Diversity and Inclusion
Journal Articles on Cultural Humility / Social Determinants
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Jones, K. (2016). Asthma And Injustice On Chicago's Southeast Side. Health Affairs, 35(5), 928-931 4p.http://http://content.healthaffairs.org/content/35/5/928
Abstract: A physician discovers a potential environmental link to asthma attacks in a poor Chicago community.
Coates, T. (2014). The case for reparations. The Atlantic, (5). 54. http://www.theatlantic.com/magazine/archive/2014/06/the-case-for-reparations/361631/
Excerpt: Two hundred fifty years of slavery. Ninety years of Jim Crow. Sixty years of separate but equal. Thirty-five years of racist housing policy. Until we reckon with our compounding moral debts, America will never be whole.
Carrese, J., Brown, K., & Jameton, A. (1993). Case Study: Culture, Healing, and Professional Obligations. The Hastings Center Report, 23(4), 15. http://dx.doi.org/10.2307/3562585
Excerpt: Dr. Leigh mused silently over a cup of coffee after a busy day at the Oakside Community Clinic. "So how far am I supposed to go with cultural sensitivity, anyway?" she asked herself. This question arose from the lingering doubt she felt about how she had responded earlier that day to a patient's mother, Ms. Ying Saeto.
Clark, L., Calvillo, E., dela Cruz, F., Fongwa, M., Kools, S., Lowe, J., & Mastel-Smith, B. (2011). Cultural Competencies for Graduate Nursing Education. Journal Of Professional Nursing, 27(3), 133-139. http://dx.doi.org/10.1016/j.profnurs.2011.02.001
Abstract: Nursing is challenged to meet the health needs of ethnic and socioculturally diverse populations. To this end, American Association of Colleges of Nursing (AACN) charged an expert nursing faculty advisory group to formulate competencies for graduate nursing education, expanding them to integrate leadership and scholarship. The Cultural Competency in Baccalaureate Nursing Education served as the springboard for the initiative. In formulating the graduate cultural competencies and the toolkit, the advisory group reviewed all AACN Essentials documents and the cultural competency literature, drew upon their collective experiences with cultural diversity, and used cultural humility as the supporting framework. Six core competencies were formulated and endorsed by the AACN board of directors and key professional nursing organizations. A companion toolkit was compiled to provide resources for the implementation of the competencies. A 1-day conference was held in California to launch the cultural competencies and toolkit. Dissemination to graduate nursing programs is in process, with emphasis on faculty readiness to undertake this graduate educational transformation. The AACN Cultural Competencies for Graduate Nursing Education set national standards to prepare culturally competent nurses at the graduate level who will contribute to the elimination of health disparities through education, clinical practice, research, scholarship, and policy.
Dickins, K., Levinson, D., Smith, S., & Humphrey, H. (2013). The Minority Student Voice at One Medical School. Academic Medicine, 88(1), 73-79. http://dx.doi.org/10.1097/acm.0b013e3182769513
Abstract: Although the minority population of the United States is projected to increase, the number of minority students in medical schools remains stagnant. The University of Chicago Pritzker School of Medicine (PSOM) matriculates students underrepresented in medicine (URM) above the national average. To identify potential strategies through which medical schools can support the success of URM medical students, interviews with URM students/graduates were conducted.
Garden, R. (2015). Who speaks for whom? Health humanities and the ethics of representation. Medical Humanities, 41(2), 77-80. http://dx.doi.org/10.1136/medhum-2014-010642
Abstract: The medical or health humanities are in essence a form of advocacy, a means of addressing a problem of underrepresentation. They focus on suffering, rather than pathology, and on sociocultural understandings of illness and disability, rather than a narrow biomedical perspective. The health humanities thus analyse and attempt to recalibrate the power imbalance in healthcare. This article reviews health humanities scholarship that addresses underrepresentation through the analysis of illness and disability narratives. It examines the ethics of representation by exploring how literary representation functions, its aesthetic as well as political dimensions, and how it operates as a relay mechanism for power. The mechanism of representation is further explored through a reading of Eli Clare's narrative Exile and Pride. Donna Haraway's notion of articulations is proposed as a tool for a more ethical approach to representation. The article suggests that transparency about the power health humanities scholars stand to gain through representation may contribute to a more ethical health humanities practice.
Nivet, M. (2015). A Diversity 3.0 Update. Academic Medicine, 90(12), 1591-1593. http://dx.doi.org/10.1097/acm.0000000000000950
Abstract: Five years ago, in a previous Academic Medicine Commentary, the author asserted that the move toward health reform and a more equitable health system required a transformation of more than how we finance, deliver, and evaluate health care. It also required a new role for diversity and inclusion as a solution to our problems, rather than continuing to see it as just another problem to be fixed. In this update, the author assesses the collective progress made by the nation’s medical schools and teaching hospitals in integrating diversity into their core strategic activities, as well as highlighting areas for continued improvement.
The author identifies five new trends in diversity and inclusion within academic medicine: broader definitions of diversity to include lesbian, gay, bisexual, and transgender people and those who have disabilities; elevated roles for diversity leaders in medical school administration; growing use of a holistic approach to evaluating medical school applicants; recognition of diversity and inclusion as a core marker of excellence; and appreciation of the significance of subpopulations within minority and underrepresented groups.
More work remains to be done, but institutional initiatives to foster and prioritize diversity and inclusion coupled with national efforts by organizations such as the Association of American Medical Colleges are working to build the capacity of U.S. medical schools and teaching hospitals to move diversity from a peripheral initiative to a core strategy for improving the education of medical students and, ultimately, the care delivered to all of our nation’s people.
Teal, C., Gill, A., Green, A., & Crandall, S. (2011). Helping medical learners recognise and manage unconscious bias toward certain patient groups. Medical Education, 46(1), 80-88. http://dx.doi.org/10.1111/j.1365-2923.2011.04101.x
Abstract: For the last 30 years, developments in cognitive sciences have demonstrated that human behaviour, beliefs and attitudes are shaped by automatic and unconscious cognitive processes. Only recently has much attention been paid to how unconscious biases based on certain patient characteristics may: (i) result in behaviour that is preferential toward or against specific patients; (ii) influence treatment decisions, and (iii) adversely influence the patient–doctor relationship. Partly in response to accreditation requirements, medical educators are now exploring how they might help students and residents to develop awareness of their own potential biases and strategies to mitigate them. METHODS: In this paper, we briefly review key cognition concepts and describe the limited published literature about educational strategies for addressing unconscious bias. DISCUSSION: We propose a developmental model to illustrate how individuals might move from absolute denial of unconscious bias to the integration of strategies to mitigate its influence on their interactions with patients and offer recommendations to educators and education researchers.
Wear, D. (2003). Insurgent Multiculturalism. Academic Medicine, 78(6), 549-554. http://dx.doi.org/10.1097/00001888-200306000-00002
Abstract: The author proposes a theoretical orientation for cultural competency that reorganizes common curricular responses to the study of culture in medical education. What has come to be known in medical education as cultural competency is theoretically truncated and may actually work against what educators hope to achieve. Using Giroux's concept of insurgent multiculturalism, she suggests that the critical study of culture might be a bridge to certain aspects of professional development. Insurgent multiculturalism moves inquiry away from a focus on nondominant groups to a study of how unequal distributions of power allow some groups but not others to acquire and keep resources, including the rituals, policies, attitudes, and protocols of medical institutions. This approach includes not only the doctor–patient relationship but also the social causes of inequalities and dominance. Linked to professional development efforts, insurgent multiculturalism can provide students with more opportunities to look at their biases, challenge their assumptions, know people beyond labels, confront the effects of power and privilege, and develop a far greater capacity for compassion and respect.
The Limits of Narrative: Medical Student Resistance to Confronting Inequality and Oppression in Literature and Beyond
Wear, D., & Aultman, J. (2005). The limits of narrative: medical student resistance to confronting inequality and oppression in literature and beyond. Med Educ, 39(10), 1056-1065. http://dx.doi.org/10.1111/j.1365-2929.2005.02270.x
Abstract: Upon designing and implementing a literature course on family values for Year 4 medical students, we found that while the supposed benefits of literary inquiry were to lead students to a deeper understanding of difficult issues such as illness and violence in the family, many of our students were unable to engage critically with the course material. This, we believe, was a result of their resistance to confronting issues such as inequality and oppression. This paper is an attempt to theorise student resistance to difficult, unruly subjects they encounter in a literature class, particularly those surrounding race, gender, social class and sexual identity.
Wear, D., Kumagai, A., Varley, J., & Zarconi, J. (2012). Cultural Competency 2.0. Academic Medicine, 87(6), 752-758. http://dx.doi.org/10.1097/acm.0b013e318253cef8
Abstract: Cultural competency efforts have received much attention in medical education. Most efforts focus on the acquisition of knowledge and skills about various groups based on race and ethnic identity, national origins, religion, and the like. The authors propose an approach, “Cultural Competency 2.0,” that does not reject such efforts but, rather, adds a more critical and expanded focus on learners’ attitudes and beliefs toward people unlike themselves. Cultural Competency 2.0 includes learners’ examination of the social position of most U.S. medical students, Bourdieu’s concept of habitus, and the phenomenon of countertransference to come to new critical insights on learners’ attitudes, beliefs, and, ultimately, interactions with all patients. Suggestions are offered for how and where Cultural Competency 2.0 can be used in the curriculum through narrative medicine, particularly through the development of reading practices that unmask illusions of “pure” objectivity often assumed in clinical settings, and that make visible how words and images constrain, manipulate, or empower individuals, groups, ideas, or practices.
The authors argue that these educational approaches should be sustained throughout the students’ clinical experiences, where they encounter patients of many kinds and see clinicians’ varied approaches to these patients. Further, these educational approaches should include assisting students in developing strategies to exercise moral courage within the limitations of their hierarchical learning environments, to strengthen their voices, and, when possible, to develop a sense of fearlessness: to always be advocates for their patients and to do what is right, fair, and good in their care.
Cultural Competency, Race, and Skin Tone Bias Among Pharmacy, Nursing, and Medical Students: Implications for Addressing Health Disparities
White-Means, S., Zhiyong Dong, Hufstader, M., & Brown, L. (2009). Cultural Competency, Race, and Skin Tone Bias Among Pharmacy, Nursing, and Medical Students: Implications for Addressing Health Disparities. Medical Care Research And Review, 66(4), 436-455. http://dx.doi.org/10.1177/1077558709333995
Abstract: The Institute of Medicine report, Unequal Treatment, asserts that conscious and unconscious bias of providers may affect treatments delivered and contribute to health disparities. The primary study objective is to measure, compare, and contrast objective and subjective cognitive processes among pharmacy, nursing, and medical students to discern potential implications for health disparities. Data were collected using a cultural competency questionnaire and two implicit association tests (IATs). Race and skin tone IATs measure unconscious bias. Cultural competency scores were significantly higher for non-Hispanic Blacks and Hispanics in medicine and pharmacy compared with non-Hispanic Whites. Multiracial nursing students also had significantly higher cultural competency scores than non-Hispanic Whites. The IAT results indicate that these health care preprofessionals exhibit implicit race and skin tone biases: preferences for Whites versus Blacks and light skin versus dark skin. Cultural competency curricula and disparities research will be advanced by understanding the factors contributing to cultural competence and bias.
Randall, V. R. (2009). Inequality in health care is killing African Americans. Hum. Rts., 36, 20.http://www.americanbar.org/publications/human_rights_magazine_home/human_rights_vol36_2009/fall2009/inequality_in_health_care_is_killing_african_americans.html
Excerpt: For blacks, health inequalities are the cumulative result of both past and current discrimination throughout U.S. culture. Due to discrimination and limited educational opportunities, blacks disproportionately work in low-pay, high-health-risk occupations (e.g., they are migrant farm workers, fast food workers, garment industry workers). Historic and present racism in land and planning policy also plays a critical role in minority health status.
Structural competency meets structural racism: race, politics, and the structure of medical knowledge
Metzl, J. M., & Roberts, D. E. (2014). Structural competency meets structural racism: race, politics, and the structure of medical knowledge. The virtual mentor: VM, 16(9), 674.http://journalofethics.ama-assn.org/2014/09/spec1-1409.html
Excerpt: Physicians in the United States have long been trained to assess race and ethnicity in the context of clinical interactions... Yet an emerging educational movement challenges the basic premise that having a culturally competent or sensitive clinician reduces patients’ overall experience of stigma or improves health outcomes. This movement, called “structural competency” , contends that many health-related factors previously attributed to culture or ethnicity also represent the downstream consequences of decisions about larger structural contexts, including health care and food delivery systems, zoning laws, local politics, urban and rural infrastructures, structural racisms, or even the very definitions of illness and health.
Metzl, J. M., & Hansen, H. (2014). Structural competency: Theorizing a new medical engagement with stigma and inequality. Social Science & Medicine, 103, 126-133.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4269606/
Excerpt: This paper describes a shift in medical education away from pedagogic approaches to stigma and inequalities that emphasize cross-cultural understandings of individual patients, toward attention to forces that influence health outcomes at levels above individual interactions.
Jones, A. H. (1997). Literature and medicine: narrative ethics. The Lancet,349(9060), 1243-1246. Excerpt:
"We often derive from observation strong intimations of truth, without being able to specify what were the circumstances we had observed which had conveyed those intimations".
Jones, A. H. (1997). Literature and medicine: narrative ethics. The Lancet,349(9060), 1243-1246.
Excerpt: "We often derive from observation strong intimations of truth, without being able to specify what were the circumstances we had observed which had conveyed those intimations".
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