To the Editor:
In my Letter to the Editor, “Prioritizing Community Engagement Principles as Academic Medicine Focuses on Health Equity,” I expressed my enthusiasm for the shift underway in medical education toward population health.1 I also implied the inherent risk arising from unconscious bias and underscored the importance of community capacity building. Although Jiménez and colleagues2 apply the five stages of creating partnerships to residency training, other important considerations warrant further discussion.
Recognizing that “community members are the source of knowledge and expertise”2 requires deliberate formal assessment and instruction on unconscious bias and principles of community engagement. In other words, there is a prestage involving introspection and education. Second, the authors’ approach implies linearity when, in fact, respecting engagement principles may mean that one cannot move beyond the first stage depending on the project or that stages one and two are years long. Openness to and humility about the stepwise nature of this approach are fundamental. In addition, knowing when it is appropriate to move from each stage should be embedded within initial training. Finally, the goal of enhancing capacity building means that communities should be positioned to be better advocates for themselves (e.g., trained community experts in a skill or technique, grant funding for a new program at a nonprofit). I recently described how the Rodham Institute, a nonprofit within the George Washington University School of Medicine and Health Sciences, provided support to a local church seeking to establish on-site mental health services and offered free grant-writing and leadership workshops in response to expressed community needs.3 If the graduate medical education community initiative cannot be sustained financially and the community defaults to its prior state, however that is measured, without lasting knowledge, skills, or resources, then the program may not have been a good fit for community-based population health.
Christopher Williams, MPH
Public health consultant, Rodham Institute, George Washington University School of Medicine and Health Sciences, Washington, DC; firstname.lastname@example.org; ORCID: https://orcid.org/0000-0001-5767-8048.
1. Williams C. Prioritizing community engagement principles as academic medicine focuses on health equity. Acad Med. 2018;93:1263.
2. Jiménez J, Andolsek KM, Martinez-Bianchi V, Michener JL. A framework for resident participation in population health. Acad Med. 2019;94:4246.
3. Williams CM, El-Bayoumi J. Optimizing upstream health in the community-oriented integrative domain. Health Equity. 2018;2:313315.