Achieving intolerance for intolerance

Equipping health care students to provide competent, respectful care for all patients, including LGBTQ populations, is both a challenge and an imperative for institutions like DMU.

As a nation founded on principles of democracy, freedom and inalienable rights, America remains unsettled in its acceptance of individuals who are not heterosexual – often referred to as lesbian, gay, bisexual, transgender or questioning their sexual orientation or gender identity, or LGBTQ.

In May, President Barack Obama announced his support of same-sex marriage, and a Washington Post/ABC News poll reported that more than half of Americans say same-sex marriage should be legal. Yet 31 states have passed amendments aimed at banning it.

Teenage gay and lesbian roles are popping up in popular television programs like “Pretty Little Liars” and “Glee.” Yet in April, gay Iowa 14-year-old Kenneth Weishuhn joined the statistic of teens who have committed suicide after being bullied. Even at Des Moines University, where students train for professions focused on caring for all people, anti-LGBTQ actions have occurred.

“I think some of our students, depending on their backgrounds, may struggle with accepting and understanding gay and lesbian individuals,” says Roberta Wattleworth, D.O.’81, M.H.A.’99, M.P.H.’04, FACOFP, FNAOME, professor of family medicine. “But if they don’t think they’ll have gay and lesbian patients, their heads are in the sand.”

The inevitable diversity among patients and the demands of providing high-quality health care require that DMU students feel safe and accepted on campus, on rotations and in residency, and that they also know how to create safe environments as health care professionals.

“Regardless of sexual orientation, race, culture and other factors, we’re all very different in our life experience,” says Jeffrey Means, Ph.D., chair of behavioral medicine at DMU. “It’s important that we teach each student how to relate to and treat each patient as an individual. That’s patient-centered care.”

Embracing diversity in its many forms and preparing students for a diverse world, says Daryl Smith, Ph.D., are not about being politically correct or “being nice.” A professor of education and psychology at the Claremont Graduate University in Claremont, CA, Smith was invited to DMU by student services staff last year to lead a campus-wide discussion about diversity and inclusiveness.

“Making diversity central to the mission of higher education is about excellence,” she said during her visit. “We have to have the capacity for difficult dialogues. Our future as a society depends on our ability to talk to each other.”

A diverse workforce of health care leaders, providers, faculty and researchers is needed to serve increasingly diverse patient populations and reduce health care disparities, Smith said. Preparing students to be that workforce, including interacting with LGBTQ patients and colleagues, is the challenge. What happens, say, when a medical provider has no idea how to counsel a teen patient who thinks he is gay? Or when that provider’s religious beliefs oppose a patient’s sexual orientation? How can medical schools address these gaps and biases so students may go on to become excellent health care providers and leaders?

“What’s really important is a good curriculum that differentiates ethics and morals,” says Will Narracci, D.O.’14, M.P.H.’14, who served as co-president in 2011-2012 of DMU’s Gay Straight Alliance. “Morality encompasses one’s personal beliefs; ethics are standards of the profession. You can have your personal beliefs, but you have to uphold professional ethics in caring for patients.”

To improve visibility and support of LGBTQ students, employees and campus visitors, DMU implemented a “Safe Zone” program. Students and employees can opt to participate in training that equips them to be allies for LGBTQ individuals.

“While other minority individuals can often identify role models and mentors, the invisibility of sexual orientation makes it difficult for LGBT members of the DMU community to ascertain where they can safely turn for support and information,” says DMU President Angela Walker Franklin, Ph.D. “Safe Zone training is an integral way to create an inclusive campus environment and to train future health care professionals.”

With last year’s change to DMU’s mission and vision statements – an effort President Franklin also led – “embracing a culture of diversity that accepts and respects the unique characteristics of each individual” is now among the University’s institutional values. In addition, last year a faculty/student committee on professionalism revised DMU’s honor code into a Professional Integrity Code that includes inclusiveness as a key tenet.

“With diversity in our mission statement, as a faculty member I feel justified in asking questions and taking care of related issues for students,” says Julia Moffitt, Ph.D., associate professor of physiology and pharmacology.

The revised mission statement also underlines the need to embed diversity throughout the curriculum.

“To develop cultural competency among students, we must expose them to differences and scenarios in which diversity is there,” Moffitt notes. “Why does every heart attack case presented in class have to be a white male in his 60s?”

A CASE FOR DIFFERENT CASES

Diversifying patients in cases presented in classes, in the simulation laboratory and in the Standardized Performance Assessment Laboratory (SPAL) is one way to reflect society’s variations in sexual orientation, race, ethnicity, language, cultural background, socioeconomic status and more. For example, Matthew Henry, Ph.D., chair of physiology and pharmacology, changed an infertility case involving a husband and wife to one in which the couple were two lesbians. Before he presented the case, however, he shared it with a colleague for feedback.

“I wanted to make sure I wasn’t going to speak in a biased way – not intentionally, but in a way that might offend someone in the class,” Henry says. “As a department chair, I want an environment where it’s safe for students and faculty to ask those questions.”

Diversifying cases exposes students to different people and situations and helps prepare them to be professional and nonjudgmental toward patients and colleagues. In an online course she teaches in DMU’s post-professional doctor of physical therapy program, Kandace Davis, D.P.T.’03, M.S.P.T.’95, includes a scenario in which students imagine they’re directors of a mid-sized clinic where a valued colleague confides he/she is gay/lesbian but does not feel the clinic is LGBT-friendly.

“More than 80 percent of the students typically answer they’d never considered the issue before,” says Davis, who practices in Gothenburg, NE. “That sparks dialogue, awareness and sensitivity.”

The University’s new Center for the Improvement of Teaching and Learning (CITL) will offer resources for helping faculty incorporate diversity and inclusiveness in their courses. Annie Daniel, Ph.D., who became CITL director on May 15, says she’ll use the data-driven faculty development program she implemented in Tulane University’s School of Medicine in New Orleans, where she completely rebuilt its office of medical education after Hurricane Katrina. That program has helped faculty improve their pedagogical skills and engage in professional development and medical education research.

“We have to have an adequate course evaluation process for students and needs assessment among faculty, so we can determine what faculty need in developing curriculum,” she says.

STUDENTS DRIVE CHANGE

Faculty praise the students who seek exposure to different populations, from going on global health service trips to visiting Des Moines’ homeless camps. This spring, the International Medicine Club seized the idea of its advisor, Alisdair “Rod” Philp, Ph.D., to organize a series of events designed to improve student awareness and competency in dealing with different cultures; recent events included a visit to a local mosque, a speaker on the culture and health issues of Native Americans, and a panel of students and providers on LGBTQ issues in health care. Osteopathic medical students who attend 10 or more of these events by the end of their second year will receive a cultural awareness endorsement on their dean’s letter of recommendation.

Faculty also praise members of the Gay Straight Alliance (GSA) for their role in driving difficult yet critical discussions over the past year. GSA member Angela Knoblauch, D.O.’14, wants to make sure those conversations continue.

“Sometimes it does take students at the grassroots level to make change occur,” she says. “I think we can make a big difference. It’s all about preparing people to be better health care providers.”