Reading a book about a conflict between a Hmong family and American doctors concerning the health care of a child might seem unimportant for a first-year medical student.
The University’s Medical School believes, however, the Anne Fadiman novel, “The Spirit Catches You, and You Fall Down,” will help future doctors be sensitive to the needs and values of people from different backgrounds.
In fact, the book is just one of the ways the Medical School currently introduces the importance of cultural sensitivity, communication and trust in the doctor-patient relationship.
The desire of the Medical School, which educates two-thirds of Minnesota’s doctors, to adapt new multicultural strategies and objectives into their curriculum is representative of a national trend toward awareness of cultural issues in medicine.
In 1998, the Association of American Medical Colleges, of which the University is a member, released a report finding almost 70 percent of schools provide some formal training in cultural competence, and 14 percent have plans to introduce it.
Dr. Deborah Danoff, the association’s assistant vice president for medical education, said this type of education would open up the lines of communication with patients who might have different values and beliefs.
“Some groups don’t deal well with issues related to prevention because, they say, our belief or our value system is that only when I’m ill will I go to see a doctor,” Danoff said.
“It will help facilitate the doctor-patient relationship,” she added.
In addition to the book, the Medical School requires students to take a class in cultural dynamics as well as courses in human sexuality and behavior.
Later in training, students can choose cultural-based electives, including courses in urban and rural medicine.
Sara Axtell, research associate in the Medical School’s division of educational development and research, said that while overall the curriculum is in line with the cultural levels of other medical schools, there are some gaps in the program.
“We have some things in our curriculum and some of those elements are really good,” Axtell said. “But it’s not as cohesive as we want it to be. That’s what we’re working on now.”
In January 1999, the Medical School formed a cultural competence committee to look at how students could be better trained to deal with patients representing different cultural viewpoints.
Axtell said they define culture broadly, including race, ethnicity, sex, disability and sexual orientation.
The committee, chaired by Axtell, consists of nearly 100 doctors, medical students and community members. It formed 10 research sub-groups to tackle different cultural issues.
In submitting their report, they recommended new strategies and objectives that the committee hopes will be integrated into the existing program. They center on training doctors to view patients within their specific cultural, economic or social context and communicate with them effectively.
While they might not be fully implemented for two or three years because of the complexity of the medical program, many of the recommendations will be adopted immediately.
Axtell said numerous compelling reasons exist for creating a more culturally competent curriculum, including alleviating the health disparities that exist between different ethnic communities and improving access to health care.
“When you ask people about why they don’t access care, one of the reasons they give is a lack of cultural competence of the health care provider,” she added.
Dr. Louis Ling, associate medical director for medical education at Hennepin County Medical Center, which serves a diverse patient population, said understanding is important to the doctor-patient relationship.
“When we communicate, we may say something and patients and families may hear something different,” Ling said.
“They’re hearing things based on the many things they have in their backgrounds and beliefs. We need to understand that, so that we can work our medical knowledge in with what they think and believe,” he added.

Justin Costley covers the Medical School and welcomes comments at [email protected]. He can also be reached at (612) 627-4070 x3224.