This is particularly true in the field of psychiatry. The University of Louisville Department of Psychiatry has taken steps for several years to incorporate cultural sensitivity into the training and continuing medical education it offers its trainees and faculty. This year, third-year resident Monique Upton, MD, went one step further.

Upton, who will pursue further training in child psychiatry next year, won a fellowship from the Substance Abuse and Mental Health Services Administration (SAMHSA) last year. SAMHSA fellowships provide grants to encourage and facilitate the doctoral and post-doctoral development of minority nurses, psychiatrists, psychologists and social workers.

“When I won the fellowship I received grant money to come up with creative ways to enhance the teaching of cultural competency in our program,” Upton said.

So instead of a putting together a short lunch where some cultural issues would be addressed, Upton and faculty members Barbara Fitzgerald and Carmelita Tobias planned an afternoon’s worth of speakers. The March 9 event also included an evening reading from an acclaimed author whose books are based on his family’s struggles with mental illness.

Nearly 30 students, trainees and clinicians from UofL and the community settled in after lunch from a local Cuban restaurant to hear from Alfonso Nichols, MD, UofL clinical assistant professor of psychiatry and practitioner with Seven Counties Services; Leah Dickstein, MD, UofL emeritus professor of psychiatry; and Otis Anderson, MD, a fellow in child and adolescent psychiatry at the University of Tennessee-Memphis.

Nichols talked about Latino culture, the stigma that often is attached to mental health issues in that community, and how such things as family involvement, folk healers and belief in spirits play a role when Latinos seek psychiatric care.

“I encourage you, in your practice, to ask about culture, and be open-minded when you get the answers,” Nichols said.

He also talked about the value of a good interpreter.

Dickstein discussed gender issues and domestic violence.

“Always ask patients, ‘have you ever been physically or sexually abused,’ and leave 15 seconds of silence,” Dickstein said. “Then end by saying ‘when you are ready to tell me, I’m listening.’”

Anderson addressed unique issues that black men face, noting that African American men with three or more psychiatric diagnoses are 17 times more likely to commit suicide than those without.

“This is the fifth year that we’ve been doing something to raise awareness of cultural issues as they relate to treatment, but it’s the first year that it’s been such an extensive program. That’s thanks to Dr. Upton,” said Allan Tasman, MD, chair of the Department of Psychiatry.

“In psychiatry, understanding both the illness and the person who has the illness — who they are — is very important to optimal treatment success,” he continued. “Treatment requires a real collaboration between the patient and the doctor; it does in all medicine, but especially in psychiatry. So, we must understand who is the person with the illness to best interact with them. The individual’s cultural, racial and ethnic background is a critically important aspect of our appreciation of our patient’s identity.”

The day ended with a public dinner event and a reading by author Victor Lavalle from his book “Big Machine,” which touches on the subjects of religion and mental illness. Lavalle has said his experiences with family members who have suffered with mental illnesses inspired his books.

“The day was a huge success,” Upton said. “It was great to expand this important event to a full day of workshops, and we had a great turnout both during the afternoon and at the dinner. Coming from a place of cultural humility and knowing how to deal with core beliefs which may be different from yours are such an important part of being a good psychiatrist and a good doctor.”

A Christian doctor who is proselytizing to her patients. A Moslem medical student who wants to pray five times a day.

University of Louisville second-year medical students discussed these case studies in a Jan. 11 session of the four-week-long, required course, At the Intersection of Medicine and Spirituality.

Other medical schools offer humanities courses to students as electives, but UofL requires that students take two humanities courses as part of their medical school education. That sets the school apart in a way school leadership feels is important.

Robert Maynard Hutchins, the president of the University of Chicago in the 1930s, said that we are all liberal artists; to live life is to be a liberal artist, quoted Edward C. Halperin, dean of the School of Medicine.

Since we are all, therefore, liberal artists, the only question is whether we shall be good ones or bad ones. I think it is essential that physicians be good ones, he said.

In addition to At the Intersection of Medicine and Spirituality, taken in the second year of study, the humanities element of the Uof L medical curriculum also requires first-year students to take History of Medicine. Students may elect to take another humanities course during their last year of study.

Class format allows for interaction with experts. The Jan. 11 session included panel members Jesse Roman, UofL’s new chair of the Department of Medicine; Avrohom Litvin, an Orthodox Jewish rabbi; Sikh psychiatrist Amarjit Chopra; Roman Catholic priest Tony Smith; and the Rev. Ronald Oliver, a protestant minister who also is a chaplain at Norton Hospital.

Roman told students that it is important to be able to deal with the issues that can arise from people’s differing faiths and cultural backgrounds: Not facing these issues can negatively impact patient care, and education, he said.

Litvin explained that from his perspective, on many levels religion is a need and not a want.

You’ve got to figure out what’s the need and what’s the want, and provide for the needs, not the wants, he said.

Panelist interaction and comments spoke to the complexity of the issues, as the conversation also reached such topics as whether students should share their religious preferences with residency interviewers and the question of authority and power that religion in the setting of medical care can raise.

Disputes between junior and senior physicians, students and teachers, or patients and doctors about religious issues are sometimes about the substance of the dispute and sometimes about who is in a position of power and who is not, Halperin said.

Class discussion of the topics at hand and required reading also takes place in small groups, which faculty members, including representatives of the local Baptist and Presbyterian seminaries, lead.

In subsequent weeks, students in the class will consider ethical questions related to marriage and dementia and how to respond with patient requests that the doctor pray with them.

The humanities element of medical education is imperative, according to students. In fact, said first-year student Alex Bajorek, it is imperative.

A patient is a living collection of familial traditions, cultural values and biases, said Bajorek, who also is finishing a master’s degree in bioethics and medical humanities. Without a solid grasp of the humanities, much like what is offered in liberal arts colleges, a medical student can only come out half-prepared to practice the ‘art’ of medicine.

According to Halperin, the humanities courses complement one another as part of the medical school curriculum.

A competent physician must have an understanding of the history of his or her discipline, which is, in part, acquired by a course in the history of medicine, he said. Medical history teaches humility, courage and the interface of medicine and society. A course in the intersection of religion and medicine teaches students sensitive and compassionate techniques of interacting with patients and society when medicine and faith traditions intersect.

Halperin received a Kentuckiana Metroversity Instructional Design Award for the spirituality and medicine course in 2009. The award recognizes innovative ways that faculty help students to learn.

At the Intersection of Spirituality and Medicine is open to physicians seeking continuing medical education credit, as well as to the interested public. Class feedback, which first was offered last year, has been positive. One student wrote in an evaluation: The topic is highly relevant to the practice of medicine and also raised important issues about patient management, cultural and religious sensitivity and ethico-legal implications.

Despite 70 miles and a difference in sports opinions, it’s great that we can come together on this, said Mark Evers, director of the Lucille P. Markey Cancer Center at UK, in his opening remarks.

Noting that lung cancer is an enormous problem in Kentucky, Don Miller, director of the James Graham Brown Cancer Center at UofL, pointed out that great minds working together might provide the best chance to eradicate it.

This event represented the first step toward what researchers hope will be fruitful collaborations. They will follow up on the connections made by working together over the next six months to create proposals for funding consideration by the Kentucky Lung Cancer Program. The proposals are due in June and will only be considered if they have a UofL and a UK component.

Participants spent the first half of the four-hour meeting viewing each others’ research posters and casually talking with one another about their research interests. Nearly 60 posters were displayed in the lobby of the Clinical Translational Research Building at UofL, alternating between UK and UofL, or blue, red, blue, red, as Miller put it.

Poster topics included smoking cessation programs in rural areas, an interest of Ellen Hahn of the UK School of Nursing; and smoke-borne fatty acids and their role in cancer growth, which is being investigated by a UofL team that had been led by the late Xueshan Gao, a postdoctoral candidate who recently died of lung cancer, and John Eaton, with whom Gao was working on her graduate studies.

UofL researcher Glenn McGregor already has a potential collaboration with UK researcher Zhigang Wang that may capitalize on an enzyme that is required for DNA mutation to take place in lung cells after the introduction of a cigarette smoke-borne carcinogen.  The researchers aim someday to design a treatment to reduce tumor growth first in mice and then in people, McGregor said.

Dr. Wang and I have known each other personally and by reputation for years and we share a similar research interest, McGregor said. It is tremendously exciting, and frankly it just makes good sense, for us to be able to work together on testing our hypothesis and hopefully furthering the field of lung cancer research and treatment.

Kris Damron, program director of the Kentucky Clinical Trials Network, led a concurrent meeting in an adjoining room that focused on clinical trial collaboration.

Our goal is to make clinical trials that have historically only been available at academic medical centers accessible to patients and physicians throughout the state, Damron said. Through the affiliations we’ve established with community cancer centers, we are working to realize this goal. We can keep patients in their communities, with their trusted physicians.

During a working lunch, the group heard from UofL researchers Jason Chesney, Andrew Lane, Brian Clem, Michael Bousamra and John Trent on the topic of metabolomics – the products left behind after cellular processes occur – and their potential application to lung cancer therapy. UK researchers Hahn, Jeffrey Moscow and John Yanelli then presented research on smoking bans in rural communities; the achievements of an existing partnership between the Markey Cancer Center and UK’s College of Pharmacy; and vaccine therapy for lung cancer, respectively.

Moscow’s presentation detailed the achievements attained by the intra-institution collaboration, which is characterized by twice monthly inter-faculty meetings and a joint seminar series. The partnership already has brought one lung cancer drug into phase II testing and leaders are hopeful that further successes will be forthcoming.

UK’s Yanelli already collaborates with Goetz Kloecker of UofL and others on vaccine research.

The goal of this event was to build collaborations in lung cancer research between the two institutions and cancer centers, Miller said. Kentucky leads the nation in the incidence of lung cancer, and we feel its burden perhaps more than any other place in the country. It’s imperative that we put our best and brightest minds together to find new ways to prevent, detect and treat this devastating disease.

 Eighty of those people would live in sub-standard housing; only one would have a college education; and 24 would have no electricity.

That’s one message organizers of the fourth annual UofL Health Sciences Center Cultural Competency Symposium wanted University of Louisville medical and dental students to receive at the Nov. 12 event at the Health Sciences Center.

The symposium was designed to allow participants, which included some UofL faculty and staff, a venue to explore facts and myths and to make the future health care providers more aware not only of the impact of stereotyping but also of some of the unique concerns that varying populations might have when seeking health care.

Presenters emphasized that the cultural beliefs, values, perceptions and health practices of diverse populations provide challenges to those who deliver health care and that it’s important that all health care providers are as cognizant of the differences as they can be.

It’s not just color, but it’s socioeconomic status, it’s religion, it’s sexual orientation, said Faye Jones, associate dean for academic affairs at UofL School of Medicine. People’s beliefs and the things they carry with them when they arrive in a clinic to be seen by a health care professional, and the health care provider’s beliefs and experiences can be vastly different. The more we can be aware of that, the better the experience of the patient – and that’s hugely important.

Sessions included Subconscious bias – implications for health care, Cultural issues in the Mennonite community, Working effectively with LGBT patients, The culture of poverty and health outcomes, Cultural consideration in women’s health: perspectives from practice in Pakistan, and Vocation rehabilitation.

In the session that focused on Mennonites, a panel that included Mennonite couple Eric and Lea Kraly addressed such topics as that community’s attitudes toward chemotherapy and radiation, hospice, herbal remedies and immunizations.

In the Mennonite community, people believe in developing skills from within, so there is a man who does some dental work with a foot pedal drill, and he actually does a pretty good job, said Richard Aud, professor in the department of medicine at UofL and a member of the panel.

In another presentation, Stan Brock, director of Remote Area Medical (RAM) talked about the Third World origins of his program and told of how shocked he was when he ran a free medical, dental and eye exam clinic in Los Angeles that attracted more than 15,000 people who were uninsured or underinsured.

I couldn’t believe that there were people right here in America who didn’t have access to health care, Brock said.

Before Brock spoke, some faculty and students of the UofL School of Dentistry received a framed T-shirt by dental alumni Bill Collins and Greg Bentley in honor of the school’s collaboration with RAM in Kentucky, and the important work that has been done by both organizations. The T-shirt was the first of 125 volunteer T-shirts used at the first RAM event in Kentucky, in 2008.

A plaque beneath it read: This is to honor the students, faculty and staff that participated. It is symbolic of the caring hearts and skillful hands that reached out to help those in need as well as reinforcing the commitment of the University of Louisville School of Dentistry to community involvement.

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