Medical Student Training Looks at Cultural Differences

BUFFALO, N.Y. -- Physicians treating refugees and immigrant populations face a minefield of potential cultural gaffes.

They should not touch a Muslim man during the initial interview. A nod of the head may mean "no" instead of "yes" if the patient is Albanian. Among Latinos, the head of the family, not the patient, makes treatment decisions.

A $604,000 federal grant from the National Heart Lung and Blood Institute to Kim S. Griswold, M.D., M.P.H., associate professor of family medicine at the University at Buffalo, will help new and experienced physicians avoid such missteps.

Buffalo is a major refugee resettlement center, currently receiving refugees from Somalia, Iraq, Cuba, Burma, Sudan and Vietnam. In the past, the area's four resettlement agencies also served an influx of persons from Rwanda, Ethiopia, Congo, Kosovo and Bosnia.

During the next five years, Griswold and colleagues in the UB School of Medicine and Biomedical Sciences will develop and test patient-centered videos, called "patient voices," for use in teaching; consolidate a hodgepodge of existing cultural-competency projects into a cohesive educational program for medical students as well as residents and practicing physicians, and produce handbooks on cultural competency.

Griswold also hopes to establish a diversity executive council that will include representatives from all areas of the medical school to guide the effort.

"UB has a variety of medical training programs in diversity," said Griswold, "but there is no cohesive plan, and there isn't a mandated curriculum that emphasizes cultural awareness. We are working to make cultural-competency training more formalized."

Griswold initiated the volunteer Refugee Cultural Competency Training Program for medical students in 2001 with a grant from New York State Department of Health, following a two-year pilot study. That program was carried out in two clinics serving refugees. The current training procedures will involve clinics at Jericho Road Family Practice in Buffalo, in conjunction with Journey's End Resettlement Agency, and at Niagara Family Health Center in Buffalo, in association with the International Institute/World Connect of Buffalo, Inc.

Additional investigators on the grant are Luis Zayas, Ph.D., and Judy Shipengrover, Ph.D., research assistant professor and research associate professor, respectively, in the UB Department of Family Medicine.

The University at Buffalo is a premier research-intensive public university, the largest and most comprehensive campus in the State University of New York. The School of Medicine and Biomedical Sciences is one of five schools that constitute UB's Academic Health Center.