Ethics & Culture in Education of Health Professionals

1. Ethics & Culture in Educationof Health Professionals John R. Stone, MD, PhD Center for Health Policy and Ethics Creighton University School of Medicine JohnStone@creighton.edu June 2007

2. Cross-cultural Healthcare Joseph R. Betancourt • “At the end of the day, physicians need a practical set of tools and skills that will enable them to provide quality care to patients everywhere, from anywhere, with whatever differences in background that may exist, in what is likely to be a brief clinical encounter.” Joseph R. Betancourt. Cultural Competence and Medical Education: Many Names, Many Perspectives, One Goal. Acad Med 78(6): 499-501.

3. Culture, Normalcy, Whiteness “Medical education as cultural competency is theoretically truncated.” “The cultural sensitivity/awareness approach … assumes that the locus of normalcy is white, Western culture-that "difference" means nonwhite, non-Western, non-heterosexual, non-English-speaking, and most recently, non-Christian-how they are different from us.” Wear, Delese. Insurgent Multiculturalism: Rethinking How and Why We Teach Culture in Medical Education. Acad Med 78(6):549-554 (Quotes) Also see: (1) Jessica Gregg & Somnath Saha. Losing Culture on the Way to Competence: The Use and Misuse of Culture in Medical Education. Acad Med. 2006; 81:542–547. (2) Janelle Taylor: “Confronting culture in medicine’s ‘culture of non-culture.” Acad Med 2003;78(6): 555-559.

4. Culture & Critique “Insurgent multiculturalism” • If implemented, “students would have opportunities to learn and practice the skills of critical analysis to identify the inequities and injustices.” Wear, Delese. Insurgent Multiculturalism: Rethinking How and Why We Teach Culture in Medical Education. Acad Med 78(6):549-554

5. Multicultural Education - Institutions • Transformation • White racial identity • Institutional practices & policies • More institutional scrutiny • Resistance Jann L. Murray-García, Harrell, Jorge A. García, Elio Gizzi, Pamela Simms-Mackey. Self-Reflection in Multicultural Training: Be Careful What You Ask For. Acad Med. 2005; 80:694–701. (My words)

6. Culture, Education, Institutions “To make the study of culture in medical education a reality,” institutions must: • Diversify socially and culturally • Train faculty in culture of health • “Identify and redress…patient discrimination.” Melanie Tervalon, Components of Culture in Health for Medical Students’ Education. Acad. Med. 2003;78:570–576.

7. Moral Foundations & Connections Rights Justice Equal & Substantial Respect Equal & Significant Moral Worth

9. Culture, Respect, JusticeHealthcare Structures and Practices ADVOCACY SCRUTINY Providers, Bioethicists, Leaders, Served Communities Equal & Substantial Respect, Justice

10. Equal & Substantial Respect – EducationDirect Cross-Cultural Healthcare • Provide excellent care. • Regardless of culture • Sensitivity to individuals as embedded • Openness to variation • Accommodation for variation • Uphold dignity • Promote autonomy • General agency in health systems (individual & group) • Healthcare choices

11. Equal & Substantial Respect - EducationProviders, Bioethicists, Leaders • Education & training: attitudes, dispositions, knowledge, skills that • avoid stereotypes, prejudice, fears, stigmas, • show sincere regard and recognition • agency • diverse expression • collaboration • cognitive and emotional knowledge—distrust example • foster structural critiques

12. Respect, Justice, & Structures • Fair influence: all stakeholders • Accommodation for variation • Workforce diversity • Culture focus • Outcome assessment • Self critique • Biomedical models & cultures • Whiteness • Male dominance • Silence/insurgency