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To transform primary care with the goal of achieving health equity, changes in the way the health care workforce is selected, trained, and ultimately delivers care should be expedited. Research has repeatedly shown the immense impact of the social determinants of health and the gaps related to health equity in the United States. Despite this knowledge, health care education and delivery systems have been slow to evolve. The Health Resources and Services Administration established the Academic Units for Primary Care Training and Enhancement to work towards strengthening the primary care workforce. Through their research, the six individual Academic Units (AU) have identified gaps related to health equity in their areas of focus. This article provides recommendations from the AUs on ways primary care health professions education can be transformed to advance health equity and serves as background for the articles to follow in the remainder of the supplement.

This study surveyed the use of systematic strategies to address social determinants of health in the primary care clinical training environment.We designed a 51-item questionnaire targeting medical educators from internal medicine, pediatrics, and family practice to assess strategies to identify and mitigate social needs, the role of trainees in this process, and barriers/facilitators to systematic approaches.The survey was completed by 104 medical educators from 77 institutions. Of the 104 respondents, 28% were not familiar with any standardized tools used for screening for social needs, 27% use geospatial (GIS) or geographic information system (GIG) data, and 35% reported that trainees were not involved in any part of assisting.Nearly one third of medical educators lack familiarity with standardized screening tools for social needs. More than one third reported that trainees are not involved with mitigating social needs. Geospatial and GIS data are not utilized frequently.

Most residency programs do not provide trainees with health equity data for their clinic patients.Equity report cards were developed for internal and family medicine residents in a large health system. After considering which equity indictors were available, how to attribute patients to residents, and what level of granularity was feasible, equity reports were created for five ambulatory quality measures. Chi-square tests were used to test the significance of differences in quality measure satisfaction between groups.Attributing patients to the physician who had seen them for the greatest proportion of encounters performed best. Creating equity reports for individual resident panels was not possible due to insufficient numbers. Most measures had sufficient patients when combining all residents' patients. Inequities were identified for four of five examined measures.Creating aggregate equity reports for all primary care residents across multiple equity indicators was feasible, documenting disparities in health care quality.

A diverse and well-trained, distributed and resourced primary care workforce is essential for advancing health equity. However, few standardized models exist to guide health care professions education (HCPE) on core competencies regarding understanding and effectively addressing social determinants of health, social injustice, structural barriers, and the high burden of health needs in marginalized populations. We propose a framework with domains of policies and incentives, enabling institutional climate, educational content and integration, and community-orientation and community engagement. The framework encompasses inter-disciplinary team-based care and immersive community experiences to equip learners with cognitive skills and knowledge needed to understand and address unmet needs and ensure equitable access to the entire continuum of care. Research is needed to understand barriers and promoters of a health equity-guided HCPE, and standards for theory-driven curricular contents and metrics to evaluate and track progress. Multisector collaborations and demonstration projects may help guide standardized training on advancing health equity.