Setting the Culture of Medical School from the Start

Objectives: The harmful effects of race and gender biases of doctors who may be unaware of their negative attitudes exacerbates the problem of differential morbidity and mortality among races. Such biases also diminish the learning opportunities during medical school. Cultural competence—respecting and valuing other cultures—is a skill that can be learned. To take a first step in training medical students to deal effectively with patients from diverse cultures, the University of California, San Francisco (UCSF) conducts a diversity workshop for entering first-year medical students. Its goal is to heighten the students' awareness of their own cultural backgrounds and those of their peers, so that they can develop and/or strengthen respect and tolerance for differences in others. This Cultural Heritage Workshop was developed by the UCSF Office of Affirmative Action, Equal Opportunity, and Diversity and was adapted for use with UCSF medical students. Description: This workshop, introduced in 1997, takes place in a two-hour block during orientation week for entering medical students. Two facilitators model the exercise. Each speaks for 10 minutes about his or her personal background and important experiences that have molded him or her. The workshop leaders' revelation of their own prejudices, how these came about through childhood experiences, and how they recognized and overcame them, has a powerful impact. Students are then divided into groups of eight to ten and are asked to tell their stories. They are asked to describe significant elements of their cultural heritages and backgrounds, which may be ethnic, racial, political, religious, economic, gender-related, cultural, or combinations of these factors. This is a trust-building activity, and participants are asked to share only what is comfortable. The exercise is directed to highlight how one's views of groups different from one's own were formed. Each small group selects a spokes-person who takes notes. The small groups meet for 40–50 minutes before the whole class reconvenes. The spokesperson from each group reports either highlights from the group or common themes among participants. The facilitators moderate and summarize the comments. Discussion: As a result of this program, students often comment that their concepts of diversity have expanded. Students are moved by the struggles of their classmates and the differences in their life stories. Paradoxically, this knowledge of differences in their backgrounds has brought people closer together because of the universality of human experiences. What starts as an experience of differences ends with a great sense of similarities and connections. Students are encouraged to continue this process and to remember when seeing patients that everyone has a story. This workshop has been offered annually for three years and is the highest-rated session of the entire orientation week, receiving a score of 4.3/5. Although the time allotted for the exercise has been expanded yearly, the enthusiasm from the students creates the sense that there is never enough time. Placing this workshop in the orientation week allows students to connect on a deeper level, fostering better integration within the class. This early discussion of cultural issues affirms the importance of the topic and helps the new class learn from each other and begin to reap the benefits of their own diverse thoughts and experiences.