Community Health Workers Are Essential to Medical Education
On a hot summer day, first-year medical students gather in Rose Park, a neighborhood of Salt Lake City, Utah. They walk with community health workers like me to survey two locations: Lucky, a grocery store, and the Day-Riverside Branch Library. As we walk, we encourage the students to take note of their surroundings. What is unique about the grocery store? How are bus stops and streets maintained? How does the library help the community? What barriers to health are visible?
Understanding Barriers to Better Health
At the store, students see the wide selection of international food options. One points out the abundance of bulk foods. Another mentions a 10% grocery discount when a shopper gets a COVID-19 shot.
On the way to the library, I point out the lack of shade and benches at each bus stop. Rawad Farhat, MD, MSPH, associate director for health equity at the Spencer Fox Eccles School of Medicine at the University of Utah, notices the uneven sidewalks and lack of safe crosswalks.
Other community health workers tell the students that Rose Park has a lot of buses, but no light rail access. Many people rely on public transit to visit a doctor. But the bus system can take a long time. "If it’s snowing, or 100 degrees outside, would you take the bus to your doctor’s appointment or stay home?” they ask rhetorically. The students nod their heads, recognizing the barrier.
At the library, students notice 10-15 tents pitched behind the building in a dry, grassy field. There are tarps, shopping carts, and abandoned personal items scattered along the living area. Several tents are crowded into the shade of the trees, escaping the late-summer heat.
The branch manager, Safi, tells students the library is for all people, housed or unhoused. He stresses how important the library is to a community in overcoming barriers to health care or housing. These barriers include government identification, public transit maps, schedules, or proper internet access to find pharmacies, clinics, or filing paperwork.
The library "never says no," Safi says. He makes it clear to students: if someone comes seeking knowledge, the library will help. The students leave with a better understanding of Rose Park, its people, and health care barriers.
Immersive Community Experience
This immersive, collaborative student activity is part of SCoPE (Skills Community and Professional Exploration). SCoPE introduces students to the Mission-Driven MD Program. Over six weeks, they receive a crash course in navigating medical school.
They learn where their classes are, visit the clinics and communities they will work in, receive study tips, and dip their toes in the basics of medicine. During the course, they connect with their mentors for the next four years.
Now, community health workers are among those mentors.
Integrating Community Health Workers in Medical Education
The class of 2027 brings with it a new generation of community health workers. In the new MD program, community health workers are both partners and preceptors. We teach students what we do, how we do it, and how doctors can collaborate with us in the clinic.
We teach students about health equity and social determinants of health. Where a person lives impacts their health. It's our job to give students tools to help them manage those impacts.
Caring for the health and well-being of an entire community cannot land on the shoulders of one profession. Doctors cannot solve inequity alone. When we learn how to lean on each other, we can impact people's lives more meaningfully.
Doctors are health experts. Community health workers are experts who bridge communities with health systems and build trust. Teaching medical students how to engage community health workers equips them to be better doctors.
When providers use community health workers, trust goes up and health improves.
Role and Value of Community Health Workers
I recently worked with a patient who has diabetes and was doing nothing to address it. They ended up in the emergency room with multiple chronic conditions. Once I could meet with the patient and understand who they were, I was able to connect them to helpful resources. Within a week, the patient was attending diabetes nutrition classes in their community.
Emergency room doctors don’t have time or stamina to address what happens after a patient leaves the ER. This is where community health workers can come in, extending the doctor's expertise to the patient's daily habits.
Finding community and connection in a time of confusion is what community health workers do best. We take all the medical jargon and translate it in a way patients can understand.
Many community health workers come from under-resourced communities. We represent all walks of life and can help patients navigate their health journeys. Some patients have experienced trauma that has led them to deeply distrust medicine. We help counter that distrust by building personal relationships with patients.
If they can trust us, we can help them improve their health and learn to trust their providers. We help them overcome barriers to better health, like transportation, food, and language.
If a patient needs a ride, we find a way to get them to their appointments. If they need food or sanitary products, we connect them with food banks. When they're confused about prescriptions, we help them with their pill schedules.
Community health workers connect medical translators to patients and doctors for better communication. These acts are no small feat, and all are essential to patients getting proper health care.
By teaching students what we do and how to utilize our specialties, we are improving patient lives and physician burnout.
Beyond the Clinic
When doctors and community health workers work together, health and health education spread past the four walls of a clinic.
As we integrate community health workers into the new MD curriculum, we will build a new generation of physicians with greater empathy, cultural humility, and the ability to ask for help in improving patient lives.
