DMU is an innovator and leader among medical schools with its multifaceted efforts to develop students’ cultural humility. One example is the osteopathic medical program’s year-long Foundations of Physicianship course, the second semester of which focuses on socially and culturally responsive care. Developed in 2017, the course received the Innovation in the Development of Enduring Educational Materials Award from the American Association of Colleges of Osteopathic Medicine in 2019.
However, recent acts of violence against persons of color and the disproportionate COVID-19 impact amplifying existing health disparities among communities of color led three DMU faculty – Richard Salas, Ph.D., chief diversity officer; Lisa Streyffeler, Ph.D., chair of the behavioral medicine department; and Julia Van Liew, Ph.D., assistant professor of behavioral medicine – to evaluate and refresh the course’s content and format.
Their efforts got a boost with a three-year, $93,430 grant, beginning on Jan. 1, 2021, from the Mid-Iowa Health Foundation (MIHF).
“We’ve come to understand DMU is a leader in so many ways in educating students about implicit bias, cultural understanding and the roles they can play in promoting access to health care,” says Suzanne Mineck, MIHF president. “We need to address disparities and barriers both individually and systematically, and I think this project does both.”
Osteopathic medical students take part two of the Foundations course in the spring semester of their first year. It emphasizes the role of sociocultural factors in medicine and focuses on honing students’ knowledge of health disparities, awareness of one’s cultural biases, and skills in applying this knowledge and awareness to patient care.
The MIHF grant supports updates including hiring second-year D.O. students as teaching assistants, adding a communication skills training, hosting an external speaker event open to the local health care community for continuing medical education credit, and funding community member participation in course discussions with students.
“These individuals talk with the students about their experiences as patients – what went well with a care provider and what they wish the provider had done differently,” says Dr. Van Liew. She and Dr. Streyffeler serve as co- directors for the course.
Michael Hoenig, M.A., program coordinator at the University of Iowa Center for Excellence in Disabilities, Center for Disabilities and Development, has worked with DMU for more than a decade to educate future health professionals on working with people with disabilities. He has participated in the Foundations course on panels of people with disabilities – his condition is blindness resulting from a retinal condition – and says the Zoom format has increased opportunities for students to engage with more community members.
“After our one-hour panel discussion, we each had breakout sessions so students could discuss their takeaways,” he says. “I was really pleased with the way Dr. Van Liew encouraged the teaching assistants to encourage dialogue. I was dreading ‘crickets’ on the Zoom line, but the hour was filled with questions and comments, such as ‘How do I know when to discuss a patient’s disability, and how can I do so tactfully?’ I could tell the students had a lot of questions and want to learn.”
As a teaching assistant for the course, second-year osteopathic medical student Samantha Schmitz helps moderate panel discussions and encourages reflections and questions during the small-group sessions that follow. “We have each student share a takeaway from the panel,” she says. “We’re all in medical school and have a lot going on, but the first-year students really amaze me on how they relate their own experiences and self-reflect on how we can be better health care providers.”
Community member Roxanne Strike, who has participated on Foundations course panels and small-group discussions, recalls one session in which students had a lot of questions about mental health. “It’s always had a stigma associated with it, especially among Asian communities. The course lets us look at mental health as part of health,” she says. “I was impressed with the course and appreciate that DMU is taking this step. In work like this, we all learn – panelists and students.”
First-year osteopathic medical student Joelle Bruckert-Frisk was attracted to DMU in part for the ways it incorporates “the human element into the science of medicine and health care.” As a medical scribe prior to medical school, she worked with a physician who made racist comments.
“I was taken aback and disengaged with the conversation. Now I have strategies for those situations. I would approach it in a curious sort of way – ‘Why are you saying that? Why would you say that about that person?’” she says. “I feel this is one of our most important classes. You really need to practice the human side of health care and recognize that we all have implicit biases. It’s also important that we have this experience early in our medical education, versus having a half-day training session when we’re in practice.”