Year 1 (Module 3)
The Introduction to Clinical Medicine (ICM) courses in Module 3 provide sustained opportunities for addressing many of the components of TACCT’s fifth Domain (Cross-Cultural Clinical Skills). Beginning in the fall 2004, we integrated cross cultural content into the Doctor-Patient Relationship course (MD301). Of particular importance during this early stage of training is incorporating exercises about self-awareness and cultural sensitivity. Another key factor that led to combining the Culture Matters and Doctor-Patient Relationship courses is their mutual reliance on teaching in small groups.
The first TACCT Domain (rationale, context, and definition) provides a useful framework for restructuring the Culture Matters content within the Doctor-Patient Relationship course. Three separate sessions utilize panels, case presentations, and small group discussions, which are led by physicians and experts from the social sciences on Penn campus such as anthropology, sociology, and social work. In the Doctor-Patient Relationship course, standardized patients (SPs) are used to build interviewing skills for first-year students. We recently increased the number of SP practice sessions to introduce cases that are specifically designed to address cultural or health disparities issues.
Specific instructions on “eliciting a culturally valid social and medical history” (Domain V) are given as part of the introduction to ICM early in the fall of the second year. We reinforce these skills through more cultural challenges and characteristics in the SP cases used in the history-taking and physical exam practice and assessments. In the final pre-clinical course, Introduction to the Clinics (MD305), we use case presentations, SP demonstrations, and small group discussions that entail cultural components for more detailed analyses of the effects of culture on “diagnosis, management, and patient-adherence skills” (Domain V).
Teaching to the TACCT components in Domains II, III, and IV that relate to population health, institutions, demographics, and the community also addresses students’ recommendations that we include more about the community in which they learn (i.e., West Philadelphia). We began to implement programs and presentations at key points in the curriculum in 2004 during the Orientation to Medical School. This session consists of presentations, panels, field trips, and small group discussions during the first few weeks. Information about demographics, social problems, and health problems facing the West Philadelphia Community is presented along with information about community strenghths-its professionals, churches, and diverse organizations. Field experiences are arranged for students to spend several hours during the first week of medical school in the West Philadelphia community to help them begin to understand the concerns and health care needs of the populations that they will be seeing during medical school. At the conclusion of these experiences during the first several weeks of medical school, “debriefing” sessions are held, to provide a forum for students to discuss their experiences. The second new series of presentations, which became part of the Doctoring I course in the spring of the first year, involves physicians and community experts discussing the health care needs, problems, and services of West and Southwest Philadelphia. In addition, the focus and format (lectures, panels, and small group discussions) of two existing pre-clinical courses -Health Care Systems and Clinical Decision Making- provide ideal forums for many of the key elements of Domains I, II, and III.