Why cultural competency courses should be requisites for medical school [PODCAST]

Listen and followApple PodcastsSpotifyYouTubeMore apps · Browse all episodes

“Doctors are people, and people are capable of prejudice and discrimination. But, in medicine, there is no place for prejudice and discrimination because a patient’s life is at stake. Stereotyping a customer and assuming that they cannot afford a certain product is emotionally hurtful, but it is far less dangerous than stereotyping a patient and misdiagnosing a life-threatening condition.

The nature of the medical profession is handling a patient’s life; doctors are the last line of defense between life and death.

As such, doctors have to balance every aspect of the patient when choosing the right treatment, and ample evidence suggests that a patient’s culture, including race, ethnicity, and class, is an important factor in determining a health outcome.

With the stakes this high, it is vital that doctors understand the intersection of culture and medicine, and they understand it as soon as their journey into medicine begins.”

Shvetali Thatte is a premedical student.

She shares her story and discusses her KevinMD article, “Why cultural competency courses should be requisites for medical school.”

Did you enjoy today’s episode?

Please click here to leave a review for The Podcast by KevinMD. Subscribe on your favorite podcast app to get notified when a new episode comes out!

Do you know someone who might enjoy this episode? Share this episode to anyone who wants to hear health care stories filled with information, insight, and inspiration.

Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show, we have Shvetali Thatte. She is a pre-medical student, and she wrote the KevinMD article “Why cultural competency courses should be requisites for medical school.” Shvetali, welcome to the show.

Shvetali Thatte: Thank you for having me. It’s so great to be here.

Kevin Pho: So we’ll get into your article in a little bit, but first off, can you tell me your story and your journey to where you are today?

Shvetali Thatte: Of course. So I started out, I grew up near a suburban town in Chicago, and ever since I was little, I really enjoyed helping people. Whether it was in school or outside of school, I was much of a helper, and I also enjoyed talking to people. My parents always joked that I would sit at their dinner table with their adult friends, and I just liked to listen in and sometimes chime in. I just really enjoyed people in general. So growing up, I always knew that whatever career I went into, I wanted it to be a career that would have a direct interaction with people, something where I could see tangible impact being made on people around me daily.

And I grew up with a lot of variety in my life. I started out looking at biochem, and I also looked at computer science, English, and law. I had a whole variety of experience in those fields, but ultimately, in high school, I took a lot of bio electives, and I also did research in cancer biology. Those were the two driving points where I fell in love with bio, especially after I took an elective in neuroscience. That’s what really drove me into thinking about going into a career in medicine, because I definitely enjoyed bio and neuroscience a lot, and I could see the impact I could have daily.

I also spent time volunteering at hospitals and shadowing doctors, which really solidified my decision of going into medicine, because I knew that this was a field that would let me use my science brain and combine it with my passion for people to give me the ultimate career. So my senior year, I applied to a lot of BS/MD programs, and I ultimately committed to Case Western. Today, I’m a sophomore at Case Western Reserve University. I major in neuroscience and economics, and I’m part of their Pre-Professional Scholars Program in medicine, which means that after my four years of undergraduate, I will be matriculating to the Case School of Medicine.

Kevin Pho: Fantastic, and best wishes on your medical journey. I’m a BA/MD graduate myself, at Boston University, so it’s a fun ride. So let’s get into your KevinMD article, “Why cultural competency courses should be requisites for medical school.” Now, for those who haven’t read your article, can you walk my audience through it and share the story of why you decided to write it?

Shvetali Thatte: So beginning in March, I took some time and I read some books. The ones that stood out to me the most were Black Man in a White Coat and Unmasking Racism and Health Care: Alive and Well, and both of these books really took me on a different path toward medicine. I always knew that medicine is very science-based. I always thought about doctors going in to see patients with basically the mindset of looking at their disease, diagnosing their symptoms, and then prescribing a treatment. But after reading these books, I realized that the sociocultural background of the patient is a big factor in determining how the patient’s health comes about, as well as how the patient will fare. And that sociocultural background is something that many physicians need to be taking into account when treating a patient, but it’s also something that can easily be overlooked with the other nitty-gritty specifics of medicine itself as a science. So that’s how I started to think about culture in medicine.

After that, I spoke with some of my fellow pre-meds. I also talked to med students and physicians to hear their thoughts on how culture plays a role in medicine, as well as how they think cultural competency can work to eliminate, or at least significantly reduce, disparities such as race, class, gender, and language disparities that currently exist greatly in our health care system. A common perspective that I found from med students and physicians was that in the years of med school, a lot of the information itself is very dense. It’s overwhelming, and it’s very specific. So in learning all of the medical terminology, physiology, anatomy, and disease-specific information, it’s difficult to take the time to also build a foundation of cultural competency, and then build upon that cultural competency foundation to learn the specifics of cross-cultural care.

So after that conversation, I did some research with some of my friends. We actually wrote a formal literature review that looks at culture and medicine, the consequences of cultural negligence in medicine, the benefits of cultural competency, as well as current cultural competency training and the merits of cultural competency as a pre-med course. And this led us to believe that if students were given the opportunity to build their foundation in cultural competency in the pre-med years, that would help them to work upon those foundations in med school without being overwhelmed by that information as well.

So my article itself is a summary of the research that I compiled in my literature review, and it discusses how, if students were offered the opportunity to take cultural competency courses at the pre-med level, then they could take more time to self-reflect upon their internal biases and prejudices, as well as take the time to really delve deep into seeing how different cultural systems and cultural values play a role in health, and the implications they have on our health as well as the health of others. So my article really talks about how the more time we can give students to self-reflect upon this, the better they will be when they become physicians themselves. And because the med school journey really begins in the pre-med years, the pre-med years are when you learn the foundations of chemistry, biology, and all the courses that you will need foundations in to learn medical-specific information during med school. I talk about how cultural competency is part of that journey, and it needs to be integrated earlier on, especially in the pre-med years.

Kevin Pho: So what’s the current status of cultural competency courses in medical school? What percentage of medical schools currently teach cultural competency?

Shvetali Thatte: So the Association of American Medical Colleges currently requires all medical schools in the United States to offer cultural competency curriculum as part of their four years of med school curriculum. But as of recent studies that have come through, most cultural competency curriculum only focuses on about two years. It’s only there for about two years, and that’s the first two years. So toward the latter years of medical school, that cultural competency training isn’t really referred to as often as it should be.

More so, the AAMC has a set of specific guidelines. They’re called the TACCT standards, and these standards aren’t really being met by each med school. Each med school might meet a couple of them, but not all of them. And so going off of that, a lot of the studies that have been done show that although there is cultural competency curriculum in each med school, it’s not universalized, nor is it adequately meeting the requirements of the AAMC itself.

Kevin Pho: Now, you’re asking for cultural competency courses in the pre-medical years. Currently, is that even an option in the majority of colleges today?

Shvetali Thatte: So a lot of schools right now require pre-med students to take some kind of behavioral or social sciences course, but none of these are necessarily specific to looking at culture and its implications on health. So what we are asking for is for individual undergraduate institutions to begin offering a course that will look at different aspects of culture in relation to health, and it would be a course that would be offered to all pre-meds, and all pre-health students too, if anyone wants to take it.

And although no course like this necessarily exists at any university as a requirement, there are schools that have tried to implement these kinds of courses in the past, and certain schools still offer these courses as electives right now. But they are often at a 200 or 300 level and require some prerequisites, because they’re often very specific. So for one example, there’s a course at my school that relates medical anthropology, society, and culture together, and that’s definitely a course that we think comes close to what we are asking. But because it has two prerequisites, it’s often not taken by many pre-med students. So what we’re asking for is a basic course that would be at the beginning.

Kevin Pho: We’re talking to Shvetali Thatte. She’s a pre-medical student, and she wrote the KevinMD article “Why cultural competency courses should be requisites for medical school.” Now, can you tell me something that you’ve been passionate about or something that you’ve been curious about over the last few months?

Shvetali Thatte: So I think after I wrote that article and we also compiled the literature review, the next steps for me this summer that have really taken over my life have been starting a petition to make cultural competency a requisite for pre-meds. That petition so far has garnered over 470 signatures, and we’ve also had the support of many health care physicians and professionals, as well as health care influencers on Twitter and Instagram. So we’re hoping to keep furthering that support.

We’ve also drafted proposals. One we’ve submitted to the Association of American Medical Colleges; right now, the Council on Admissions is reviewing that proposal, so we’re hoping to hear back from them soon. And we’ve also submitted proposals to individual undergraduate institutions. The friends that I wrote the literature review with go to three different universities, so we’ve submitted it to our four universities, and we’ve also had many of our supporters sign up to send a proposal to their individual undergraduate institution. So right now, we have over 20 institutions that we are in conversation with about discussing the logistics of implementing such a course, and we’re hoping to continue expanding our initiative and just see where it can really go.

Kevin Pho: And for people interested in finding out more about your message, how can people do that?

Shvetali Thatte: So we have an Instagram account that’s @cultural_competency, and we also have a Linktree. So if you go to linktree.com/culturalcompetency, you can also find all of our information there: our literature review, both of our proposals, the link to our petition, as well as a Google Form that you can sign up on to submit a proposal to your individual undergraduate institution.

Kevin Pho: And my final question: Do you have a take-home message that you want to share with the KevinMD audience?

Shvetali Thatte: I think after doing all of my research and writing that article, I really believe that perspectives are broadened over time, and the more time that we can give our physicians to explore and understand their cultural values, the cultural values of others, and the implications of culture on health, the better. Our nation is continuously diversifying, and by 2050, the U.S. Census Bureau predicts that there’s not going to be a single ethnic majority. So our physicians need to be prepared to provide the best cross-cultural care, and as data shows, current cultural competency training isn’t enough in med school, and we aren’t providing the best cross-cultural care that we could.

So allowing students to recognize the importance of culture early on, and apply those foundations to cross-cultural-specific care in med school and beyond. The data stands with us on this. Studies done by UCLA and Vanderbilt University show how students who take cultural competency during their undergrad have an enhanced ability to understand how issues are determinants of health, and how other structural stigmas, health economics, and race can all play a role in treating patients. So I really believe that understanding cultural competence at the pre-med level can have a great influence on the way our physicians will care for our patients, especially as we go into a future with an ever-diversifying nation.

And I just hope that all of the listeners out there, if they believe in our mission, will go to our website, sign our petition, and really urge the AAMC and any undergrad institutions that they’re affiliated with to start offering cultural competency for pre-meds.

Kevin Pho: Well, thank you so much for sharing your story and your insight, and thanks again for being on the show.

Shvetali Thatte: Yes, thank you for having me.

Listen and followApple PodcastsSpotifyYouTubeMore apps · Browse all episodes