Health Equity at OHSU Family Medicine Residency
Residency Statement of Purpose and Commitment to Anti-Racism and Anti-Oppression
The OHSU Family Medicine Residency in Portland trains leaders in healthcare. Our specialty is tied historically to several social justice movements in the 1960s and our department and residency are all part of that legacy. Family Medicine is also part of a broader health system that has long perpetuated racism and other forms of oppression, and we acknowledge that these practices and impacts persist into today.
As a residency program, we will dedicate our energy to unlearning the oppressive practices of white supremacy culture, and in its place, learn how to practice healthcare in a way that promotes authentic relationships, healing, and justice. In doing so, we hope to start addressing the public health crisis of racism by using our minds, voices and power, joining the movement which will create a world of equity and opportunity for all. We commit to these practices in how we build teams, care for patients, partner with communities, teach trainees, educate ourselves, and radically re-imagine a just healthcare system that promotes health and equity.
We welcome all who seek to create a more just world.
Our health equity curriculum occurs throughout all four years and is becoming increasingly integrated into all aspects of our residency training. The curriculum follows a systematic progression from intrapersonal biases and constructs, through interpersonal and intersectional frameworks, before reaching institutional and societal level concepts. It is intended to be didactic, conversational, experiential, and integrated. The curriculum contains built-in experience in community engagement as well as support for relevant individual academic and professional work.
We recognize that education alone is not sufficient to address the racist and oppressive structures of medicine and the world. As such, we aim to continually unlearn and critique what we have learned and connect our curricular work to our broader vision of shifting our policies, our institutions, and our societal structures in a more just and equitable direction.
Highlights of the curriculum include:
- Implicit bias workshop and theoretical framework introduction during intern orientation
- Robust longitudinal curriculum through all four years of residency
- Quarterly anti-racism and anti-oppression workshops
- Quarterly social justice and equity reading/film and discussion group
- Racial caucus groups (currently in development)
- Community organizing and population level advocacy longitudinal training and experiences
- Flexible time in all four years for additional learning experiences and projects
- Dedicated time and support for equity-focused capstone projects
- Myriad clinical, research, and leadership opportunities
We believe that all clinical care should be rooted in values of social justice and with the goal of promoting health equity. Some of our clinical experiences are specifically designed for learners to gain experience with settings and populations that are victims of structural racism, capitalism, and other oppressive structures.
- Richmond Federally Qualified Health Center: continuity clinic site
- Scappoose Rural Health Center: continuity clinic site
- Family Medicine Inpatient Service: Admitting service for Department of Family Medicine, Multnomah County, Outside In (FQHC in downtown Portland serving largely houseless population) and Virginia Garcia (predominantly Spanish-speaking population served)
- Substance Use Disorder Treatment (including MAT): in all clinics, dedicated treatment facility Springbrook Family Week
- Substance Use Disorder in Pregnancy Care: Project Nurture treatment collaborative (Family Medicine physicians providing prenatal care in collaboration with and on-site at local SUD treatment facility, delivery of patients at OHSU on Family Medicine L&D service)
- Gender Affirming Care: all continuity clinics
- Psychiatry Rotations: continuity clinics, Unity Inpatient Mental Health Facility (serves all of Portland), Behavioral Health Rotations
- Multnomah County Clinic Rotations
- Virginia Garcia Clinic Rotations (predominantly Spanish-speaking population)
- Prison Medicine rotations
- Rural Medicine in Enterprise, OR
- Rural Surgery in Ontario, OR
- Benson Polytechnic High School School-Based Health Center
To prepare our residents to serve in leadership roles within the community, we have an extensive 4-year leadership training curriculum that is highly valued by our residents.
Residents regularly serve as board members, committee panels, and other memberships on OHSU, city, and statewide organizations, offered through the residency.
Some of the most consistent leadership opportunities occur through our partnerships with MACG (Metropolitan Alliance for Common Good), OAFP (Oregon Academy of Family Practice), and the Oregon Health Authority, on various community organizing and legislative efforts that often have a health equity component. Residents currently serve as OAFP board members, OAFP Commission on External Affairs committee members, Oregon Health Authority DELTA program facilitators, to name a few.
In addition, our residents are often involved in leadership positions within OHSU itself. Examples include the House Officers Association and Union, Sustainability Steering Committee, and the School of Medicine’s recently created Equity and Justice Curriculum Committee.
Our residents and faculty have the opportunity to serve as participants and facilitators in a unique leadership course conducted several times a year by the Relational Leadership Institute (RLI). The RLI training course was developed and founded in conjunction between OHSU Family Medicine and Primary Care Progress. The course focuses on relational skills, team dynamics, power and privilege, difficult conversations, and integration of values-based team and leadership skills in service of high-functioning and equity driven healthcare teams to empower system change. Learn more at rlipdx.org.
OHSU Department of Family Medicine has a large, robust, and nationally recognized research division. Many opportunities exist for residents to engage in practice-based, healthcare system, insurance, and other translational research efforts. As described above, ample capstone time and support is built into our residency program for this work. Residents are also requested to assist with teaching within the medical school on topics that include clinical, epidemiology and healthcare system, and health disparities.
Examples of equity-focused capstone topics from recent graduates
OHSU FM Class of 2020:
- Equity and Inclusion Curriculum in Family Medicine Residency - Brit Nilsen, MD
- Mental Health in Portland’s Muslim Population- Mustafa Mahmood, MD
- Evaluation of Health Equity and Social Justice Reading and Discussion Group - Amanda Aninwene, MD
- Patient Perspectives of Project Nurture - A Qualitative Analysis - Claire Montaigne, MD
- Planning School Health Services in the Scappoose School District: Performing a Community Needs Assessment - Dominic Caruso, MD, MPH
- A Food Insecurity Project at the Benson School-Based Health Center - Ryan Manns, MD
OHSU FM Class of 2019:
- Developing an Objective Structured Clinical Exam (OSCE) to Improve Transgender Health Care - Ben Hersh, MD
- Training OHSU Family Medicine Residents in Medication Assisted Treatment for Opioid Use Disorder - Kris Azevedo, MD
- Establishing a Hospital-based Medical Legal Partnership - Jenna Walters, MD
- Family-Centered Neonatal Opioid Withdrawal Syndrome (NOWS) Care: A Multi-disciplinary Improvement Initiative at OHSU - Lisa Kipersztok, MD
- Implementation of Training and Protocol for Improved Management of Neonatal Opioid Withdrawal Syndrome, in conjunction with Project Nurture SUD in Pregnancy Care Collaborative
- Opiate Use Disorder Capstone -A Multifaceted Approach - Gabe Plourde, MD
- Adventure Therapy for the Treatment of Addiction - Kelly Shaffer, MD
- Depression and ACE Screening in Pregnancy - Rachel Sircar, MD
While we will continue striving toward excellence in teaching principles of health equity, providing high quality leadership training, and fostering collaborative work with community partners, we also are committed to creating an environment where our current patients, residents, faculty, and all staff from diverse backgrounds feel safe, connected, equitably reimbursed, and well supported. This is a key focus of our recently developed Antiracism and Antioppression Committee — a team of residents and residency faculty that meets every two to four weeks to do this work.
For several years, residents and faculty have run the Health Equity and Social Justice (HESJ) team, which hosts regular discussion groups for department faculty, staff, trainees, and their family and friends on anti-oppression topics. HESJ has helped foster a shared language and understanding of structural racism, and is now practicing racial caucusing. The goal of this approach is to foster healing and braver spaces for all to engage in honest, vulnerable dialogue and co-learning, without causing harm to POC colleagues. We are in the process of creating additional quarterly caucusing groups within the residency program for enhanced resident-specific support, and hope to build additional support infrastructure in the near future.
HESJ members also curate content each week for the department’s all-staff newsletter. This includes upcoming anti-racism events and learning opportunities, as well as discussions of articles to read, and local actions department members can take.