Zooming Across the Silos

An ethics class meeting becomes interprofessional to take on big health equity problems.

The call went out in late October 2020 across University of Michigan’s interprofessional networks: College of Pharmacy Assistant Dean and Clinical Professor Gundy Sweet would be opening a special mid-November session of her health ethics class to students across the health sciences at U-M. It was an opportunity for students to learn together about an important topic: “putting health back in health care.”

Professor Sweet and U-M School of Public Health Assistant Professor of Health Management and Policy Ebbin Dotson were uniting forces to get teams of future health professionals to discuss health inequities. Specifically they were seeking collaborative ways to approach social determinants in the health of individuals and communities. Health care institutions “are increasingly recognizing disease and illness can no longer be treated by medicine alone,” potential participants were told in the outreach email. Through full and breakout discussions, students from various disciplines would discuss the link between an individual’s essential needs and health, to “explore and define specific actions we can take as individuals to address the problem, and identify what we can do together to influence structural changes that are needed.”

Registrations came in from more than 20 students (from the U-M Medical School and Schools of Kinesiology, Social Work, and Public Health) to join the 87 College of Pharmacy third-years. The pre-work for everyone was to watch the documentary What Counts from Health Leaders USA and to consider “the emotions it triggers in you, and aspects of health care you had not previously considered.” The film movingly documents decades of struggle and progress among clinicians to recognize and address individual factors standing between patients and health–including food insecurity, inadequate housing, and other social determinants and systemic failures.

At the start of the interprofessional session, Professor Sweet told the students that she had stumbled upon the documentary and decided she had to share because “it helps reframe and reshape how we think about health, inequity, and how we can make progress.” She had reached out to a U-M IPE colleague–Professor Dotson–for partnership in this area that he was more versed in. With graphs and slides, he presented background on upstream/downstream inequities and inequalities, and how change is personal–and why care providers need to personalize it to make a difference. “When you ask the right questions, the answers become clear,” he said.

Polls, verbal discussions, and an active chat kept the more than 100 students engaged–talking about how they might work together across disciplines to address issues the professors were raising. A few examples from chat:

  • “Our system is so broken–programs that are supposed to address food insecurity and homelessness aren’t funded enough.” 
  • “It’s food apartheid–look it up.”
  • “The U.S. healthcare system is set up for profit–insulin costs 10 times what it does an hour drive away in Canada.”
  • “How do we empower ourselves? Involve patients before policy makers.”

In their final breakout sessions, students worked together energetically in real time, building out Google docs in response to the instructors’ questions. Brainstorming came fast and furious (see excerpt below). Clearly solutions to difficult problems won’t come easy, but without wide-open discussions they are not likely to come at all.

“Zoom makes it easier for us to come together across schools this semester,” said pharmacy student Kelly Powell (also a Center for IPE Student Advisory Committee co-chair). “We’re also dealing with Zoom fatigue, but this session was something I really liked.“

Excerpt from a Breakout Session:

  • Policy makers (have health care providers run for office to aid in making policies so they can be effective), advocacy groups
  • Community pharmacist–start the convo, collect stories, connect with community resources (ex. Warming shelter)
  • Payers 
  • Voting/Community engagement 
  • Include patients and their voices
  • Community service organizations 
  • Churches and religious centers 
  • Mental Health Peer Support Services and/or other social work/mental health support programs. 
  • Lyft and Uber or community forms of transportation. 
  • Food banks and other food support programs such as SNAP, WIC, etc… 
  • University of Michigan in the Ann Arbor Community (or other institution with large influence over an area in other parts of the state / country) 
  • Transition of care-follow-up after discharge
  • More advocacy for preventative care