SCIENTIFIC
Appalachian Culture & History , An Important Lesson for Incoming Medical Students
AUTHORS :
Jason S . Hedrick , MA Director of Academic Operations & Accreditation , Department of Medical Education , West Virginia University School of Medicine
Larry A . Rhodes , MD Executive Director of Rural Programs , James H . Walker Chair Pediatric Cardiology & Professor of Pediatrics , West Virginia University School of Medicine
Scott Cottrell , EdD Associate Dean of Curriculum and Student Services & Professor , Department of Medical Education , West Virginia University School of Medicine
Norman D . Ferrari III , MD Vice Dean for Medical Education , Chair of the Department of Medical Education & Professor of Pediatrics , West Virginia University School of Medicine
CONFLICTS OF INTEREST : None
INTRODUCTION
There is an expectation that medical students will be exposed to and gain cultural competence prior to graduation . Accreditation standards for all American and Canadian allopathic medical schools specifically require training in cultural competence . 1 The Association of American Medical Colleges has denoted that “ Cultural and linguistic competence is a set of congruent behaviors , knowledge , attitudes , and policies that come together in a system , organization , or among professionals that enables effective work in cross-cultural situations .” 2 There is no shortage of examples in the literature of ways in which medical schools have attempted to integrate formal educational sessions or events to enhance student cultural competence . Examples include , among others , pre-matriculation experiences , 3 orientation-based sessions , 4 , 5 patient simulations , 6 and clerkship-based workshops . 7 Moreover , the
ABSTRACT
INTRODUCTION There is an expectation that medical students will be exposed to and gain cultural competence prior to graduation . It is prudent to ensure that cultural competence education starts early in the medical school curriculum .
METHODS A 90-minute educational session (“ Appalachian Culture and History ”) was created at the West Virginia University School of Medicine as a part of the cultural competency curriculum to better introduce and orient new medical school matriculates to the culture and history of both the state and Appalachia . Students anonymously completed on-line evaluations at the conclusion of the session to rate the quality of the presentation on a five-point scale which ranged from 1 (“ very dissatisfied ”) to 5 (“ extremely satisfied ”).
literature has also shown that students value multi-pronged approaches to delivering multicultural education that is not necessarily related to one educational experience , but is imbedded throughout the medical curriculum . 8 Similarly , the same can be said for educating students about recognizing implicit bias and a need to provide a wide-variety of educational experiences for students to begin understanding these biases . 9 In 2015 , the Medical Degree Curriculum Committee at the West Virginia University School of Medicine ( WVU SoM ) explicitly created a curricular thread entitled “ Diversity , Inclusion and Healthcare Disparities ” to implement , manage , and monitor related content . Curricular threads are established to ensure that certain content areas are integrated both horizontally ( content is delivered at varying points in any academic year ), as well as vertically ( content is delivered across academic years ). In recent years , the thread has grown robustly to include didactic sessions in the Public Health course , case-based discussions in the Problem-Based Learning course and Physical Diagnosis and
RESULTS Students rated the session at a mean of 4.52 , 4.37 , and 4.53 in 2018 , 2019 , and 2020 respectively . Positive comments were generated by in-state and out-of-state students .
DISCUSSION Matriculating students have been overwhelmingly satisfied with the Appalachian Culture and History educational session based upon anonymous evaluations .
CONCLUSIONS As the majority of medical students have positively appraised the Appalachian Culture and History educational session , there is reason to believe they will be better prepared to learn from and care for patients from Appalachia .
Clinical Integration course series , as well as deliberate clinical clerkship learning experiences .
It is prudent to ensure that cultural competence education starts early in the medical school curriculum . Part of the curricular thread is an introduction to the culture and history of Appalachia and West Virginia ( WV ) that is delivered during medical student Professional Development Week ( commonly referred to as “ New Student Orientation ”). Although the WVU SoM had offered an introduction to Appalachia during first-year orientation in previous years , in 2016 the presentation was re-engineered in an effort to better prepare students for learning and working in the region . The literature has shown that provider cultural competence is of importance in the Appalachian setting . 10 , 11 , 12 In a study that included three Appalachian Ohio counties , satisfaction was found to be higher among patients who perceived their provider as utilizing patient centered cultural competence during their clinical encounter . 10 The main goal of the Appa-
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