Presenting Cultural Diversity and Spirituality to First-year Medical Students

Objective: Physicians who demonstrate understanding of different beliefs gain their patients' respect and trust. The Association of American Medical Colleges and the Liaison Committee on Medical Education (LCME) suggest that medical students need education about the cultural and spiritual preferences of patients. Recently, the LCME proposed that students be required to demonstrate cultural competence. Description: At the University of Arkansas for Medical Sciences, we agree that cultural diversity and spirituality are important topics for medical students. At the inception of our Introduction to Clinical Medicine course, we provided a cultural diversity lecture by a nationally known medical anthropologist. The lecture was supplemented by a handout that detailed traditional cultural distinctions. Unfortunately, this session was not well received by our first-year students. We believe this was because we failed to establish the relevance of the topic. For fall 1999 we revised our presentation. We added information about spirituality and titled the session, “Understanding Patient Beliefs.” Our goal for the students was that they become as adept at understanding a patient's cultural and spiritual issues as they are at obtaining the medical history. Our learning objectives were that students would be able to (1) explain ways in which patients' cultural and spiritual beliefs affect their disease process and illness experiences, (2) describe how spiritual and cultural factors influence the doctor-patient relationship, and (3) conduct a spiritual assessment using Puchalski's FICA or Maugans's SPIRIT mnemonic.1,2 We invited a panel of four clinical faculty to present and discuss spiritual and cultural issues that commonly affect the practice of medicine. Each was asked to focus on one of four topics: (1) clinical and ethical guidelines for discussing spiritual beliefs with a patient and for sharing one's own beliefs; (2) treatment of patients from different cultures or with different languages in a busy primary care practice; (3) racial/ethnic differences and difficulties in the doctor-patient relationship; (4) the “mind-body” aspects of illness. We asked the panelists to use personal experiences and patient cases in order to engage the students' interest. The medical anthropologist moderated the discussion and facilitated student questions during the one-and-one-half-hour session. The composition of the panel was diverse. Three panelists were physicians and one was a psychologist; three were white, one was African American; one was a woman. Discussion: The session was generally well received by the students. Although we had asked the panelists to limit their opening remarks to five minutes and to address the specific issues described above, it was difficult to keep them on task. Each panelist delivered a “mini-lecture,” leaving little time for the students' questions. Most of the panelists also spoke to issues tangential to the learning objectives. In spite of these difficulties, however, we intend to use this model again next year. We believe we can better manage the discussion by having the moderator provide brief opening remarks, ask one or two prepared questions to start the discussion, and then open the floor for student-guided discussion. We hope our experience will provide a model for other medical schools.