A doctor of Korean heritage who grew up in Oregon becomes uncomfortable when a patient asks her about “the medicine of your people.” A Brazilian immigrant who doesn’t speak English struggles to communicate with the doctor who’s treating her nine-year-old asthmatic son. A physician suspects his Mexican-American patient’s failure to get regular blood glucose levels for his type 2 diabetes and hypertension is due to his ethnic background.
These are situations that require health care providers to have more than scientific knowledge about health conditions and treatment options. They call for providers to adhere to the American Osteopathic Association’s code of ethics, which specifies they should not only “provide necessary care without regard to gender, race, color, religion,…” but that they also “conduct themselves with appropriate respect for their patients’ social and cultural needs.”
Fostering that adherence is the goal of a course at DMU, Foundations of Physicianship: Culturally Responsive Care, developed two years ago by Jeritt Tucker, Ph.D., assistant professor in the department of behavioral medicine, and Rich Salas, Ph.D., DMU’s chief diversity officer. They note the course’s outcomes “represent strong foundational knowledge, skills and attitudes essential to the delivery of quality health care in the 21st century.”
The American Association of Colleges of Osteopathic Medicine (AACOM) agrees. During its annual conference, Educating Leaders 2019, held April 10-12 in Washington, DC, AACOM’s Society of Osteopathic Medical Educators (SOME) honored Drs. Tucker and Salas with its Innovation in the Development of Enduring Educational Materials Award for developing the course.
“We’re the only school among the 35 osteopathic schools to embed this in the curriculum,” Dr. Salas says. A member of the AACOM Council on Diversity and Equity (CODE), he was bombarded with questions from members from other institutions in a recent CODE meeting after he shared DMU’s efforts to foster students’ cultural competency.
The one-credit Foundations of Physicianship course is required of all osteopathic medical students at DMU in the spring semester of their first year. Its goals are to extend students’ awareness of their cultural identity, values and assumptions; their knowledge of existing health care disparities and how culture shapes experience; and their skills in transferring this awareness and knowledge to patient care. It is facilitated by students who participated the previous fall semester in the Diversity Health Series, which includes films and frank discussions on aspects of difference.
“The Diversity Health Series started the conversation about this course,” Dr. Salas says. “Dr. Tucker has taken it to a whole new level so the course includes components of cultural identity, self-reflection and team-based learning. Students are required to understand how implicit bias has an impact on health care. The course can include moments of discomfort and feelings that challenge students to have an open mind and an open heart, as they’re going to be working with patients who are very different from themselves.”
Dr. Tucker notes, “Roughly 20 percent of the AOA’s 240 sub-competencies use the word ‘culture’ or include aspects of culturally responsive care, but they’re not really formalized in the curriculum.” He and Dr. Salas state that the Foundations of Physicianship course emphasizes these AOA core competencies “to help students recognize how culturally responsive care is consistent with their emerging professional identities as osteopathic physicians.”
Students described the benefits of the course in letters supporting the application for the SOME Innovation Award. “Foundations of Physicianship was vital to my personal and professional growth as a first-year medical student, and I am excited to take what I’ve learned into my clinical clerkships next year when I begin to interact with patients,” stated one.
Another student said she hadn’t experienced much diversity growing up in a small, rural Midwestern town. “I had never thought about how these differences may affect my future profession. The Foundations class opened my eyes to the importance in awareness of diversity and the complications that can come with these differences,” she wrote. “As a result of this course, I have taken my first of many steps toward becoming a culturally competent physician.”