lachian Culture and History session is to introduce medical students to the culture of the state and the region for work with this population , to learn more about their peers , and ultimately , more about themselves .
METHODS
A 90-minute interactive educational session was established and first presented to incoming medical students in fall 2016 . The presentation is structured around five questions , which include :
• Where is WV and Appalachia ?
• When did the region of Appalachia and state of WV emerge ( i . e ., what is the history ?)?
• Who are West Virginians and Appalachians ?
• What does it mean to be West Virginian or Appalachian ?
• Why is it important to know about WV and Appalachia as a medical student ?
A general outline of the session by topic is relayed in the Table . The initial half of the presentation is delivered by a WVU SoM employee who is well-versed in the subject matter and holds a master ’ s degree in history . Before the discussion begins , students are polled and asked if they identify as Appalachian . The first section is devoted to identifying the location of the state and region including major population centers , rural locations , mountainous areas , and major rivers and highway systems . Students are then shown a map of Appalachian counties as identified by the Appalachian Regional Commission . 13 Students are re-polled and asked if they are actually from an Appalachian county .
From there , the presentation moves into a greater over-view of the region and state ’ s history beginning with exploration and the arrival of German and Scots-Irish settlers . 14 , 15 This conversation includes a discussion of the developing of Appalachian dialect . Moreover , the point is made that indeed an Appalachian dialect persists today , and there are implications for passing judgement or alienating those individuals with a dialect , which could include classmates or patients . 16 , 17 The history portion of the presentation also includes a discussion of the arrival and dispersing of faith traditions in WV as well as the migration of certain ethnicities who particularly followed labor opportunities . 18
The presentation transitions to a discussion of the role that coal mining , timbering , and natural gas extraction has had upon the Appalachian culture . Moreover , time is spent explicating presidential candidate John F . Kennedy ’ s visits to the region prior to the 1960 Election and subsequent new attention coming to the poverty-stricken mountains . 19 , 20 The presentation then turns to a closer examination of the people of the state and region , including but not limited to , the region ’ s demographic makeup , educational attainment trends , occupational and military service trends , the proportion of the population with a disability and other important metrics including population movement and economic metrics by county . In 2020 , the Multicultural Association for Students in Healthcare student organization proposed that in light of recent national attention regarding racial and social injustice , the school should expand educational opportunities regarding racial minorities . Although a part of the presentation had always focused on the migration of African Americans into WV , it was further expanded to include a discussion of African American communities , their role in industry , and ultimately what led to an outmigration to American industrial centers . 21
The next part of the presentation is then hosted by a physician who expands upon why it is important to learn about these topics to provide optimal care to the patients in the state and region . This second-half of the presentation begins with discussing qualities of many rural Appalachians , including , among others , a feeling of attachment to the land , resiliency , a strong sense of place , at times distrust , and spirituality . Moreover , time is spent discussing how these qualities may be factors in patient-centered clinical decisionmaking . In order to facilitate the discussion about current disparities in the region , the presenter explicates the impacts of the healthcare provider shortages and access issues , challenges related to regional educational attainment at both the secondary and post-secondary levels , and economic difficulties , including poverty . 22 , 23 , 24 It has been pertinent to include a robust discussion of the opioid-crisis in the region , including the ways in which the epidemic may be related to the aforementioned disparities . 25 Additionally , the conversation has included secondary impacts of the opioid-crisis including strains on extended family and social-services .
The latter half of the presentation also includes real-life patient vignettes and anecdotes . For example , one anecdote is about a pediatric patient from rural WV with an ophthalmologic condition requiring an intervention to restore visual acuity . Before proceeding , the family felt compelled to consult with their church leadership for spiritual guidance and prayer . This vignette exemplifies the role that community and spirituality may be kept at the forefront of family ’ s healthcare decision-making . Another anecdote includes a pediatric patient presenting in clinic with a great-grandparent as their legal guardian . Upon talking with the patient and their guardian , it becomes clear they have legal guardianship because of drug-usage by both the parents and the grandparents highlighting some of the secondary impacts of the opioid crisis .
RESULTS
On a five-point scale which ranged from 1 (“ very dissatisfied ”) to 5 (“ extremely satisfied ”), students rated the session at a mean of 4.52 , 4.37 , and 4.53 in 2018 , 2019 , and 2020 respectively . Sample student comments in the evaluations included the following : “ I enjoyed the Appalachian culture presentation because I thought it was very helpful in understanding the patients we will encounter .” Another student denoted , “ I found the Appalachian History presentation to be interesting … I like learning more about the patient population that I hope to serve one day .” Additionally , one commenter stated , “ I found the Appalachian Culture session the most interesting . It really allowed me to understand the important [ ance ] of practicing medicine in WV even though I have lived here most of my life !”
West Virginia Medical Journal • March 2021 • 27