With financial support from leading internal medicine organizations, UT Health San Antonio will launch “Promotores and Residents in Internal Medicine for Equity (PRIME): A Collaborative Health Equity Curriculum.” According to the principal investigators, Jason Morrow, MD, and Elena Jiménez Gutiérrez, MD, this transformational program will help diverse community members and medical professionals better understand each other as they work together to improve health.
The Alliance for Academic Internal Medicine (AAIM), the American Board of Internal Medicine (ABIM), the ABIM Foundation, the American College of Physicians (ACP) and the Josiah Macy Jr. Foundation announced the funding July 12. The organizations are providing $400,000 in awards to be split among 24 projects at medical schools and training programs, including at UT Health San Antonio.
Grantees will use this funding to support programs that incorporate diversity, equity and inclusion into internal medicine education and training, emphasizing inter-professional projects that incorporate members from across the care team.
“Promotores are specially trained and trusted community members who educate and advocate for families and neighborhoods regarding healthy nutrition, health care services and other local resources,” said Morrow, who is an associate professor of medicine and is the Howard and Betty Halff Professor of Medical Humanities and Ethics in the Joe R. and Teresa Lozano Long School of Medicine.
By creating shared experiences among community health workers (“promotores de salud” in Spanish) and residents of the Internal Medicine Residency Program in the Long School of Medicine, the PRIME program recognizes the critical role of local voices.
San Antonio, the seventh largest city in the U.S., is 63% Hispanic and home to thousands of international refugees. It has the highest poverty rate among the 25 largest metropolitan areas, with about 20% of the population living below the poverty level, 20% uninsured and 16% with Type 2 diabetes mellitus, according to the project summary.
The Internal Medicine Residency Program at UT Health San Antonio is a large and diverse program. In 2021, a Health Equity Track of the program was established with Gutiérrez, assistant professor of medicine, and Morrow as its co-directors. Their time is supported by a local, multi-year grant, with UT Health San Antonio’s Center for Medical Humanities & Ethics and the Department of Medicine serving as key partners.
“The heart of this track is transformational, community-focused experiences,” Gutiérrez said. “The PRIME curriculum consists of an innovative set of educational opportunities to bring health equity to the forefront.”
The first experiences will occur in the classroom. Internal medicine residents will be introduced to local promotores who will participate in an interactive curriculum involving Forum Theater. In Forum Theater, a facilitator sets a scene—a performance—involving disparities or disempowerment. Residents will be “spect-actors” [cq] who can step in and change the scene using core skills related to health literacy, cultural humility and trauma-informed care.
In the second experience, residents will apply their skills and partner with promotores to visit families across San Antonio. This “equity partnership” will function as a continuity experience over 18 months. Residents will present a capstone reflection to the entire residency program.
Most of the funding will support honoraria for promotores to participate in the classroom and continuity experiences. A smaller portion will be used for specialized facilitator training in Forum Theater.
“PRIME reflects the central role of inter-professional values,” Gutiérrez said. “We recognize that physicians-in-training and promotores share a passion for improving the lived experiences of the people they serve.”
“These shared values can produce clinicians who effectively demonstrate cultural humility,” Morrow said. “This will be embodied in residents’ knowledge and decision-making related to core equity communication skills, community needs and resources, and opportunities for health system changes related to physician advocacy for at-risk populations.”