R1 (Resident Advocacy Project) Flexible and Enhanced Learning with our RICHER Partners: Reciprocal Partnerships between Medical Students and Equity-Deserving Communities to Promote Vaccine Access and Teach Health Advocacy
Authors: Binda Catherine , Grover Sanya , Beevor-Potts Amy , Bondi Lauren , Ponton Ethan , Lau Will , Dicicco Alesia , Boroditsky Noah , Ritland Lisa , McFadden Alysha , McIntosh Gwynth , Duffy Damian , Hodgson Kate , Hawkins Lorelei , Loock Christine , Rici Taylor , Szostek Lisa , Tsai Melody 
Published: September 2023

Abstract

Rationale and Objectives
The University of British Columbia provides medical students in years 1, 2, and 4 with protected time to explore the CanMEDs competencies in student-directed service, education, and research through the Flexible and Enhanced Learning (FLEX) program. Six FLEX students in the past three years have engaged in reciprocal partnerships with the Responsive, Intersectoral Community Child Health Education and Research group (RICHER). RICHER is a consortium of interdisciplinary healthcare providers, resource centres, and community members working across sectors and systems who serve equity-deserving children, youth, and families in Vancouver’s inner-city. Students develop leadership, health advocacy, and collaboration competencies through mentorship and co-learning with the RICHER team and community partners. For example, students have partnered to promote and amplify vaccine equity, knowledge of children’s and youth’s rights, food security, and social-emotional learning.

Project Description
For each FLEX project, community members identify local priorities. They conduct needs assessments and environmental scans. Students complete project proposals, ethics board and grant applications, and elicit iterative community feedback. Students collect data and communicate findings to stakeholders, including community members and RICHER clinicians. RICHER further amplifies community voices by sharing FLEX project results with local and provincial decision-makers, resulting in policy change and resource mobilization. Projects are evaluated qualitatively by stakeholders. For example, during the COVID-19 lockdown, many inner-city families faced barriers accessing COVID vaccines. The Downtown Eastside neighbourhood had some of the lowest vaccination rates in the province.

Outcomes
FLEX students surveyed 122 community members and found that 89 (73%) community members experienced a significant barrier to accessing COVID vaccines, such as: no access to technology or ID required to register or book an appointment, no access to transportation to a vaccine clinic, or trauma associated with accessing healthcare or injections. The RICHER team was able to respond to these findings by authoring a letter to the local health authority, who mobilized a pop-up vaccine clinic at an accessible, local community centre using the principles of brokered trust.

Discussion/Future Directions
This vaccine equity project has set a precedence for accessible care and created a model for future vaccine clinics to provide protection against viruses like influenza. FLEX students and hospital staff learned from Indigenous Elders and community members how to use the medicine wheel in the context of wholistic healthcare. As health advocates, FLEX students learned to ask, “who are we not seeing and why?” and learned how to write motivational letters to changemakers.