Brent C. Williams, MD, MPH: Sustaining change

Around 2010, the medical school embarked on a total curricular reform. Central to the reform was the notion that Michigan graduates should be excellent clinicians AND change agents serving society’s needs.

At that time, many schools were starting scholarly concentrations programs, in which medical students pursued research in a specific area during medical school. UMMS expanded this idea by including Paths of Excellence in the new curriculum. Significantly, school leadership decided that the first path would focus on addressing health disparities in the United States and low-income countries.

After more than a year of planning by a group of 10 to 12 faculty, GHD enrolled its first class of students in the spring of 2012. Over the next several years, GHD would become the model for a total of seven other Paths.

The mission of GHD is to facilitate medical students’ exploration of addressing health disparities by creating sustained change in collaboration with communities throughout their professional lives, whether these communities are in the United States or across the globe.

While the role has evolved a bit over time, being GHD Director centers on creating value to medical students, participating faculty, the medical school, and the communities we serve through GHD programs. On the surface this has involved setting up a system of faculty advisors, facilitating scholarly projects by the students, and providing other learning experiences.

Deeper and more critical work, however, has been creating a community of faculty and students who know and support each other in addressing society’s greatest health needs, especially among folks who don’t have power, resources or access to health care.

When I decided to go into medicine, I intended to have a career in global health. I shifted away from global health after finishing my residency, for a variety of reasons, and pursued a career at U-M in health services research, geriatrics and medical education. Along the way, however, I pursued activities related to service in domestic health disparities. For example, I helped set up and served as volunteer Medical Director of a local homeless shelter clinic for over 20 years, and helped better integrate community mental health services for vulnerable patients into our health system.

When the opportunity came, I jumped at the chance to be the Director of the GHD Path since I could pursue direct involvement in health disparities in both domestic and international settings, more or less a dream come true for me. It was all the more attractive because it centered on interactions with students, which I love, and a simultaneous offer to become the Medical Director of the Complex Care Management Program, a (then) new clinical operation at U-M directed at folks with low-income, precarious housing and mental health challenges.

My roots in internal medicine are in primary care, where knowing about the whole patient, their culture and their living environment is natural and necessary. My background in public health and health services research created a perspective centered on populations and systemic issues as integrally related to the needs of individual patients. Both perspectives have been critical to the work of GHD in developing educational programs, coaching students and engaging faculty to address the needs of vulnerable patients and populations.

We live in an era of growing income disparities and gaps of (literally) global proportions among patients and populations, both here in the United States and abroad. We are also learning daily about the deep inequities related to structural racism, cultural norms, bigotry and unconscious bias that stretch across many nations. Compound all that with the causes and effects of political unrest and global climate change, and it’s apparent that giving students tools and inspiration to address these larger realities is essential for clinical medicine to be effective and relevant in the 21st century.

GHD students are a fantastic bunch of young people. They bring passion, moral commitment, often a sense of outrage at human injustice, and enormous eagerness to learn, develop skills, and make a difference. Within those general traits, GHD students range from the very experienced, who may be running or starting their own non-profit organizations, to folks with just a few experiences among vulnerable populations but eager to dig deeper. This diversity really makes the GHD community strong, as students and faculty learn constantly from each other.

Michigan does a terrific job of making great clinicians. My job is to plant and water the seeds of social service and systems thinking. These two cornerstones, incorporated into physicians’ careers, will create docs who can make change for the greater good, in addition to one patient at a time.

So many things – chief among them enthusiasm, openness to new ideas, and willingness to examine and improve themselves as they seek to understand others and the world around them. These characteristics are infectious, and help keep me growing and curious.

I enjoy exploring new activities and travel with my wife, fishing, and am an active member of a faith community where music and singing in the choir are key sources of enjoyment.

Frankly, I think just about every student should join a Path of Excellence. They serve to keep students’ eyes on the larger picture and their place in it, and they help students meet other students, faculty and folks outside U-M with similar interests. These will be valuable assets throughout their professional lifetimes.