Background
A patient’s sociocultural background informs her or his health beliefs and behaviors. Physicians-in-training must be prepared to care for a socioculturally diverse patient population. Exposure to patients of varied race and ethnicity, physical ability, sexual orientation, gender identity, religions, etc., coupled with the communication skills to be respectful while gathering information through patient interviews and physical examinations, can give physicians a framework within which to form more effective patient-doctor relationships.
Goal
The goal is to prepare physicians-in-training to utilize the approach of cultural humility to provide culturally sensitive health care providers to diverse populations.
Implementation
Development of these skills, and the emotional intelligence to apply them, is introduced early and continued throughout the curriculum as a longitudinal theme. It begins with the School’s educational objectives, where the components of cultural competence and cultural humility, are articulated in broad goals and specific objectives. Activities to help students achieve these objectives are woven throughout the curriculum.
The value and impact of diversity in the educational environment is addressed in three sessions during the first week orientation program. Students participate in large group sessions, small group discussions, and exercises that provide a vital forum for discussion and raising awareness of students’ pre-existing concepts and biases, and sets the stage for the curriculum that follows.
Introduction to Being a Physician
Within the Introduction to Being a Physician course, during the first full week of medical school classes, students spend a day in a Pittsburgh community that is challenged by economic decline. Through this immersive experience students gain perspective about the everyday challenges faced by many of the patients they will treat. This experience has been a vital start to the curriculum for nearly two decades.
Patient, Physician and Society Block
Continuing in the Patient, Physician and Society block, the Ethics, Law and Professionalism course includes sessions that address consent to treatment and treatment refusal, including raising student awareness of cultural and personal influences on the decision to accept or decline treatment. The importance of viewing health matters from a patient perspective is in the forefront in sessions on law at the end of life, actively hastening death, abortion and assisted reproduction.
Behavioral Medicine
In the Behavioral Medicine course, during spring of the first year, students learn how behavioral and social factors can impact disease, in areas such as pain, substance use disorders and motivation to change health behaviors.
Clinical Clerkships
During the clinical clerkships, cultural competence and cultural humility are incorporated in didactic sessions and clinical experiences. In the Family Medicine Clerkship, a small group session on culturally competent care is part of the day-long introductory curriculum. In the Pediatric Clerkship, students may opt to rotate at the SALUD clinic which serves the Spanish-speaking community. Many students volunteer at SALUD and other clinics for underserved populations throughout the four years.
Professional Enrichment Courses
Professional enrichment courses provide additional opportunities for learning in this area, beyond the required curriculum. For example, basic and intermediate courses in medical Spanish have been extremely well received by students. Introductory Spanish instruction is offered during the summer between first and second year. More advanced courses on practical conversations in medical Spanish are offered to first and second year students during the academic year.
The success of the Spanish program inspired expansion to other languages and cultures. The first medical French workshop was conducted, to help students preparing for a Family Medicine-sponsored clinical experience in Haiti. Student interest in research and clinical rotations at the UPMC hospital in Palermo, Italy, has also increased significantly in recent years. As part of preparation for those cultural immersions, an Italian language program has been developed. This program incorporates a combination of independent study using Rosetta Stone and in-class practice with an Italian language instructor and native speakers. It is tailored to fit within students’ busy academic calendars while providing a platform for more in-depth learning once they arrive in Palermo.
With all of this interest and growth in language and cross-cultural preparation for students planning experiences here and abroad, these programs have been organized to form the foundation of the Passport to Care program. This program provides resources and organization to help students acquire language skills and cultural background to prepare them for special curricular experiences and everyday professional practice with diverse populations.