Impacts of Culture on Perceptions of Intimate Partner Violence Among Fijian Indian Women in the United States.

INTRODUCTION: South Asian women are at a higher risk for experiencing intimate partner violence (IPV) in the United States. Fijian Indian (FI) women are part of the diverse South Asian diaspora; however, there are no published data on their experience with IPV. This phenomenological study (a) examined if FI culture influences how women define, experience, and seek help for IPV and (b) identified impacts these themes have on FI women's IPV-related help-seeking, behaviors in regard to U.S. health systems and law enforcement. METHODS: Ten FI women in California, 18 years and older, who either were born in Fiji or had parents born in Fiji, were recruited through convenience and snowball sampling. Semistructured interviews took place either face-to-face or via Zoom. Transcribed interview data underwent reflective thematic analysis by two members of the research team. RESULTS: Normalizing and silencing of IPV events are bolstered by cultural practices of (a) familism/collectivism that ask women to prioritize family intactness over their own emotional and physical safety, (b) traditional patriarchal gender roles, (c) threats of shame and judgment within the community, and (d) the gendered hierarchy tenets of some forms of Hinduism. FI women are more inclined to seek help for IPV from within versus outside the family, with healthcare providers and law enforcement described as women's last choices for assistance. CONCLUSIONS: Although a small and regionalized immigrant community, this study of FI women reflects the importance of health and human service providers' understanding of the histories and cultural nuances of the local immigrant populations they serve.

California's Central Valley: Teaching Social Determinants of Health and Cultural Humility Through an Interprofessional, Overnight Road Trip.

This study explored the value of an overnight interprofessional road trip of students, faculty, staff, and community members through the Central Valley of California. The goal of the mobile classroom was to teach complex topics such as cultural humility, health disparities, population health, implicit bias, interprofessionalism, community engagement, and social determinants of health. Participants identified educational outcomes valuable to them and assessed how closely the experience aligned with their university's strategic goals. Pre/post-surveys consisted of Likert scale and open-ended questions over five trips (N=186). Qualitative and quantitative analyses reflected an informational and transformational experience, especially through the sharing of personal stories and connections among participants and community hosts. Participants rated the experience as strongly aligned with the university's strategic goals. This field-trip pedagogy positioned a professionally diverse group to learn together about the contributions, socio-historical complexities, and health challenges of a region where their students and patients live.

Dialogue as skill: training a health professions workforce that can talk about race and racism.

Efforts in the field of multicultural education for the health professions have focused on increasing trainees' knowledge base and awareness of other cultures, and on teaching technical communication skills in cross-cultural encounters. Yet to be adequately addressed in training are profound issues of racial bias and the often awkward challenge of cross-racial dialogue, both of which likely play some part in well-documented racial disparities in health care encounters. We seek to establish the need for the skill of dialoguing explicitly with patients, colleagues, and others about race and racism and its implications for patient well-being, for clinical practice, and for the ongoing personal and professional development of health care professionals. We present evidence establishing the need to go beyond training in interview skills that efficiently "extract" relevant cultural and clinical information from patients. This evidence includes concepts from social psychology that include implicit bias, explicit bias, and aversive racism. Aiming to connect the dots of diverse literatures, we believe health professions educators and institutional leaders can play a pivotal role in reducing racial disparities in health care encounters by actively promoting, nurturing, and participating in this dialogue, modeling its value as an indispensable skill and institutional priority.

The institutional context of multicultural education: what is your institutional curriculum?

Recently revised accreditation standards require medical schools and residency training programs to integrate multicultural training into their curricula. Most multicultural training models concern the educational outcomes of individual trainees who have received digestible "units" of multicultural education or "cultural competence" training designed for trainees' individual consumption. Few have taken a critical perspective on how an individual trainee must learn, change his or her behavior, and sustain that behavioral change within a specific institutional context. The authors discuss the educational impact of one's institutional learning environment--the institution's ethos, teachers, modeling, policies, and processes--on the multicultural education of physician trainees. A usable conceptual model is offered with which educators can identify those dimensions of one's "institutional curriculum" that may enhance or obstruct trainees' optimal learning and behavior change regarding issues of multiculturalism in medicine. Comparisons are drawn to the recent medical literature concerning professionalism education and the hidden curriculum. Distinctions are drawn between overlapping areas of planned, received, intended, and unintended learning and values, as communicated from faculty, attendings, and residents to students. Ways of maximizing ideal learning and minimizing unintended consequences are discussed. The goal is for medical educators to be able to ask, What is the institutional curriculum of my training program regarding issues of race, difference, etc? What elements of that institutional curriculum can be recaptured and reclaimed as consistent with and supportive of tenets of excellent patient care for all?

Self-reflection in multicultural training: be careful what you ask for.

Self-reflection in multicultural education is an important means to develop self-awareness and ultimately to change professional behavior in favor of more equitable health care to diverse populations. As conceptualized by scholars in the field of psychology, racial identity theory is critical to understanding and planning for the potentially wide range of predictable reactions to provocative activities, including those negative reactions that do not necessarily herald a flaw in programming. Careful consideration of racial identity developmental phases can also assist program planners to optimally meet the needs of individual physician trainees in their ongoing constructive professional and personal development, and in strategically mobilizing and having ready the type of institutional leadership that supports trainees' change processes. The authors focus on white physician trainees, the largest racial group of U.S. physicians and medical students. They first explain what they mean by the terms white and nonwhite. Racial identity theory is then applied, with true case examples, to explore such issues as where the self-proclaimed "color-blind" trainee fits into this theoretical schema, and how medical educators can best serve trainees who are resistant or indifferent to discussions of racism in medicine and equity in health care delivery. Ultimately, the authors' goal is to demonstrate that engendering genuine self-reflection can substantively improve the delivery of health care to the nation's diverse population. To help achieve that goal, they emphasize what to anticipate in effecting optimal trainee education and how to create an institutional climate supportive of individual change.

From enrichment to equity: comments on diversifying the K-12 medical school pipeline.

Educating a physician workforce that reflects the increasing racial and ethnic diversity of our nation is an ongoing challenge of urgent concern. Many medical school kindergarten through 1 2th grade (K-12) pipeline programs focus on "enriching" underrepresented minority (URM) students using strategies to change or "improve" individual students. This discussion raises concerns over longstanding racial and ethnic inequities in America's public schools that, in part, result in the predictable and systematic underachievement of URM students. These insidious processes can disqualify URM students from successful participation in the medical school pipeline at its earliest stages. The paper also discusses the cultural challenges URM students often face in aspiring to exceptional academic achievement within America's schools. Finally, this paper highlights the need for illustrative examples of medical school-public school partnerships that pursue an agenda of equity to balance the current downstream focus on the enrichment of individual students.