Multicultural Education in Medicine

Can a working semi-rural physician, an assistant clinical professor who has accepted medical students, interns and residents for years, but has never stepped into a medical school classroom in any teaching capacity, have any valid personal insight into the state of multicultural education in medicine? Probably not. After 28 years of practice, my personal experience is now moot.  My only current exposure to this aspect of medical education has only been through interaction with my learners, in my community setting. I have had Asian students, a Muslim resident, an intern from the Congo, and the majority Caucasian. Usually, things are pretty professional. I’ve had awkward moments when a learner has marginalized psychiatric patients, co-workers over the years who have told racial jokes.

Multicultural Crayons; multicultural education in medicine Nathan Gibbs via Compfight

I wonder. Is there formal multicultural education in medicine now? Or do we just assume, as we do so often in medicine, that our advanced students are “full up” with this material, already formed products? Do we just hope that the continual gritty contact with the whole breadth of humanity, the kind of experience medicine can offer, is enough to produce that social activist?

Is that what we do? Do we use the power of our position in any kind of meaningful way in this regard?

How do things stand south of the border, where racial tensions seem at least from this more northern perspective, just a wee bit hotter nowadays? How are teachers taught in the US? How are these professionals, tasked with helping form our children’s minds and hearts, prepared? How does that world power, still so struggling with these issues, work to plant seeds of harmony and equity in their children?

To regurgitate Gorski (2008), most courses instructing teachers multicultural education (MTE) in the US are not “designed to prepare teachers to identify or eliminate racism, socioeconomic, or other inequities, or to create equitable learning environments” (p.17). Gorski (2008) sees MTE as not just a course, or an exercise in self illumination, or a set of strategies for teaching, but as a “political movement concerned with social justice, as an approach for comprehensive reform, as a critical analysis of power and privilege, or as a process for eliminating educational inequities” (p.17). Most of the courses he reviewed were primarily concerned with either assimilation, a conservative type of MTE leaning heavily on deficit ideology, or with a more liberal outlook that taught awareness but had no emphasis on the power structure, or how to change it. Many courses presented MTE through a “market-capitalist lens” (Gorski, 2008, p.11).

Gorski (2008) actually proposes that current courses fit into one of five different categories: “a) teaching the “other”, b) teaching with tolerance and sensitivity c) teaching with multicultural competence d) teaching with sociopolitical context, and d) teaching with resistance and counter- Hegemonic practice” (p. 9). These types of courses actually look remarkably like Helm’s stages of white identity development (Singleton, 2006, p. 204). One starts with expecting assimilation (“Contact”, colourblind), then moves to listening and trying to understand (“Disintegration, reintegration, pseudo-independent”), to improving one’s self definition (“Immersion, Emersion”), to becoming maximally realized, the social activist (“Autonomy”).

Is it any wonder that the majority of courses, written by frail human beings, fail to reach Gorski’s loftiest plateau? Just as a person must first awaken to his race, and the implications of it, one can only then walk a path of further enlightenment. These courses reveal this development, or progress of society. The minority of courses were stuck in the assimilation phase. Many more were more advanced, moving along that path of awareness. Most did not meet Gorski’s (2008) criteria for social activism.

Equity means more than a shared, equal playing field. It means giving students what they need in order to learn, grow and develop as well rounded, productive people. It means helping all students not only meet and exceed academic expectations, but also helping that person up that needs more help, be it because of ADHD, being a product of a broken family, or whatever reason, including those from a different culture.

By forming a different approach to education, the multiculturally advanced teacher can be that sociopolitical instrument of change. Social action plans described by Stanley (n.d.), perhaps the most advanced strategy to not only transform curricula  but become that multicultural centre of learning, become more than lessons. Students begin to take on conservative entities that hold the status quo: the town council, the health board, the police. In some ways, a grade 5 poster campaign may just make more inroads than an organized adult strategy. Who could say no to hanging a kid’s poster, or answering their innocent questions?

So, after this long circuitous route through Gorski’s (2008) research, does this imply anything about the current status of MTE in the US? One can assume that these courses in MTE serve to teach aspiring education professionals at least some of the theory. How much of this is retained? How much of this is transferred into daily practice? Is it all just filed away?

One would imagine that the state of affairs in the US would be at least a partial dilution of the ideal set before teachers in their college programs. As the college programs leave something to be desired in over 70% of the cases (Gorski, 2008), one can assume that the state of MTE in the US also leaves something to be desired!

Perhaps the best way to produce that maximally realized, multiculturally aware, immersed, social activist is to just practise. How can one interact with colleagues, treat one’s patient base, see every shape of eye tear, every shade of brow furrow, and not realize that humanity is one? Multicultural education in medicine may just be taught best between the lines.

But this takes time. We have a responsibility as teachers to walk the talk, to demonstrate appropriate action. And, to challenge.

Do we need a course in medicine? Medicine itself is probably the best course. Multiculturalism should be taught on the ward, in the clinic, in the lab, on house call, in the ICU.

Pretty big classroom? Just remember,  you’re it.

If you’re a teacher, you are that classroom.

 

References:

Gorski, P.C. (2008). What we’re teaching teachers: An analysis of multicultural teacher education courses. [pdf]. Retrieved from

http://cup.blackboard.com/bbcswebdav/pid-322214-dt-content-rid-5579405_1/courses/20141010356/resources/week3/MTE.pdf

 

Singleton, G.E.& Linton, C. (2006). Courageous conversations about race: A field guide for achieving equity in schools. Thousand Oaks, California: Corwin Press.

 

Stanley, C.A. (n.d.). Teaching in action: Multicultural education as the highest form of understanding. [html]. Retrieved from: http://cup.blackboard.com/bbcswebdav/pid-322214-dt-content-rid-5579405_1/courses/20141010356/resources/week3/teach-action.html

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