With a growing need for more health professionals to pursue careers in community clinics in diverse and underserved communities, UC Davis Health System launched the 2011 Summer Institute on Race and Health for first-year School of Medicine students in June to help students better understand culturally appropriate approaches to care.
"The Institute's training strategies went beyond a cultural-tourism approach," said Betty Irene Moore School of Nursing Consulting Faculty Member Jann Murray-Garcia, who taught the intensive four-week pilot program. "The students reflected on and explored together deep issues of identity, power imbalances and the historical contexts that result in disparities in both health status and health-care delivery."
Students participated in several different assignments and fieldwork designed to create personal responses and provoke reflective thinking captured through journal writing. They toured Oak Park, a neighborhood adjacent to the UC Davis Sacramento campus, to see public policy and geography impact race and health. The students met with Jesus Hernandez, a doctoral student in Sociology at UC Davis, to discuss redlining, a discriminatory practice in the first half of the 1900s where financial services to specific neighborhoods, generally based on poor economic status and race, are limited or denied. In Sacramento, especially in Oak Park, this practice led to many of today's health and housing disparities, Hernandez said. Students also explored mapping technology and its use to illustrate the complex intersection of policy, health, populations and geography.
The program emphasized migrant health to study the impact of race and immigration on health. Participants toured Locke, a Sacramento-Delta community developed in the early 1900s by Chinese immigrants. They also met with the leader of a Hmong charter school in the Sacramento area.
In another activity, the students met with a farm owner of Mexican descent in Woodland and spent a few hours on his land. According to Murray-Garcia, such experiences provide opportunities for students to see firsthand the various factors, many related to race, work and lifestyle, that influence people's health and access to health care. The goal of the program, Murray-Garcia said, is to prepare future health-care providers to use a person-centered approach to care that is based upon the individual's needs and experiences and not just the injury or illness itself.
"I remember looking at [the farmer's] hands and comparing them to my own," one student, Charlie Wang, wrote in his journal. "I think I'm coming to the realization that all stereotypes are dehumanizing, even if they aren't overtly so. Anything that suppresses--oppresses--the human experience can't be anything but. So I'm learning even more so to listen to my patients, and make no assumptions."
The Race and Health Institute also prepares students to work together cohesively in teams, a critical need in today's health-care workforce, according to numerous researchers and health-care leaders. Murray-Garcia and other guest lecturers discussed race and power issues that exist in all layers of work within an institution, a community and society.
Murray-Garcia collaborated with Amy Doroy, a registered nurse at a critical care unit and a master's degree student at the School of Nursing, to create the fieldwork that would bring this concept to life for the students. Doroy shared a history of nursing with the students and coordinated job-shadow experiences with nurses at UC Davis Medical Center. She plans to analyze their experiences as part of her master's thesis.
"The institute is an innovative way to further develop interprofessional health-care teams," Doroy said. "It's fascinating to see how positively both nurses and students responded to this new discussion."
The summer institute was funded as part of the $1.7 million Transforming Education and Community Health for Medical Students grant funded by the Health Resources and Services Administration. Tonya Fancher, a physician with a master's degree in Public Health, is the principal investigator and leads the 4-year multidisciplinary community-based experience for UC Davis School of Medicine students interested in primary care and care for the underserved. The project also provided stipends for several students to reside in Sacramento to focus on these studies.
Murray-Garcia created the summer institute curriculum in collaboration with Fancher and other faculty at UC Davis Health System. As a pediatrician in the Bay Area, Murray-Garcia helped train health professionals in cultural humility, a concept she wove into the institute's curriculum. At UC Davis Health System, Murray-Garcia also leads the Interprofessional Book Club for students, faculty and staff.
Fancher and Murray-Garcia plan to offer the institute again in 2012, taking what worked best from this pilot program and considering possible ways to expand.
"Racial disparities in health care cannot be eliminated without looking at ourselves and the circles in which we live and work," Murray-Garcia said.