Precision equity aims to transform Cumming School of Medicine

The Cumming School of Medicine (CSM) at the University of Calgary is looking to transform health-care education through action on equity with a novel approach to leading change, in hopes this will ripple through health care as students move into their careers.

The precision equity approach is led by members of the Health Equity and Systems Transformation (HEST) portfolio. This new addition to CSM is anchored by the Office of Faculty Development (OFD) and the Precision Equity and Social Justice Office (PESJO). The HEST portfolio fosters collaboration, champions inclusive practices, and drives policy and structural reform. The push is led by Dr. Kannin Osei-Tutu, MD, senior associate dean of health equity and systems transformation; Dr. Pamela Chu, MD, associate dean of precision equity and social justice; Dr. Fareen Zaver, MSc'22, MD, associate dean of faculty development; and Dr. Shannon Ruzycki, BSc'09, MD, director of Precision Equity, Research and Evaluation.

“The precision equity strategy is the opposite of a one-size-fits-all approach to equity, diversity and belonging,” says Osei-Tutu. This means engaging the campus community, with a tailored approach, to identify opportunities for reducing inequity or bias. 

One of the first steps includes surveys about the unique experiences and hopes of members of the CSM community. Data collected will aid in dismantling bias and achieving equity, authentic inclusion and belonging.

One of the anticipated benefits of precision equity is providing thoughtful interventions and solutions to issues identified specifically by community members. Members of the HEST team will focus on needs assessments for specific groups and then tailor plans to meet desired outcomes. They will then study the impact of these changes, measure outcomes and adjust as needed. 

“Precision equity is an ongoing process that will respond to the evolving needs of campus communities, building capacity at all levels, including faculty development, teaching, research, innovation and evaluation, and an integrated communications strategy to lead cultural change within the school,” says Osei-Tutu.

Patient experiences of discrimination within health care are well-documented — pregnancy-related deaths among Black patients in the U.S. and U.K. exceed their white counterparts by more than three times; COVID-19 infection, hospitalization and death rates were highest in non-white populations, with Black populations faring the worst; LGBTQ2S+ youth often experience systemic and stigma-related barriers to accessing health and poorer mental health outcomes. Across Canada, Indigenous populations face significant health disparities, from medicalized racism to health-care access. 

However, experiences of bias in a medical school setting don’t have the same breadth of research and meta analysis behind it. “While we know there are biases, we don’t know the specific kinds of barriers and othering our communities have come up against, and we can’t make impactful change without understanding those experiences," says Osei-Tutu, a hospitalist. "What we do know is what we’ve learned from the health-care system and we expect it to be parallel. But it’s important that we make sure we’re addressing what’s most important to our community, not just what we believe to be important.”

Chu says a precision equity approach will help create transformation within the medical school that will carry into students’ future practices. “I feel like I have seen first-hand far too many people, whether it be my patients, or students or my colleagues, clinicians, teachers, scientists who in these systems have experienced the harms of oppression,” Chu says.

Inequities, as noted by Osei-Tutu, include longer emergency wait times for Indigenous people, less pain medication being provided to for racialized patients, longer or shorter lengths of stay in hospital for racialized groups, and more complications after procedures. 

Chu, a gynecologic oncologist and surgeon, finds herself thinking about how outcomes for racialized groups could be different had their care been better-fit to them. “If they had had trust and faith in medical systems and health-care providers to provide them with patient-centred, culturally competent and trauma-informed care — where people took time to understand their individual beliefs (e.g. cultural, ethnic, religious), remove stigma, provided health education and care in their preferred language, or accounted for their previous trauma, how might their cancer-care experience or disease trajectory have been improved?” says Chu.

Preliminary support in the form of a tool kit is available to teams who are interested in EDIA work. 

“The tool kit can help teams assess their organizational structures, leadership readiness and member needs to identify gaps," says Ruzycki, a clinician-researcher and general internist. "These gaps are matched to interventions or initiatives that are meant to address them specifically, tying measurement directly to action — which is something that has been difficult for EDIA (equity, diversity, inclusion, accessibility) committees, due to lack of evidence and experience.” 

With precision equity now beginning its work, the HEST team hopes to see the CSM community embrace these changes within policies and procedures. “If people are aware that the supports and interventions we’re providing are making a difference in terms of how people feel — a sense of belonging, inclusion in the school — then we’ll want to continue to model those strategies and amplify our effect both within CSM and beyond,” says Osei-Tutu.

Zaver, an emergency medicine physician, echoes this at the faculty level: “Precision equity in faculty development allows us to tailor support to each faculty's unique needs, fostering growth and true inclusion. By embracing precision equity, we’re building a more inclusive and resilient academic community through targeted, personalized development.”

Osei-Tutu says he sees a bright future for medicine at UCalgary if we actively engage in these values and principles and place them front and centre.