The Hector P. Garcia Cultural Comepetence Award was held on September 19, 2014. David E. Hayes-Bautista, Ph.D., currently Professor of Medicine and Director of the Center for the Study of Latino Health and Culture at the David Geffen School of Medicine at UCLA, wowed the crowd. Dr. Hayes-Bautista's talk is both enlightening and entertaining. Watch the keynote below and keep an eye out for Dr. Hayes-Bautista's book, "El Cinco de Mayo: An American Tradition".
Hispanic Center of Excellence Director Dr. Norma Perez and UTMB President Dr. Callender, congratulate winner Matthew Edwards, MS3.
Congratulations to this year's winner, Matthew Edwards, MS3. Each year, we are honored with the very best of cultural competence across all our schools and we want to congratulate everyone who entered. With Matthew's permission, we have the complete transcript of his inspiring essay.
I met with a close family friend, an elderly man named John, during Thanksgiving weekend of my second-year of medical school. He had just been diagnosed with hypertension and hyperlipidemia, and I had just completed a ten-week course in cardiovascular and pulmonary medicine. John informed me that his doctor prescribed him a statin, an angiotensin receptor blocker (ARB), and a number of lifestyle modifications. Seemingly frustrated, he asked me why I thought his doctor prescribed these medications and whether I thought they really worked. "The doctor told me that Blacks have a higher rate of high blood pressure," he said, as I nodded approvingly. He paused for a moment, struggling, before uttering words that caught me unawares: "But as I think back to my parents and grandparents who lived without all these medication, and... I wonder if 'medicine' is really on my side."
Suddenly my knowledge of the cardiovascular system seemed to matter very little. Until this moment in my medical education, I had always felt comfortable with issues of race and terms like cultural competence. After all, I was raised in a medically underserved community and grew up in a family of fairly modest means. As a sociology major in college, I was familiar with the history of American medicine, the legacy of the Tuskegee "experiment," and the role that race and socio-economic factors played in creating health disparities. I had grappled with concepts such as implicit bias, "us vs. them," and in-groups and out-groups in term papers and small group discussions. Moreover, I had positive experiences treating patients from various racial, ethnic, and socioeconomic backgrounds not only as a student-clinician treating medicine and gynecology patients at UTMB's St. Vincent's Student-Run Free Clinic and Frontera de Salud, but also in my clinical curriculum in medical school.
Yet I found myself struggling to relate to John's concerns. I thought it was well-understood how far medical ethics and the doctor-patient relationship had come since the 1960s. Moreover, it seemed obvious to me that a person with hypertension and elevated lipids would see the utility of medication and lifestyle modification. My experience with John forced me to question: what exactly is cultural competence, if not the ability to relate to and function with people of different cultures and backgrounds? I assumed that my race, background, and life experiences made me uniquely poised to relate to different individuals, especially those with backgrounds similar to my own. Moreover, it was something that had been affirmed by mentors, medical school interviewers, and advisors.
My own experience with the culture of medicine has shaped the way I view the human condition. It has allowed me to reconcile the simultaneous resiliency and precariousness of the human body. As a species, we are able to withstand devastating trauma and still recover some semblance of normal function. Yet seemingly benign disturbances in physiology can dramatically shorten life. For example, my increasing knowledge of the cumulative insults at the molecular level enable me to better understand how years of uncontrolled hypertension or high blood sugar frequently have more disastrous impacts on the body systems in the long-term than the acute effects of a few years of reckless activity in adolescence or early adulthood. These same strengths and vulnerabilities are what unite us, regardless of cultural, ethnic, religious, or socioeconomic groups. I now understand cultural competency through the lens of the uniting human condition rather than the lens of individual differences. Disparities along lines of race, gender, language, and socioeconomic status only heighten these deleterious effects.
I now realize that no single experience makes an individual culturally competent. Cultural competence is not an artifact of an individual's background, or even the result of months or years of cumulative, passive experience. It is a continual process of learning from patients, much like any other aspect of medicine. It requires a willingness to engage in introspection and acknowledge one's beliefs and biases. For me, it requires a conscious effort to continually reevaluate my own experiences as they have undoubtedly changed over time. Moreover, medical training and medical practice engender their own cultures distinct from socio-economics, politics, religion, or ethnicity-cultures that emphasize reason and decision-making filtered through and modified by clinical and personal experience. The earlier we as clinicians realize this, the better we are positioned to address the needs of an increasingly diverse population.
Although John and I had shared many other conversations about medicine, culture, and history, this one felt different. It felt different because while I most likely could explain the clinical pathogenesis of hypertension and hyperlipidemia in more detail than John likely cared to know, I had only lived a fraction of his life. A product of the baby-boomer generation, having grown up during the Civil Rights era, and having lived through experiences I only read in history books, John was infinitely more qualified to teach me on the matter.
I listened, said very little, and encouraged John to keep speaking. Throughout the conversation John seemed troubled by the doctor's mention of race. Yet, physicians are taught to think in terms of probability-both in terms of what diseases are most frequent in a population as well as those that affect particular populations disproportionately. Though crude, these cognitive shortcuts are an important part of clinical decision-making. We are taught to be vigilant for signs of preventable disease, especially given their prevalence in underrepresented communities.
Patients like John do not, however, see themselves merely as members of a group with a higher likelihood of a particular disease. They do not see race and culture and age as fixed discrete determinants. Although medical students are taught to use facts like race and socioeconomic status and gender in our clinical reasoning, we are not always taught how to express these facts to our patients in a way that is sensitive to their history and the collective memory. I do not think that John objected so much to the fact that race was a feature in his discussion with his doctor as much as he resented how it was used - as a sort of prima facie explanation for why he needed to change his lifestyle. I think John may have come away with a different outlook on this situation if his physician had taken a few seconds to become familiar with John's background and frame his subsequent comments in a culturally appropriate context.
By the end of our conversation, John seemed to be more at peace with his physician's recommendation. Yet I genuinely believe that I was the one who gained the most from the experience: I had a personal lesson on the importance of humility and self-reflection in all facets of the doctor-patient relationship, especially with matters of culture and background. My encounter with John humbled me, and taught me that no single feature my life - be it race, gender, socioeconomic background, or education-endowed me with cultural competence. Rather, cultural competence is a life-long process, one that is continually refined by wisdom and shaped by experience.
July 24-25, 2014 | HHS, National Institutes of Health | Bethesda, MD
Early Bird Registration ends June 1st! | Agenda
Dear Dr. Perez:
The Global Clinical Scholars Research Training (GCSRT) program (hms.harvard.edu/gcsrt) is a groundbreaking one-year program of blended learning at Harvard Medical School intended for clinicians and clinician-scientists who desire rigorous training in the methods and conduct of clinical research.
The GCSRT program is accepting applications for the 2014/15 program, which begins June 21, 2014. The program's three main goals are to build skills in clinical research, provide knowledge in biostatistics, epidemiology, and clinical trials and develop a global network. For more information about the program, go to our website.
Apply HERE or register for a web-based information session to learn more about the program. Next GCSRT web-based information session will be held on April 9, 2014 at 9:00 am (EST).
Ajay K. Singh, MBBS, FRCP, MBA
Director, Global Clinical Scholars Research Training Program
Director, Global Programs
Harvard Medical School Gordon Hall, Suite 001
25 Shattuck Street, Boston, MA 02115
About Our Health - Results from the Hispanic Community Health Study/Study of Latinos
Produced by the National Alliance for Hispanic Health with the support of the National Heart, Lung, and Blood Institute.
A Comprehensive Report on Cancer among Hispanics in Texas
By Comparative Effectiveness Research on Cancer in Texas (CERCIT)
Each student, or Mentee, will be matched with a team of three (3) Mentors. The team will consist of one primary Mentor (senior researcher in academia, public or private sector), one secondary Mentor (doctoral student or senior researcher without an active project), and one tertiary Mentor (researcher at Mentee's institution).
The primary Mentor must have an active research project that relates to a health issue affecting the Hispanic community that the Mentee can contribute to. Teams should e-meet at least once a month for one hour via video/phone conferencing to ensure that the Mentee is making progress on agreed-upon research.
To supplement the research experience, Mentees will participate in bi-monthly online lectures that focus on research methods, research careers, and disseminating research. At the end of the program, Mentees will submit a research product: abstract, research poster, and give an oral presentation. For a complete list of requirements,CLICK HERE.
Webinar: Wednesday, September 25, 2:00 - 3:00 P.M. ET
The AAMC Group on Diversity and Inclusion (GDI) is sponsoring a webinar titled, "Publishing the Results of Scholarly Work in Medical Education: The Art of Writing and Getting Published," on Wednesday, September 25, 2:00 - 3:00 P.M. ET. The webinar will include an overview of the review and publication processes and focus on techniques for writing clear, concise, and interesting articles. It will include a discussion of the essential components of scholarly articles, research reports, and other publications. Webinar leaders will share insights on best practices for submitting content to Academic Medicine and MedEdPORTAL and will present common reasons for rejected submissions. Additional topics that will be discussed include working revising a submission, interacting with editors, adhering to publication ethics guidelines, and understanding the peer-review process.
Webinar: October 7, 2013
With support from the University of Michigan Medical School, Dr. Matthew Davis is launching a free nationwide course on health policy open to medical students (as well as students from other health professions programs), on the Coursera open online curriculum platform. The six-week course, entitled "Understanding and Improving the US Healthcare System," is intended to engage learner "to think about how they can play a role in improving the system at the individual level -- as patients, healthcare providers, and/or in other capacities."
Faculty Director: Norma A. Perez, M.D., Dr.P.H.
Location: Cameron Park Clinic in Brownsville, TX
FAMU-4022: Integrated Community Health Project: Frontera de Salud Community Health Ambulatory Community Selective
Join us for the first faculty development conference of the COEC. This exciting conference will provide opportunities for professional networking and skills development for faculty to advance in academic medicine.
The Academic and Enrichment Program (AEP) is a four to five week summer program that provides basic science course reviews and additional academic enrichment activities that enhance the student's competitiveness for a career in the health field.