Bridging Gaps: The Crucial Role of Training Medical Students in Culturally Responsive Care

In 2020 the Des Moines University Behavioral Medicine, Medical Humanities & Bioethics Department and Office of Diversity and Multicultural Affairs sought a HealthConnect grant from Mid-Iowa Health Foundation to expand current educational offerings related to providing culturally and socially responsive care and to understanding the impacts of social determinants of health, including the experience of racism, on patient health outcomes. Over the last three years, this was achieved by expanding a course in the osteopathic medicine curriculum as well as holding multiple speaker series events featuring regional and national experts with invitations to the local community, medical stakeholders and hospital systems within the Greater Des Moines area.

Enhancing this Crucial Curriculum

Cultivating cultural awareness and competence among healthcare professionals directly influences patient care and overall healthcare outcomes. According to a 2003 health report entitled Defining Cultural Competence: A Practical Framework for Addressing Racial/Ethnic Disparities in Health and Health Care (Betancourt JR, et al, 2003), framework of organizational, structural, and clinical cultural competence interventions can facilitate the elimination of these disparities and improve care for all Americans by equipping medical students with the knowledge and skills to navigate cultural nuances, healthcare providers can better address the unique needs of various communities.

The Physician as Professional course, in its 7th year at Des Moines University, offers first year students in the Doctor of Osteopathic Medicine (DO) program the opportunity to learn from faculty members, community representatives and each other in a variety of settings including lectures, panels and small group discussions. Expanding beyond the course, funding from Mid-Iowa Health Foundation provided DMU’s Office of Diversity and Multicultural Affairs the opportunity to implement several speaker series centered around communication, microaggressions and implicit bias. The series are not only available to DMU students but to the broader medical community as continuing medical education (CME) credits.

Since the grant was awarded, three cohorts of first-year students were enrolled, totaling 652 students. To offer additional engagement opportunities to second-year students, an opportunity to continue their engagement with the curriculum as teaching assistants in support of the next class taking the course was developed. The second-year students serve as peer mentors to first-year students and help facilitate discussions following scheduled community member panels. The most recent community panel included individuals from One Iowa, the State of Iowa Department of Iowa Health and Human Services, Meskwaki Nation, EMBARC, Department of Veterans Affairs, Central Iowa Center for Independent Living (CICIL) and other organizations serving diverse communities in our area.

Mid-Iowa Health Foundation President and CEO Dr. Nalo Johnson states, “We’re proud of our grant model and the way it allows our grantees the opportunity to reassess the needs of their audience and the community at large to be responsive and adjust their projects as needed.”

DMU’s HealthConnect Grant has also been used to enhance the curriculum by bringing in community members to share their experiences firsthand with students in the course. The course now boasts interactive discussions with community members, made possible by honoraria payments that acknowledge their invaluable contributions. This aspect of the class is a great benefit to students as they can learn from diverse personal and professional experiences from individuals who live and work in our Greater Des Moines community. After these community panel events, students and second-year teaching assistants spend 60 minutes in more interactive small-group discussions with individual panelists to deepen what they’ve learned.

Julia Van Liew, PhD, Assistant Professor, Behavioral Medicine, Medical Humanities and Bioethics reflects “[With this grant] we’ve also been able to support research on these topics, which is important. We can learn ourselves about what’s working and what’s not and share our findings with our colleagues in medical education. There is a lot of discussion around ‘how can we do better as a field in this area?’. We are able to present at and attend conferences with the grant dollars that help move our course forward and help other institutions move their curriculum forward.”

Measuring Impact

Cultural education plays a crucial role in enhancing empathy and reducing bias among medical professionals. Exposure to diverse cultural experiences allows students to challenge preconceived notions and biases they may unconsciously hold. This self-awareness is pivotal in ensuring that medical practitioners approach each patient with an open mind, free from stereotypes that can hinder effective care.

Students completed several pre- and post-course quantitative and qualitative assessments that help faculty measure the impact of the course and several positive effects were identified. Students enrolled in the enhanced medical education course have reported transformative impacts on their perspectives and competencies. The course has been instrumental in fostering a heightened awareness and sensitivity to cultural factors in healthcare, as evidenced by a significant increase in the Cultural Competence Assessment (CCA-Total). Students have noted improvements in their competence when working with individuals from diverse cultural backgrounds, reflected in an increased score on the CCA-Competence scale. The course has also demonstrated its efficacy in helping students recognize the relevance of their own attitudes, beliefs, and stereotypes to patient care, as reflected by improvements in the Cultural Medicine Questionnaire (CMQ).

“There were many times that I noticed that I had biases and they were playing into my thoughts and probably my actions. I had to challenge myself to recognize them and work on them." -First-year Student

“Motivational interviewing was the most important skill I learned across the board. Even just the theory of it allowed me to approach patient problems in a much more unbiased and receptive way." -Third-year Student

Notably, students reported an increased perceived importance of working towards eliminating healthcare disparities, enhanced knowledge and attitudes regarding social determinants of health, and boosted confidence in conducting various activities related to cultural competency, patient care, and professionalism. The course has played a pivotal role in cultivating cultural humility, the ongoing process of self-exploration and self-critique combined with a willingness to learn from others, among students, showcasing the comprehensive impact on their holistic development as future healthcare professionals.

Lisa Streyffeler, PhD Chair and Associate Professor, Behavioral Medicine, Medical Humanities and Bioethics emphasizes, “We’re thinking about how we can talk about these topics in a way that encourages people to keep their ears open—that they remain interested in other people’s experiences. The good thing about being in a medical school is that our students really do want to take care of other people. They want to make the world better. We continue to frame this course as an essential way to help our students effectively. We put a lot of thought and care into how we talk about this material in a way that supports and opens everyone in the room to these topics and conversations.”

Looking Ahead

Faculty at Des Moines University continue to build in more conversation about health equity and the social determinants of health especially in their third year as they begin their clinical rotations. Recent research seeking feedback from third-year students suggests that they feel confident immediately after completing the course in the skills and knowledge they gained during their time in the course, but when they get into the realities of practice, they realize they need additional support.

When asked what is in store for the future of this course, Dr. Van Liew says, “In medical school, there’s a lot that happens between the end of your first year and the end of your third year. The qualitative data we recently gained from our third-year students affirms what we are doing but identified that they still need additional support navigating real-world scenarios within a clinical setting, knowing the social resources for a patient who can’t access their prescription, working with an interpreter—some of those points of care. Their feedback illuminated to us that this course can’t be an end point for our students, it’s really a starting point. This training needs to thread throughout their education, including during their clinical years.”

Investing in cultural education and awareness in medical student education is paramount. It not only improves patient-doctor relationships and reduces health disparities but also cultivates a generation of healthcare professionals capable of navigating the complexities of our diverse world. As we strive for a more inclusive and equitable healthcare system, integrating cultural education into medical training is an investment in the future of compassionate, patient-centered care.

Learn more about Des Moines University’s upcoming implicit bias speaker series.