Treating patients is only half the journey to addressing and improving their health. Patients back must follow care instructions, including properly taking any prescribed medications and making lifestyle changes. These instructions are often complex and hard to follow even for educated patients; among people from disadvantaged backgrounds and diverse populations such as that of the Galilee, where cultural, linguistic, and educational gaps exist between physicians and their patients, failure to follow doctors’ instructions is common.

As part of the Azrieli Faculty of Medicine’s mission to promote health equity, Dr. Sivan Spitzer, head of Population Health Education, developed a unique curriculum for educating and training future doctors to understand the relationship between society and medicine, and the influence of social factors on health outcomes.

An important arm of Dr. Spitzer’s research and education agenda is ETGAR, Bar Ilan University’s flagship community project set up with a major grant from Israel’s Council for Higher Education. Created five years ago, by Dr. Sivan Spitzer and Prof. emeritus Mary Rudolf, ETGAR aims both to improve patient outcomes and reduce the high costs to the healthcare system of repeated hospitalizations. This unique program, that does not exist in other medical schools in Israel, assists disadvantaged patients across the Galilee in their transition from hospital to home while training future doctors to not only better understand the challenges disadvantaged patients face, but have the skills to address them.

Required of all medical students in their clinical years, ETGAR is a course incorporated into the students’ clinical rotations at six hospitals affiliated with the medical school in Safed, Nahariya, Nazareth, and Poriah. Students learn about the role of social determinants in patients’ ability to cope with disease, the various cultures of Galilee residents – among them Hebrew, Arabic, and Russian speakers – and how to communicate effectively with people from different backgrounds. Students then accompany patients after their discharge from the hospital. They conduct a home visit and a follow-up phone call and help patients understand their condition, medical instructions, check their medication and link up with community services as necessary.