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How their journey begins

Health Care Disparities

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With all that there is to learn in medical school, where is the logical place to begin?  For our students, it’s Health Care Disparities (HCD): a three day course designed to help students understand the social context of the patients they will care for during their training and beyond. The course is an inquiry into the existence and reasons for medical health care disparities; it questions the meaning of culture and cultural competency, and explores the healthcare challenges in the local Baltimore community.

We had the pleasure of speaking with April Fitzgerald, M.D., the course director, a few weeks ago to gain a little insight into Health Care Disparities.  Dr. Fitzgerald has been the course director for four years and Mindi Levine, MS, CHES, of SOURCE (Student Outreach Resource Center), has been the co-director since the inception of the Genes to Society Curriculum five years ago.

HCD has three pillars that create the foundation for the course.  The first is ‘Health Care Disparities,’ which entails lectures from interdisciplinary faculty from the School of Medicine, Bloomberg School of Public Health and the Baltimore Department of Health.

The second pillar is ‘Cultural competency.’  Through this chapter, students strengthen their communication skills: they learn how to interact and connect with patients, what types of language to use and not to use when around patients, and they also discover the importance of being curious about patients and their values.  Students become familiar with the medicine culture, its language and gestures.  Of course, three days is not enough time to master these skills, but the groundwork is established and communication is strongly emphasized throughout the Genes to Society Curriculum.  Students are encouraged to share their ideas, their point of view and to speak up throughout their education.

The third pillar is ‘Service-learning,’ which begins with students going on a bus tour of Baltimore City to familiarize them with their new home.  In groups, they spend an afternoon dedicated to community service at local Baltimore organizations like Healthcare for the Homeless, Moveable Feast, Project PLASE, and Amazing Grace Church.  The third day of the course is spent as reflection on their service experience. Additional information is also shared from other service groups in Baltimore and how they impact the community.  This chapter allows students to see with their own eyes the social, behavioral, and economic factors prevalent in the communities of Baltimore.

HCD is a starting point for students; an introduction into the medical field.  After taking this course, they often realize how much there is to learn about working with patients, and treating health and disease.  Students learn how a patient’s culture impacts their care, how a student’s own biases can impact care, and how to bridge the divide between the culture of medicine and a patient’s own culture.  HCD strives to introduce a shift in thought process for students and hopes to open up their way of thinking.  Many students remark how much this course evokes emotion and self-reflection in just the three days.

Dr. Fitzgerald commented that she truly enjoys teaching the very first course in the students’ medical school journey.  They come into it enthusiastic and excited to begin their career.   And HCD helps to set the tone for the rest of their medical school journey—that introspection and reflection are important aspects of being a great physician, and that adaption to the environment and variability among patients is important to understand health and disease.

Printed in the Health Care Disparities handbook given out on the very first day is the infamous Sir William Osler quote that effectively sums up the goal of HCD, “The good physician treats the disease; the great physician treats the patient who has the disease.”