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Knight Ridder: Medical schools training doctors in cultural differences

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  • Popplestone, Ann
    Medical schools training doctors in cultural differences BY MITCH MITCHELL Knight Ridder Newspapers FORT WORTH, Texas - KRT NEWSFEATURES (KRT) - Looking into
    Message 1 of 1 , Nov 18 1:04 PM
      Knight Ridder: Medical schools training doctors in cultural differences

      Medical schools training doctors in cultural differences
      Knight Ridder Newspapers
      (KRT) - Looking into the eyes of a Korean patient might be considered rude. And a playful rub on the head of a Muslim child would be offensive for many of that faith.

      But for many doctors, with only a few minutes to examine their many patients and order treatment, those potential cultural gaffes can create a barrier to their understanding and treatment of those patients.

      "We know that we can do a better job and get better compliance if we better understand the backgrounds of our patients," said Rebecca Kirkland, senior associate dean of medical education at the Baylor College of Medicine in Houston. "If you look at the demographics of our populations, they have changed significantly. We want to do the best we can do to help people get well and address some of their beliefs in ways that we never did before."

      The changing face of America - varying ethnicities, national origins, languages and religious creeds - is prompting medical schools to rethink the way they teach budding doctors to deliver health care in a multicultural society.

      They are veering from the lecture-test-lecture cycle that typifies most medical classrooms and assigning students to interact with real people - even if it is in role-playing.

      Medical students are learning to ask patients about their cultural heritage, are often given opportunities to work overseas, and may be required to complete part of their training in ethnic communities. All to learn to incorporate a patient's cultural heritage - social and psychological - into the short time they spend together.

      "We want to incorporate these issues into the training programs," said Nilesh Chatterjee, a social scientist at Texas A&M University. "The health-care school has to be a place where people interact. The communities need to come together and help create a system that is in communion with their needs."

      Without this training, doctors run the risk of inadvertently insulting patients or misunderstanding their concerns. Then, when a patient fails to return for a follow-up visit, doctors sometimes label the patient as noncompliant, meaning that they don't follow medical advice.

      To keep doctors from falling into that trap, medical schools are taking different approaches:
      The University of North Texas Health Science Center at Fort Worth has a Cultural Conundrums course that requires first-year medical students to solve a cultural problem within a team. Students then give an oral presentation of the team's solution. Administrators plan to make the class more realistic with actors and computerized mannequins.

      First- and second-year medical students are also required to work 16 hours in a community program. All students have the opportunity to do clinical work in rural or medically underserved areas. During spring break, students can elect to work for a week in a public-service program in El Paso. Students enrolled in medicine and public health can take a semester-long course on health issues associated with the Texas-Mexico border.

      At Baylor College of Medicine, medical students can take an international track that allows study in South America and other places.

      John Peter Smith Hospital in Fort Worth, which has the largest family-practice residency program in the nation, has its doctors who are serving residencies to staff its international health clinic in downtown Fort Worth.

      The University of Texas Medical Branch at Galveston is designing Web-based training modules that allow students to role play as physicians, patients or relatives to widen their cross-cultural experiences.

      The potential for cultural barriers continues to grow. U.S. residents now speak 329 languages, and in some cities, less than 60 percent of the population speaks English, according to an Agency for Healthcare Research and Quality report.

      It's a growing audience that can appreciate the efforts.
      "You can see a look of joy in their eyes when they hear that I can speak Spanish," said Carlos Clark, a third-year medical student at UNT's Health Science Center. Clark examines patients at the center's Northside clinic in Fort Worth as part of his course work. "You can hear them breathe a sigh of relief when they realize that they can actually talk to me."

      The U.S. Census Bureau estimates that by 2030, the Hispanic population will have grown by 113 percent, while the number of Asian-Americans will have grown by 132 percent. But the cultural divide between patient and physician does not crumble when language barriers are toppled.

      Students generally emerge from the course work realizing how much they have left to learn. The medical schools can only expose students to different cultures but they cannot make them cultural experts, said Muriel Marshall, an associate professor at the center.

      Center studies show that 62 percent of the first-year, first-semester medical school students in 2002 thought they were culturally competent when they entered the course, but only 12 percent thought they were culturally competent by the end of the session.

      According to the survey, 96 percent of the students thought the cultural attitudes of patients affect their relationships with their physicians, and 96 percent thought they sometimes stereotype people.

      Medical schools are trying to reduce those survey numbers by exposing their students to different cultures and the problems they might face delivering health care in those settings.

      "The minority population is growing," said Gazelle Craig, a third-year medical school student who is fulfilling her educational requirements at the Northside clinic. "You have to make students like myself aware of different cultures. There are things that you have to screen for that are different for different groups of people. And if you don't, you're not providing adequate health care."

      © 2002, Fort Worth Star-Telegram.

      Ann Popplestone

      CCC Metro TLC

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