and center – bringing people that are experiencing these issues to talk directly with students.
While this person-to-person approach can have structural issues like compensating community members for their time, the course takes all these details into account, focusing on building meaningful, respectful and educational relationships over time.
It’s a curriculum that has also carved out time to partner with “experts who have dedicated their entire careers to understanding different facets of housing, food justice and the history of racism in the Twin Cities and how that impacts people’s diseases. And we can partner with the Center for Art of Medicine and understand how students can reflect on their experiences of themselves and within this context. It just gives a lot of space to respectfully address all the different angles that comprise this problem, instead of going through all of the training and the looking back and saying, ‘well, now I need to fix something that I didn’t even begin to understand.’”
The “wicked problem” of health inequity
“I think the timing of this course is perfect,” says Dr. Sury about the placement of the new course near the beginning of the students’ learning tracks, “both with what’s going on in the world and also where students are in their knowledge. They’re so far ahead of where, I could probably speak for any of the three of us, where we were when we were learning.”
However, health inequity is still a problem in active search of what could be a difficult and complicated solution – a notion that can be challenging in a culture of urgency that wants the answer yesterday.
As far as a concrete answer, Dr. Sury knows that “we don’t have it. We’re still working hard. But what’s so intellectually interesting and critical about this is that health inequity is such a complex, vast and wicked problem that requires true, genuine, interdisciplinary thinking.”
Which brings up the interesting concept of a “wicked problem” – one that is so embedded and elaborate that moving one piece to help solve the puzzle can end up affecting other pieces, making the solution that much harder.
Unfortunately, health inequity can’t be solved by one person or through a little bit of research. And while Community Health MPact is an excellent start, Dr. Sury is under no illusion that it’s a perfect answer right out of the gate. Along with the anti-racist curricula being created in medical education, the question still needs to be asked: “Is this time and effort substantively shifting the way people think about their medical career? Is it negatively affecting the student experiences in some kind of way that we’re not thinking of? Is it having benefit to patient outcomes in some kind of way?”
Right now, we’re living in a phase of generating action and trying to do new things. It’s exciting and important work, but it’s also crucial to be mindful of the “wicked problem” impacts. The work of today and tomorrow is moving the needle, but the effects it creates also need to be noticed and studied – making sure that everything still aligns with the goals and hopes for the future we want to build.
To hear more from Dr. Sury, including additional challenges with incorporating health equity into both education and medical practice, and what practicing physicians can do to catch up with students already learning about community-focused medicine, listen to this episode of Off the Charts.