Getting comfortable: College of Medicine initiatives prepare learners to care for patients from diverse backgrounds
Whether she’s listening to a podcast or reading a book, Dr. Katharine Dalke is always seeking out new perspectives from lives that are different than hers.
“I try to engage with cultures and voices that I don’t come into contact with on a regular basis,” said Dalke, an assistant professor of psychiatry and behavioral health at Penn State College of Medicine. “It’s refreshing to see the world through another individual’s eyes, and it helps me challenge my biases.”
It’s that kind of attitude that made her the natural choice for director of the College of Medicine’s Office for Culturally Responsive Health Care Education. Dalke was recently honored with the Local Spotlight Award from the LGBT Center of Central PA for her work with various local and national groups on improving health care for patients with sexual and gender diversity.
“What I love about my job as director is harnessing our learning community’s passion for culturally responsive health care,” Dalke said. “Students and faculty are working together to enhance our curriculum to promote cultural competency and the examination of personal and structural biases in clinical care.”
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Founded in fall 2018, the Office for Culturally Responsive Health Care Education works to ensure that medical students, physician assistant students and graduate students have the knowledge, skills and attitudes necessary to provide culturally excellent health care and research for diverse populations. Diverse populations include but are not limited to those defined by race, ethnicity, language, sex, sexual orientation, gender identity and expression, religion, veteran status and ability.
According to Tomi Dreibelbis, senior director for educational affairs at the College of Medicine, the office was created in response to feedback from students who expressed a desire for more opportunities to learn how to care for patients from diverse backgrounds. In doing so, the office hopes to promote health, reduce the impact of disparities and work toward health equity.
Fostering cultural competence
Dalke works with course directors, students and community partners to ensure that the curriculum meets the Liaison Committee on Medical Education standards for cultural competence. She is also responsible for innovating, enriching and integrating the curriculum for culturally responsive health care across the four pillars of the College of Medicine – Biomedical Sciences, Health Humanities, Clinical Sciences and Health Systems Sciences.
Topics related to culturally responsive care transcend the four pillars. For example, helping both learners and educators understand that sex and gender identity are two different concepts is important when discussing sex-linked genetic conditions, or health problems that disparately impact women, in a biomedical sciences course.
“When we say that a condition is more common in female patients, learners may not know whether that is due to someone’s genetic sex, hormone exposure, body parts or social experience.” Dalke said. For example, transgender and intersex women can have unique combinations of those characteristics.
“Encouraging students and faculty to think critically about these concepts helps ensure we can understand, communicate with and effectively interact with people from a variety of cultural backgrounds.”
Being aware of unconscious bias
Culturally responsive care is about more than just knowing basic cultural facts about the patient in front of you. Dalke said encouraging students to become self-reflective so they can identify and minimize the impact of unconscious bias in their decision-making is a key goal for the office.
Dalke recalls that when starting medical school, the only time a person in a case study was identified as gay was when the class was discussing HIV. She warned that trends like that can introduce and reinforce cognitive bias and social stigma.
“As a member of the LGBTQI community, I don’t want case studies like that to unintentionally send a message that someone’s identity should only be visible when they have an illness, especially one that is still so stigmatized,” Dalke said. “As an educator, I want my learners to learn all the modes of transmission and risk factors for HIV.”
Ultimately, Dalke enjoys collaborating with faculty, students and staff to create opportunities for people to learn cultural competency in a non-threatening space.
“Sometimes teaching and learning about issues of diversity, equity and inclusion can feel emotionally charged, political or challenging to people who are not well-versed in the language,” Dalke said. “We want to provide students and faculty with strategies to explore these questions in a safe environment.”
Medical students put their culturally responsive skills in action during the Health Equities Clerkship, a required, four-week clinical and social medicine training experience that is unique to Penn State College of Medicine. It puts students in care settings where there may be physician shortages, medically underserved populations or limited resources for both the practice and the patient. These diverse communities provide opportunities for students to learn from physicians how to be adaptive, collaborative, critical thinkers who make do with less.
“We want to train physicians who are comfortable advocating for their patients,” said Dreibelbis, who co-directs the clerkship. “The Office for Culturally Responsive Health Care Education and the Health Equities Clerkship ensure that our students have the tools they need to be mindful of bias and to provide the best care for patients from a variety of backgrounds.”
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