Daniel Palazuelos prepares medical students and trainees to serve communities — especially those most in need and facing injustice — by building systems to support health equity and providing the best possible mentoring.
Palazuelos’ work has brought him in touch with people all over the world, but he will now focus on communities in Boston as the new director of the Office for Community-Centered Medical Education (OCCME) at Harvard Medical School.
OCCME was founded two years ago in response to calls from students and offers opportunities for medical and dental students to work in the Boston communities of Mission Hill, Roxbury, and Jamaica Plain at varying depths of engagement, beginning in their first week of medical school and extending through graduation.
Palazuelos — who is HMS assistant professor of medicine, part-time, and assistant director of the Doris and Howard Hiatt Residency in Global Health Equity and Internal Medicine at Brigham and Women’s Hospital — comes to the office having led medical education and career development programs for pre-medical students, medical students, and residents interested in global community health work. He has founded three nongovernmental organizations and is director of community health systems at Partners In Health.
Harvard Medicine News spoke with Palazuelos about his vision for OCCME and how HMS and its medical students, community organizations, and patients all benefit from community-centered health care.
Harvard Medicine News: What does community-based medical education look like?
Daniel Palazuelos: It has many layers, and one is simply doing the work of being a good neighbor.
There is great value in a Harvard Medical student serving people in a soup kitchen, for example. It puts the student in a position of service and humility and encourages them to be an observer and a listener.
The student can start asking questions; for example, why is it that in such a wealthy city where there is such abundance, we have so many people without a home? Why do we have so many community-based organizations focusing on food availability, especially healthy food?
These are questions that are connected to root causes of many illnesses and disparities, and exploring them offers important learning opportunities to our students.
The community organizers can be incredible educators. By sharing their perspectives, our medical students learn what our formal medical structures lacked that made them say, I have to create an organization to address this problem in my own community.
HMNews: What are some of your goals for OCCME’s programming?
Palazuelos: We’re working on several things. One is expanding the community accompaniment program (CAP), which was launched by students to attract their classmates to community-centered efforts.
Previously, we heard that our students with their enthusiasm would create community outreach opportunities themselves. They would work very hard and commit deeply, but then the busy schedules and intensity of working in our hospitals and clinics would pull them away from this community-based work.
We’re creating a structure, based on feedback from community organizations, for our students’ first three semesters at HMS. Each first-year who comes to OCCME will get paired with a second-year peer who will introduce them to the community organization and get them up to speed. That student will do their community-based organization work during their second semester, with a minimum commitment of five hours per month. Then, in their third semester, they will get a first-year peer mentee who they then introduce to the organization, and the cycle continues. We hope the buddy system will provide continuity so organizations can see more of their goals fulfilled.
We are planning a first semester elective for CAP students that will include time for discussion, reflection, and a lecture series featuring our community partners, who will be invited and given a recognition and honorarium to formally teach our students. By elevating community members’ voices and wisdom, our students will have an incredible opportunity to learn about the lived realities of patients and community members that too rarely get featured in formal medical education.
HMNews: What research opportunities does OCCME offer HMS students?
Palazuelos: So, from this basis of volunteer work, service, and reflection, we have a quick ramp-up toward research. And one of Harvard’s strengths is the opportunity for our students to do deep scholarship.
During their first summer, students are able to do community engagement projects, with the option to carry that work into a scholarly project to be conducted after their clinical rotations.
We think a lot of students will want to work with OCCME because our kind of engaged scholarship is different from lab research in that it’s in service to a practical need identified and co-created by a mentor from a community-based organization.
Some community-based organizations will be new to this, but some have decades of experience. For example, Community Servings embeds policy and scholarship in everything they do. From their work that began during the AIDS crisis, they have created seminal research around the value of medically tailored meals.
Another organization recently said they have a mountain of data in the form of exit interviews from participants that no one has had time to analyze. That’s ready-made for an HMS medical student to get an incredible experience in processing data and supporting the work of a community-based organization.
Finally, I think a lot of the students who form deep relationships through these collaborations will opt to take a research year. We hope to support student scholarship with extra layers of academic support and mentorship in the community that will make that fifth year really robust.
Youth introduce us to the future if we give them the space to speak and be heard.
—Daniel Palazuelos
HMNews: What is your long-term vision for the office?
Palazuelos: I hope that as a result of their experiences with OCCME, our students will approach medical care and become medical leaders in a different way.
When students see the folks from Mission Hill or Roxbury on rounds, they will appreciate the diverse histories of those neighborhoods. They will understand what those communities experienced during the pandemic compared to other, more affluent neighborhoods in Boston. These insights could change how they practice medicine, both in interactions with patients and on more systemic issues.
Or imagine a student who becomes future CEO of Mass General Brigham or Beth Israel Lahey Health and how they will envision Mission Hill after having worked in that community as a medical student. It will not be just a “neighborhood.” That will be the mother who lives in an affordable housing system that is a product of her activism. That will be the local religious leader who has knowledge about how the community has changed over the decades.
I hope OCCME becomes part of the fabric of the way we teach at Harvard Medical School, and that the model we have created is reproducible. By participating in conversations across medical schools, sharing resources and best practices, and advancing scholarship, we can build that model, not just at Harvard, but anywhere medical education is provided.
I’m optimistic because this doesn’t cost a lot and it’s based on the perpetually replenishable source of youthful optimism. Youth introduce us to the future if we give them the space to speak and be heard.
HMNews: How do you see yourself leading the office?
Palazuelos: My style of leadership is to be caring and friendly, but also to support the positive emotional and intellectual aspects of mobilizing for social change.
I hope to pass on to our students what I’ve learned: Pessimism is a privilege.
The communities I’ve worked with in sub-Saharan Africa, Latin America, Haiti, and other parts of the world have taught me that despair is a privilege. If you are fighting for survival or to make the world better for your children, then you don’t have time to slide into pessimism.
I applaud Harvard leadership for making a commitment to this office. I truly believe it is an investment in the U.S. health care system. I want our students to believe that our medical system will improve and that it’s possible for them to participate in improving the experience of every patient in America and beyond.
This interview was edited for length and clarity.
