Addressing Health Inequities: The Harbor-UCLA Residency Program's Approach to Digital Health Equity

Introduction

Harbor-UCLA Medical Center serves a predominantly Latino population, many of whom are non-English speakers, within the LA County Department of Health and Human Services. This community faces significant challenges, including financial constraints and limited access to home broadband. The Family Medicine Residency Program at Harbor-UCLA Medical Center is dedicated to addressing these health inequities, particularly through innovative approaches to digital health equity.

Understanding the Digital Divide

The community served by Harbor-UCLA faces significant challenges:

Socioeconomic factors: The median annual income for many families falls between $5,000 and $10,000.
Limited broadband access: Approximately 15-20% of households lack home broadband.
Low utilization of existing resources: Despite the introduction of a wellness portal in 2005, only 38% of the Harbor-UCLA population engages with it.
In-person appointments: A vast majority (80%) of appointments are conducted in person, with only 18% via phone and 2% occurring via video at the clinic in Lomita.

To address this, a collaboration was initiated with Dr. Theresa Nevarez to investigate the underlying causes of this digital health equity gap in this underserved community.

Raising Awareness Through Education

To counter the lack of awareness, it became evident that digital health education needed to be embedded early in healthcare training. One-hour educational presentations on digital health equity were conducted for various groups:

25 physicians and trainees at Harbor-UCLA Medical Center’s Health Equity Series
10 nursing students at AltaMed’s Nurse Education, Practice, Quality, and Retention Program
45 pre-health students from high school to medical level at Harbor-UCLA’s Summer Urban Health Fellowship

Survey data collected before and after the presentations demonstrated a significant increase in awareness and understanding of digital health equity across all groups. Notably, participants from the Summer Urban Health Fellowship exhibited a significant rise in confidence regarding the use of digital health technologies, with 90% feeling moderately to highly responsible for educating their future patients about these technologies.

Developing a Tailored Curriculum

Building on these insights, Dr. Nevarez and a team have developed a Digital Health Equity Curriculum tailored for underrepresented minority pre-med students. This curriculum aims to equip future healthcare professionals with the necessary tools and knowledge to effectively implement digital health equity in underserved communities.

This five-day Digital Health Equity Curriculum tailored for underrepresented minority pre-med students stems from the impactful responses received after a one-hour presentation on digital health equity, where minority pre-med students expressed a newfound sense of responsibility toward incorporating digital health in their future practices.

The goal is to elevate digital health technology use at Harbor-UCLA by training future healthcare workers in digital health equity. By integrating this training into the gap year curriculum for underrepresented pre-med students, the program aims to inspire continued learning in digital health throughout their medical education and residencies, fostering a generation of healthcare professionals adept in digital health applications.

Positive Outcomes and Future Impact

Upon completion of the curriculum, three students participated in a post-curriculum survey, yielding encouraging results. All of them (100%) reported being ‘familiar’ to ‘very familiar’ with digital health technologies. Two-thirds (66.7%) of the students affirmed that the curriculum not only met their expectations but would also rate its quality as ‘very good’. Importantly, all students unanimously agreed (100%) on the significance of integrating digital health into medical education. Furthermore, two-thirds (66.7%) expressed a high level of confidence in their ability to adapt to and proficiently use digital health tools and technologies within a healthcare setting. These findings underscore the effectiveness of the curriculum in enhancing digital health competencies among future medical professionals.

Thus far, three students have successfully completed the Digital Health Equity Curriculum, with one student, Cinthya, a first-generation Latina, being particularly inspired to delve deeper into this field. Thanks to the generous support from Dr. Nevarez and the Committee of Interns and Residents, sufficient funding was secured for Cinthya to travel to San Francisco for a conference. Cinthya’s story is a powerful testament to the profound impact of investing in the education of underserved minority students in digital health equity. Her involvement not only propelled her career forward but also contributed significantly to culturally competent work in the field of digital health. It underscores the pivotal role that underrepresented medical students play in advancing digital health equity within our communities, bringing crucial lived experiences and an innate understanding of the challenges faced by the patients we serve.

Harbor-UCLA's Commitment to Diversity and Inclusion

Harbor-UCLA is deeply committed to fostering a diverse and inclusive environment within its residency programs. This commitment is reflected in several key areas:

Recruitment: The Department of Emergency Medicine enthusiastically recruits residents, fellows, and faculty who can utilize their unique backgrounds and perspectives to enhance patient care.
Inclusion: The program commits to developing a workplace inclusive of every race, ethnicity, faith, gender identity, and sexual orientation.
Leadership: A majority of the leadership comprises women and persons of color.
Representation: The department celebrates diversity in its providers and strives to develop a medical workforce that reflects its patient population.

A Supportive and Collaborative Community

The Harbor-UCLA Emergency Medicine Residency is a sizeable program with an intimate sense of community. The approachability of leadership and the deep bonds between residents foster a sense of family within the department. “Buddy groups” cultivate relationships between current residents, alumni, and faculty. The on-site psychologist provides support through the inherent rigors of the specialty. Weekly resident/attending beach volleyball games, “board meetings” in the south bay swells, family play-dates, and nights out in LA are just a few of the ways the program loves to spend time together.

Addressing Community Needs Through Research and Initiatives

Harbor-UCLA is actively involved in several research initiatives and community programs aimed at addressing specific healthcare needs within South Los Angeles County:

South LA CPR Initiative: This 3-year community-engaged research effort explores CPR and AED knowledge in Compton and Gardena, using local voices to create life-saving interventions that improve bystander response and cardiac arrest survival.
Medication Assisted Therapy/Substance Use Disorder: The program has a dedicated substance use disorder navigator and partners with the Whole Person Care Substance Use Disorder program to ensure that patients receive the right care. It is also working in partnership with the Bridge program to assess opiate use disorder.
Operationalization of Data Dashboards to Boost LA County Traffic Safety and Post-Crash Care: Harbor-UCLA Medical Center, the LA County EMS Agency, and The Lundquist Institute are taking the first steps to create an LA County regional data dashboard, utilizing stakeholder inputs, assistance from NEMSIS leadership, and LA County data to produce a dashboard mock-up and proposal for operationalization.
Evaluating the Effectiveness of a Novel EMS Mobile App to Improve Post-Crash Care: The UCLA Department of Emergency Medicine, in collaboration with Harbor-UCLA Medical Center, the LA County EMS Agency, and The Lundquist Institute is evaluating an LA County EMS protocol mobile application to assess its effect on paramedic performance, and identify the application's usability characteristics.
Southwest Strategies to Innovate EmeRgENcy Care Clinical Trials Networks (SW SIREN): The Strategies to Innovate EmeRgENcy Care Clinical Trials Network (SIREN) is a clinical trials network funded by the National Institute for Neurological Disorders and Stroke (NINDS), the National Heart Lung and Blood Institute (NHLBI) and the National Center for Advancing Translational Science (NCATS). The goal of SIREN is to improve the outcomes by identifying effective treatments given.

Residency Program Overview

The pediatric residency program at Harbor-UCLA has a long history of outstanding clinical training in a supportive, collegial environment that emphasizes education and autonomy while serving the medically underserved. Patients are referred from all parts of Los Angeles County, a center of ethnic diversity with immigrants from nearly every point on the globe. Residents are welcomed as health educators and advocates at local schools as part of their advocacy experiences.

The Harbor-UCLA Medical Center, Division of Vascular and Endovascular Surgery, David Geffen School of Medicine at UCLA, has an unexpected opening for a PGY-1 categorial integrated vascular surgery resident beginning July 1, 2023. The vascular surgery residency program was initiated in 2021 and currently has two residents who will be PGY-2 and PGY-3 during the 2023-2024 academic year. The primary objective is to prepare the trainee to function as a specialist in vascular disease management. The program emphasizes the prevention, diagnosis, and treatment of vascular disease including medical management, open, and endovascular surgery. This program uniquely provides a structured experience in both academic and private hospital settings. Throughout the program the resident is expected to engage in self-study and academic research pursuits. At completion of the residency, competency is defined based on achievement of core competencies, professional growth, and commitment to lifelong learning.

Meet the Residents

The Harbor-UCLA residency program boasts a diverse and talented group of residents. Here are some of their backgrounds, interests, and future aspirations:

Class of 2026:
- Lisa Bell, MD: From Torrance, CA; interested in Global Health and Quality Improvement; enjoys hiking, biking, and camping; Next Adventure: Trekking in Patagonia!
- Tiffany Fan, MD: From Pasadena, CA; interested in Social EM, med ed, advocacy, and ultrasound; enjoys exploring LA’s music scene and acrylic pour painting; Next Adventure: Meeting her extended family in Sao Paulo, Brazil!
- Cesar S. Fortuna, MD: From San Bernardino, CA; interested in Ultrasound and Critical care; enjoys going to breweries and rewatching the Office; Next Adventure: Going to New Orleans for a bachelor party!
- Fernando S. Gonzalez, MD: From Los Angeles, CA; interested in Ultrasound; enjoys sports and music; Next Adventure: Wherever the music is good.
- Haydar Ibrahim, MD: From Erbil, Iraq; interested in Social EM and global health; enjoys photography, cooking, and travel; Next Adventure: Going to South Korea and Japan!
- J. Hunter Jackson, MD: From Salt Lake City, Utah; interested in Administration, quality improvement, and social EM; enjoys running, reading, and tennis; Next Adventure: Japan? New Zealand? Burning Man?!
- Bhavya Kumar, MD: From Renton, WA; interested in Social EM and Critical Care; enjoys dancing, cooking, and exploring new music and foods; Next Adventure: Learning to find happiness in life’s little joys.
- Stephen Macaspac, MD: From Kapolei, Hawaii; interested in MedEd, Critical care, and Social EM; enjoys piano, travel, and beach volleyball; Next Adventure: Japan in cherry blossom season!
- Maddie Mori, MD: From Gilroy, CA; interested in Wilderness Medicine; enjoys ocean activities, backpacking, and rock climbing; Next Adventure: Salmon fishing on the Columbia River!
- Mai Riquier, MD: From Longmeadow, MA; interested in Medical education and EMS; enjoys music, eating good food, and traveling; Next Adventure: Visiting the national parks that the west coast has to offer!
- Jolene Nguyen-Cuu, MD: From Villa Park, CA; interested in Social EM, Med Ed, and Event Medicine; enjoys snowboarding, traveling, and event planning; Next Adventure: Banff.
- Kylie Prentice, MD: From Redondo Beach, CA; interested in Social EM, ultrasound, and sports med; enjoys surfing, dogs, and breweries; Next Adventure: Hawaii.
- Aislinn McMillan, MD: From Washington DC; interested in International EM, Ultrasound, and Wilderness; enjoys hiking, paddle boarding, and live music; Next Adventure: Backpacking in Banff.
- Vivek Shah, MD: From Chino, CA; interested in Critical care, palliative care, and medical education; enjoys Brazilian Jiu Jitsu and weightlifting; Next Adventure: Banff!
- Lily Stokoe, MD: From Harrison, NY; interested in Med Ed and SIM; enjoys volleyball, bar trivia, and finding new drink/food spots; Next Adventure: Heading to England to visit family and catch a Newcastle United game!
- Corey Young, MD: From South Pasadena, CA; interested in Ultrasound and medical education; enjoys rock climbing, Rubik’s cubes, and video games; Next Adventure: Go lead climbing outdoors!
Class of 2027:
- Arjan Abar, MD, MBA: From Chicago, Illinois; interested in Global Health and Operations Management; enjoys finding LA’s best breakfast burrito and playing Super Smash Bros; Next Adventure: Japan!
- Brooke Clemmensen, MD: From Reno, Nevada; interested in Social EM and Informatics; enjoys all things outdoors, arts & crafts, and learning Spanish; Next Adventure: Backcountry skiing in the Eastern Sierra.
- Veronica Gonzalez, MD: From Gardena, California; interested in Ultrasound, Social EM, and MedEd; enjoys going to happy hour with friends and crocheting; Next Adventure: Going on a Europe trip with her sisters!
- Aileen Guillen, MD: From Cerritos, California; interested in Social EM, Ultrasound, and Global Health; enjoys hiking, snowboarding, and scuba diving; Next Adventure: Italy in the fall.
- Erika Hollywood, DO: From Vista, California; interested in Sports Medicine, Pain Management, Critical Care, and Social EM; enjoys surfing, yoga, and rollerblading; Next Adventure: Sayulita, Mexico.
- Cynthia Luo, MD: From Cos Cob, Connecticut; interested in Women’s Health, International EM, Palliative Care, and Education; enjoys cooking/baking and hiking; Next Adventure: West Coast national parks!
- Meg Maeda, MD: From Torrance, California; interested in Social EM, EMS, and Ultrasound; enjoys traveling, hiking, and skydiving; Next Adventure: Kyushu and Shikoku, Japan!
- Brendan McIntyre, MD, MBA: From Syracuse, New York; interested in Health equity, Medical education, Medical technology, and Administration; enjoys CrossFit, running, and skiing; Next Adventure: CDMX.
- Holly Mulinder, MD, MPH: From London, England; interested in Social EM and Global Health; enjoys yoga, Pilates, and reading; Next Adventure: Off to Bali for yoga and surfing.
- Devika Nadkarni, MD: From Bangalore, India.
Other Residents:
- Augustine, Florida: Medical School: Florida State University College of Medicine; enjoys surfing, guitar/music production, and hiking; Next Adventure: Huntington Gardens.
- Melody Fang, MD: From Fremont, California; enjoys playing basketball, watching sports, and sunbathing; Next Adventure: Yosemite or Zion.
- Natalie Hernandez, MD, MPH: From Tucson, Arizona; San Francisco, California; Washington DC; enjoys dancing, soccer, and arts and crafts; Next Adventure: Would love to travel somewhere tropical with delicious food.
- Lyolya Hovhannisyan, MD, MSc: From Yerevan, Armenia/Glendale, California; enjoys rollerblading, etymology, and hiking/camping; Next Adventure: Hop to Banff/Patagonia/Mount Ararat.
- Dan Im, MD: From South Korea/Gardena, California; enjoys Netflix, exploring restaurants, and road trips; Next Adventure: Food trip to Japan or Mexico!
- Aaron Katrikh, MD: From West Hollywood, California; enjoys music production and DJing, hiking, and travel; Next Adventure: Any National Park.
- Kenneth Lee, MD: From Los Angeles, California; enjoys running, snowboarding, and basketball; Next Adventure: The motherland (Korea!).
- Nicholas Macaluso, MD: From Merrick, New York; enjoys running and trying new vegetarian foods; Next Adventure: Hope to make it back to Italy to explore Florence!
- Bradley McIntyre, MD: From Cincinnati, Ohio; enjoys biking, visiting national parks, and musicals; Next Adventure: Hiking/camping Mt. Rainier National Park.
- Niresh Perera, MD: From Northridge, California; enjoys the beach, hiking, and volleyball; Next Adventure: Would love to travel to Hawaii or Japan.
- Karen Tate, MD: From Torrance, California; enjoys running and spending time outside; Next Adventure: Disneyland!
- Joyce Wahba, MD: From Cupertino, California; enjoys volleyball, hiking, and low budget traveling; Next Adventure: Southeast Asia is next on the bucket list!
- Joshua Wasmund, MD: From Memphis, Tennessee; enjoys hiking, dog stuff, and Dungeon’s and Dragons; Next Adventure: Backpacking full Smoky Mountain portion of the AT.

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