Amazing Race for Health Advocacy

Real-world experiences help new doctors understand the complex social determinants of health for families.

Caitlin Crawshaw - 30 October 2017

Years ago, pediatrician Mia Lang referred a young patient to a specialist and was frustrated when the sick child's family missed the appointment. She called them afterward and was shocked by the explanation: "The appointment was on the only day they could get to the food bank."

Lang, a clinician and UAlberta associate professor of pediatrics, realized she'd let herself judge the family before taking time to understand their circumstances. "To me, that was a powerful lesson," she said. As a committed health advocate-a physician who takes the time to understand and dismantle their patients' barriers to health-Lang was reminded that even well-intentioned doctors can lapse into judgmental thinking.

Lang subsequently became the director of the U of A's pediatric residency program, and her role involves educating new doctors about social determinants of health such as family income, support networks, education and culture. "I was very much aware that both residents and my own colleagues lacked an understanding about the vulnerabilities many of our patients experience," she said. But the PowerPoint presentations and lectures offered to residents were not likely to help much.

One day, while watching the The Amazing Race-a reality television show based on a worldwide scavenger hunt-Lang had an idea. Instead of classroom-based learning, she'd break groups of new residents into teams and send them out to tackle challenges in the community.

'The Amazing Race for Health Advocacy' takes place every second year and divides residents into five or six teams, each with a different challenge. Recently, a group was asked to take the bus to and from the food bank and transport the food back with old suitcases and a stroller. Another team was asked to buy everything on a lengthy grocery list-including expensive vitamin D drops for children-with just $20. "Until you experience that unique embarrassment of having to take an item out of your cart, you don't understand what it's like to live within a modest budget," she said.

Just like the television show, two groups each session encounter unexpected roadblocks, such as parking tickets that must be dealt with at the campus parking office, or a confusing child tax benefit form to fill out. At the end of the activity, residents debrief and share what they've learned with one another. "By the end of it, the residents haven't walked a mile in anyone's shoes by any means, but maybe they've taken a small step," said Lang.

Feedback from both participants and community partners-like the Edmonton Food Bank, Boyle Street Community Services and Youth Empowerment and Support Services-has been overwhelmingly positive year over year. Lang's peers have also lauded her efforts and, in 2016, she earned the Patil Teaching Innovation Award from the Association for Medical Education (an international organization).

Lang says physicians around the world are starting to understand the importance of social determinants to patient outcomes. "Until we understand our patients' circumstances, there's a limit to how effective our treatments will be."

This story was originally published in the University of Alberta Department of Pediatrics 2016-2017 Year in Review, Working Wonders.