SOAR Curriculum

                                                 
Nicele Puente, MD, resident physician at Family Health Center of Worcester, class of 2020. Photo by An-Hoa Giang, MD, for the Workers of Worcester project. 

WFMR is committed to training leaders in anti-racism and anti-oppression work and considers these concepts a basic area of competency for all family medicine physicians. We acknowledge that racism and other forms of oppression are built into the fabric of our society and that medicine has a long history of supporting, advancing, and validating White Supremacy through the manipulation of science and the inequitable distribution of care. If we are ever to build a more just and equitable society, physicians must reckon with these realities and their often unexamined roles in their perpetuation.

Residents receive training and education in critical social theories and community-based theories of change, including key concepts like those below, taken from our residency bylaws:

Social Structures: The policies, economic systems, and other institutions (e.g., health care, legal, education) that have produced and now maintain modern social inequities as well as health disparities, often along lines of social categories such as race, ethnicity, class, gender, sexuality, and ability.

Race: A social and political construct used to categorize human beings based on an arbitrary and superficial set of physical characteristics, non-biological markers, and presumed ancestry. Race was created by medical science to justify White Supremacy.

Racism: A system of social structures that assigns value to human lives based on the social construct of race and provides access, safety, resources, and structural power to those with racial privilege and denies it to those without it. The system is built into the fabric of our society, sanctioned by the state, and designed to produce and reproduce race-based inequality in a way that ultimately saps the strength of the whole society through the waste of human potential. 

Structural Oppression: Systems of social control and hierarchy based on deeply-ingrained prejudices within power structures, which have far-reaching implications on the opportunities, resources, and freedoms available to those who are outside of the dominant social group. Examples of oppression include the structures of racism, sexism, homophobia, transphobia, anti-Latinx discrimination, classism, xenophobia, ableism, and others.

Anti-Racism: A process of actively identifying and opposing racism, which acknowledges that racism has been naturalized into our social experience and must be explicitly opposed to limit its innate capacity for self-perpetuation.

Our longitudinal SOAR curriculum consists of two main components: framework sessions across all three years of residency and integration into all residency didactics. 

FRAMEWORK SESSIONS
These longitudinal sessions provide a shared language and understanding of concepts that inform our perspective on medical science, disease processes, epidemiology, and the interpretation of data.

Residents attend the following framework sessions during their residency, beginning in the first block of Foundations:

CORE TOPIC INTEGRATION
Racism and oppression are woven into every aspect of medicine, so framework sessions and/or occasional trainings are inadequate to the task of dismantling these structures. To help residents consider how inequity is applied to individual topics, we integrate SOAR material into every topic covered in the residency, sometimes briefly and sometimes in great depth. Here are just a few examples:

Topic: Chronic Kidney Disease
SOAR Integration: The impact of using a race-based modification in GFR calculations for Black patients

Topic: Depression
SOAR Integration: The epidemic of suicide among trans and queer youth

Topic: Asthma
SOAR Integration: The lifelong effects of environmental racism on the health of Black and Brown kids

Topic: Weight Management
SOAR Integration: The racist and sexist history of the Body Mass Index and its disparate impact on women and communities of color

Topic: Lyme Disease and Tick-Borne Illnesses
SOAR Integration: Erythema migrans on skin of color

In collaboration with the UMass Chan DRIVE (Diversity, Representation, and Inclusion for Value in Education) Committee, all WFMR faculty and residents teaching a didactic are asked to use a Curriculum Appraisal Tool. This tool helps facilitators ensure their presentations utilize inclusive language, images, and cases that are free from harmful stereotypes and concepts rooted in White Supremacy and other structures of oppression. Our SOAR Committee and the DRIVE Committee offer all teaching faculty support in the design of their didactics to meet the goals of our curriculum.

Babafemi “Femi” Onabanjo, MD, AAHIVS, family medicine attending and team lead provider at Family Health Center of Worcester. Photo by An-Hoa Giang, MD, for the Workers of Worcester project.