Video Abstract

Video Abstract

Social determinants of health include, but are not limited to, physical environment, poverty, racism, chronic stress, educational disparities, and health care disparities and contribute to worse overall health outcomes for people of color when compared with White Americans.1,2  These health and social inequities have been amplified by the current coronavirus disease 2019 (COVID-19) pandemic, in which racial and ethnic minority groups are at increased risk of acquiring COVID-19 and of having greater morbidity and mortality from COVID-19.3,4  Policies, programs, and systems that promote equity can help alleviate health disparities.5 

From early in the pandemic, it has been evident that children are less likely to develop severe illness from COVID-1969 ; however, other aspects of childhood well-being, including psychosocial stressors, have been exacerbated by the pandemic-related shutdowns. Adolescents in particular are experiencing a disruption of normal routines because of school closures and limitations on social interactions and extracurricular activities. In addition, many adolescents are experiencing stress related to illness of family members, parental unemployment, homelessness, and substance use, all of which have increased during the pandemic.10,11  Furthermore, the transition from in-person to virtual learning has the potential to negatively impact student engagement, an important component of psychological adjustment.12,13 

We collaborated with the local high school system to create a project-based public health curriculum for a select group of high school students interested in the health sciences. Challenging students of color to devise solutions to health disparities from the pandemic served the dual purpose of engaging students during virtual learning while offering opportunities to serve their own communities that are disproportionately affected by COVID-19.

The goals of this curriculum were to (1) develop youth-driven public health products that addressed the current racial and ethnic disparities in the students’ communities, (2) expose students to core ideas of health equity and social justice, (3) allow students to collaborate with medical professionals, and (4) engage students in a time of potential disengagement because of online learning and loss of personalized group instruction.

The initial contact for the project was the Chief of Teaching and Learning, a public school official who enlisted 4 local high school Health Science Academies (HSAs) and their respective leadership in spring 2020. The 4 area schools were selected for having primarily students of color and for serving the city wards most impacted by the COVID-19 pandemic. The HSA leadership teams were teachers and directors from each school who served as project coleads with the medical team. The HSA leadership team selected the 5 to 8 junior and senior students by reviewing which students had demonstrated previous interest in the topic, as well as strong academic performance.

The medical leadership team consisted of 2 faculty members and a fellow. This team cocreated the project with HSA leadership, disseminated medical information used throughout the course, and served as directors for the medical mentor trainee teams. The 4 medical mentor trainee teams consisted of a pediatric resident from a tertiary care children’s hospital and a medical student from the affiliated medical school. The medical mentor trainee teams and HSA teachers coled classes at all 4 schools. The medical trainees presented up-to-date translation of new scientific information to the HSA students and helped the students develop their health projects.

The Chief of Teaching and Learning and HSA Leadership developed a 3-month curriculum based on design thinking, an iterative process used to systematically extract, teach, learn and apply human-centered techniques to identify innovative solutions, as explained below.14  The curriculum used a problem-centered design that engaged students in real-life issues, taught students to look at a problem and formulate solutions, increased the relevance of the curriculum, and encouraged creativity, innovation and collaboration.

The curriculum was divided into the 5 stages of design thinking: collecting data from the community through empathy interviews, defining the problem, creating a solution, building a prototype, and testing the prototype. The prototype could be a health message, product, or procedure. Although each stage was navigated sequentially, students were encouraged to continually revisit earlier stages of design and development after obtaining input from the community, HSA teachers, directors, and medical mentor teams.

In the initial stage of design thinking, students performed community empathy interviews,14  which are semistructed interviews that focus on the experience and feelings of those being interviewed. Students were given basic instruction on empathy interviews, by HSA teachers, including how to ask open ended questions and how to encourage storytelling. They were then instructed to interview members of their community, including peers, family members, and neighbors. The list of themes compiled from these interviews included unequal access to personal protective equipment, undervaluation of current public health measures, mistrust of government and of medical authorities, and the need for social distance during the protests inspired by the Black Lives Matter movement that were occurring simultaneously with this curriculum.

Each medical mentor team attended weekly virtual classes with the HSA students and directors. Each session began with a presentation or “Medical Minute” from the medical mentor team. Presentation topics were focused on understanding COVID-19 transmission and illness, health equity, and reliable sources of health information. The remainder of each session was facilitated by the HSA director and was dedicated to developing a health product, to sharing results from previous weeks, and to planning next stages. Outside of the classroom sessions, the medical mentor teams met with the medical leadership team weekly to reflect on the previous week’s session, provide feedback, and prepare for the upcoming week’s goals and objectives. Additionally, the medical leadership team met with the HSA directors weekly to share and reflect on feedback from all participants in the curriculum as part of ongoing course planning.

The educational goals of this collaborative curriculum sought to guide HSA students to understand COVID-19 through the lens of health equity, to identify beliefs and concerns within the students’ own communities, and to create COVID-19 health messaging addressing those concerns. The students worked collaboratively to define both their desired public health message about COVID-19 and their intended audience. They used class sessions to discuss the concepts taught around health equity and COVID-19 and to share ideas for public health messaging. Midway through the course, the students gave formal presentations of their work products to the school faculty and to the 3 physician leaders. Feedback was provided, most often around the need for more targeted messaging by identifying a narrower audience. This feedback was used to refine their health messages. They produced posters and videos shared on social media, through both personal and school-based platforms. The videos were focused on preventing infection from COVID-19, with core messages of hand-washing, limiting contact with others, and wearing a mask, particularly during protests and marches. The intended audiences were most often their peers, but some groups chose their home neighborhood, and some chose people planning to attend crowded demonstrations.

To measure impact, the students had a class session on how scientists evaluate outcomes of any experiment. From this lesson, the students chose to track process measures, specifically the number of views of their posts and the number of unique viewers. Impact measures, such as change in health behaviors, were discussed. Assessing impact through repeat interviews of community members was not possible because of time constraints of this summer course.

In addition to the tangible work projects, the curriculum exposed the HSA students to concepts of health equity and social justice. Although knowledge was not directly assessed, the students reported that learning about health equity gave words to their lived experience interacting with the medical system. The students also observed that creating focused messaging for this project made them more discerning when viewing commercial advertising; specifically, they now understood that advertisers segment populations to sell products and that, as youth, they were an important market segment.

The school district leaders noted another advantage of having medical professionals interact with the HSA students. The students’ exposure to medical professionals gave them an opportunity to ask the medical students and pediatric residents about their educational path to medicine. The high school participants requested a panel of Black physicians to speak with them. Although this session was canceled ironically because of COVID-19, the need and desire for career mentorship from the medical community was apparent.

An unanticipated outcome was that by the end of the curriculum, the students reported seeing themselves in new roles, both as agents of change and as public health voices among their peers and families. Informal feedback from the students in our program included their pride at being reliable sources of health information for their families and friends. This shift came from the students being challenged to not only understand the health impact of COVID-19 but also to articulate a health message for their own community. With the ongoing disparate effects of COVID-19, a future curriculum can include vaccination hesitancy and implementation.

Although successful, our efforts were not without challenges. The first was the concrete problem of time for classes. Although the students were eager to participate in the program, many of them needed to balance work responsibilities with their commitment to the program. The teachers conducted outreach to ensure that students could attend classes and identified the technology resources needed for the work product. As added incentives, students were offered community service hours, a requirement for high school graduation, for participating in the curriculum. In addition to the students’ time, the organizers also noted the competing requests for pediatric residents’ time. The medical students were able to attend all sessions and provided continuity for the medical team.

The second significant challenge was to conduct our program in a rapidly changing social environment centered on the ongoing COVID-19 pandemic and rising awareness of racial injustice. We addressed these challenges by incorporating them into our curriculum. For example, one session was paused to allow for reflection as students expressed anger, frustration, hurt, and hope for the wellness of their communities. Throughout the course, each week’s Medical Minute reflected up-to-date medical information as well as current COVID-19 metrics (ie, case numbers, death counts, etc). The rise in civil unrest was reframed and made relevant to our ongoing discussions of health equity. This included sessions that were focused on the historical roots of health disparities and the role of medical institutions in creating medical mistrust in communities of color. This allowed for students to apply their understandings of social injustice in health to current events.

This curriculum was a collaboration between a tertiary care children’s hospital and the local public school system to bring a public health curriculum to 4 high schools. Similar school-based interventions, including programs addressing obesity through gardening and physical fitness15  and programs aimed at reducing dental disease through education,16  have successfully targeted public health concerns. Additionally, other school-based curricula have been designed to encourage underrepresented minority students to enter professional health fields, such as public health,17  medical professions,18  and dentistry.19  This curriculum was focused on addressing a public health concern through the lens of health equity and had the intentional benefit of connecting students of color particularly interested in the health sciences to health professionals, encouraging them to envision themselves as public health agents.

Integration of a public health curriculum into existing school coursework is a reproducible model for collaboration between medical institutions and public school systems. At the core of the success was the shared vision that the students were capable of understanding the complexities of health equity and of devising public health messaging around COVID-19. The results of our work have led to an ongoing internship between our hospital and the HSAs with which we worked. This internship will build on the dual goals of exposing students of color to careers in health care and of teaching and reflecting on health equity and social justice within medicine. Future curricula around ongoing health disparities can address COVID-19 vaccination hesitancy and implementation.

FUNDING: No external funding.

Drs Chapman, Cohen, and Jones conceptualized and designed the study, participated in curriculum development and design, and reviewed and revised the manuscript; and all authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

     
  • COVID-19

    coronavirus disease 2019

  •  
  • HAS

    Health Sciences Academy

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Competing Interests

FINANCIAL DISCLOSURE: The authors have indicated they have no financial relationships relevant to this article to disclose.

POTENTIAL CONFLICT OF INTEREST: The authors have no potential conflicts of interest relevant to this article to disclose.