In one of our first few meetings for the Diversity Council (DC), our first faculty advisor, Dr. Braciale, told us she would write a course proposal. The idea was simple; have every teacher do one to two hours of lecture a semester on their own lecture material having to do with health disparities and/or cultural competency. You can read the actual course proposal here (click here) but know that the idea was a 10 year old one we borrowed from the AAMC (Association of American Medical Colleges, click here). Also, you may want to know that there are certain states which dictate that this must be taught in their medical schools (such as New York) as well as the LCME (the folks who accredit a medical school in the US) and the ACGME (folks who accredit residency programs) request or require cultural competency be taught/understood. Furthermore, you should know that AUC spends approximately 4 hours or less talking a mixture of issues, one of which is cultural competency.
When dave, joe, mike, chanell and myself learned all this, we were shocked. We had been talking for some time about our frustrations with the curriculum and how health disparities in the US and Canada were ignored. What was disturbing was that many of our colleagues didn’t even know there were health disparities, and to make matters worse, our teachers were propagating an ideology that biology and genetics are a significant factor/cause. Thing is most US institutions place high importance on health disparities and know that such ideologies are totally untrue, “Current information about the biologic and genetic characteristics of minority and underserved populations does not explain the health disparities experienced by these groups” (CDC, Office of Minority Health Disparities).
Knowing all this we were ecstatic to hear about Dr. Braciale’s course proposal. However, there were some within the Diversity Council who worried we were moving to fast. So I tried to go to all the teachers and get their support for the proposal before Dr. Braciale presented it to the monthly Teacher Meeting. Unfortunately, the proposal was shot down anyhow. Complaints from teachers included, “We don’t have enough time”, “It’s not that important”, “I can’t teach this and I am not qualified to teach this.” Furthermore, the Behavioral Department chair, Dr. Johnson, walked into Dr. Braciales office and dropped the Behavioral Course syllabus onto her office before walking out. Behavioral science has one lecture, depending on the semester, for 50 minutes devoted to this subject. Afterwards I was told to be careful and not step on “anyones toes” or that people have “long toes” at AUC.
Not one to give up, I tried to write a proposal after my term as president of the Diversity Council was up. During my time as President I had found that Dr. Johnson had wrote a similar proposal to Dr. Braciale’s years back. I spoke with her a few times on the subject matter and she told me that other Caribbean schools had such a course. I looked at other Caribbean medical schools such as Ross and SGU and found they had specific courses for this subject matter. One of which was called Doctor, Patient and Society. I modeled my course off it (click here to read about it) with the fundamental focus on health disparities and Culture Competency. The problem was I needed a Course director; someone who would teach the course, write the syllabus and pitch it to the curriculum committee/administration. I tried Dr. Johnson. She said that she didn’t really want to but that she would co-direct the proposal. I asked Dr. Braciale if she would co-direct with Dr. Johnson such a course. She said sure. A short time later Dr. Johnson tells me she does not want to do the course. I decided that I would get all the teachers I had spoken too together and see once and for all if anyone would chair my course. I asked Dr. Johnson to organize such a meeting briefly between classes and she tells me that, “Yes, well, I think we should take this off your shoulders.” I thought nothing of it but a short time later I was told that I was being to aggressive. Dr. Johnson had requested to meet Dr. Testa and Dr. Braciale about me and my course proposal so that everyone was on the same page when she told me no.
Then came my last two semesters and I met our Medical Ethics teacher Dr. Edwards. I spoke with her about my course proposal and Dr. Braciale’s and she said that she wanted to teach such a course. She said that she would write a syllabus and get back to back to me and my colleagues who were working on the proposal (myself, kyle, gundi, jessica – they helped write both of my course proposals). We gave her a bunch of ideas for the syllabus and course which you can read here. More than anything we wanted this course to be the course where everything AUC didn’t teach was finally being taught. Tragically, however, a family member of Dr. Edward’s died. She had to drop everything and I know I would have done the same had I been in her shoes. I wish I had met Dr. Edwards sooner.
When I left AUC, after all the efforts my colleagues and I made, student opinion had changed. I remember sitting in class and watching peers of my semester go back and forth with teachers on cultural competency. It was a good feeling, knowing that my arguments did not fall on deaf ears. But then the hate crime happened and I watched people’s reactions and my doubts grew. I realized that the newer semesters had no clue about cultural competency and health disparities. Also, that only one or two organizations were continuing the discussion, half heartily, on cultural competency.
Remember though that on the heels of the hate crime incident the school has promised a new pilot course for May 2011. I for one hope they come thru.
What do you think???