SUNY Downstate Health Sciences University
Department of Emergency Medicine
SUNY Downstate Medical Center recognizes that, if unchecked, there may be those within
a medical community who ascribe negative labels and stereotypes to minority and/or
inner-city communities, its residents, and the larger community of color. This is
in direct conflict with the notion that the role of a medical doctor requires objectivity
tempered with an unbiased compassion for his/her fellowman. When the latter quality
is lacking, a doctor's role in the vast landscape of patient care can be seriously
jeopardized. The problem is multifactorial and rather complex, involving academic
and clinical faculty. Reflected in the ideas expressed by these persons is a dire
lack of understanding and appreciation for cultural diversity, and of the impact of
socioeconomics on healthcare maintenance and access. In such an environment, some
medical students may be profoundly conditioned with the stereotypes they hear during
their training, which can impact on their performance as physicians.
We recognize that the views and opinions expressed by many within the Downstate community are predicated on the innate nature of humans to label (and stereotype), which is in turn based on the conditioning they have received. It has the potential to cause problems in any field, but is particularly a concern in the medical profession: when a physician is not culturally competent, and/or practices under the influence of his/her own prejudices and bias, a patient's health care and welfare can be adversely affected. Extensive research exists to show the negative clinical impact that a lack of cultural competency in the medical field has on patients. Failure to consider a patient's cultural norms can result in many adverse outcomes. Among these outcomes are inaccurate histories, decreased satisfaction with care, non-adherence, poor continuity of care, less preventative screening, miscommunication, difficulties with informed consent, inadequate analgesia, a lower likelihood of having a primary care provider, decreased access to care, unintended use of harmful remedies by patients, delayed immunizations, and fewer prescriptions.(2)
To proactively address these concerns, the SUNY Downstate Medical Center supports:
- The reevaluation of the standard of professional conduct, as it pertains to the issues of cultural insensitivity and bias.
- The need for appropriate mechanisms to ensure the maintenance of the above mentioned standard.
- The need for an appropriate contact person at Downstate, addressing the concerns of students and faculty that witness acts of bias or prejudice.
- The need for increased community involvement in school activities to dispel existing myths and increase student exposure.
- Training for students and faculty in the effects of cultural (and socioeconomic) insensitivity and bias to comprehensive medical care.
Within medicine we are witnessing a decreasing number of facilities and an increasing
demand and dependency on medical services.(7) This makes increasing the number of qualified and diverse physicians a priority.
A preponderance of the current available literature supports the benefits of diversity.
Diversity increases the number of physicians willing to practice in underserved neighborhoods,
it enhances the cultural competency of non-minority physicians adding to their general
breadth of exposure and knowledge, and diversity diminishes morbidity and mortality
resulting from physician bias.(8, 9) A diversified staff can enhance patient communication, trust, and comfort.(6) The IOM wrote:
The healthcare workforce and its ability to deliver quality care for racial and ethnic minorities can be improved substantially by increasing the proportion of underrepresented U.S. racial and ethnic minorities among health professionals.(3)
Numerous publications have demonstrates that currently there is little diversity in medicine.(8) Devising an effective strategy to expand the number of highly trained minority physicians ready to embrace the challenge of representation and determined to utilize their fund of knowledge, cultural experiences, and presence to change the direction of medicine is a challenge. Residency programs can play an instrumental role in shaping medicine for the foreseeable future. Everyone benefits from diversity, and programs like SUNY Downstate are models of diversity that have proven the ease and effectiveness of implementing diversity programs.
A Proposal for Change...
The people of minority groups constitute greater than twenty-five percent of the United
States population (That percentage is even larger in New York City). However, minority
representation in the health professions is less than ten percent. In addition, several
studies have noted empirical evidence suggesting that African American and Hispanic
physicians are more likely to practice in areas of under-represented racial and ethnic
groups as well as designated healthcare shortage areas. Therefore presenting us with
more than a social injustice but a Public Health dilemma.
While many innovative minority pipeline programs are working diligently to correct these racial disparities in health related professions, the impact has remained negligible and in fact the percentage of minority males has continued to decline.
Plan of Action:
To Center for Minority Health Excellence (CMHE) establish a joint division of the Emergency Medicine and Internal Medicine departments with a formal theme entitled the Diversity As Excellence (DAE) initiative. This multi-tiered program will be carried out through the following objectives:
1. Cross-Cultural Education
The DAE seeks to promote culturally competent medicine within the Department of Emergency Medicine and SUNY Downstate College of Medicine, to educate medical students, residents and faculty on the sociomedical influences affecting patient's health beliefs and behaviors.
2. Minority Faculty/Housestaff Recruitment and Development
The DAE works with department leadership to foster ethnic diversity among the medical house staff and attending physician faculty of SUNY Downstate College of Medicine with a goal of producing a professional staff that reflects the ethnic diversity of the New York City Community.
3. Community Outreach
The DAE seeks to facilitate a variety of outreach initiatives as vehicles for community health promotion and disease prevention with a goal of promoting partnerships with community based organizations.
4. Multicultural Research
The DAE seeks to promote research focusing on minority health and health policy with a goal of creating opportunities for research in areas that specifically address the multiethnic patient population and the elimination of racial and ethnic health disparities.
5. Minority Mentorship
The DAE seeks to develop an environment of mentorship and dynamic exchange between minority faculty, house staff, and medical students.
- Cross-Cultural Education
- Develop culturally sensitive and competent training programs and materials
- Establish Liaison positions in Department of Emergency Medicine
- Establish Liaison position in Department of Internal Medicine
- Minority Faculty/Housestaff Recruitment and Development
- Direct Faculty and House staff Candidate Recruitment
- Exhibition/Recruitment at SNMA and NMA events (Regionally and Nationally)
- Minority Recruitment Annual Commemorative Dinners
- Community Outreach
- Establish central Brooklyn Sexual Assault Forensic Examination (SAFE) program
- Expand Doctors Against Murder (DAM) program
- Partnership with Arthur Ashe Institute
- Partnership with Physician for Nations Health Program
- Multicultural Research
- Engage in strategic projects promoting clinical research focusing on minority health and health policy.
- Partner with MPH program and Division of Preventative Medicine
- Minority Mentorship
- Faculty - House Staff Mentorship Program
- House Staff - Medical Student Mentorship program
- Develop Faculty and House Staff Alliance Network
- Establish Minority House Staff Association
- Partner with Daniel Hale Williams Society
- Partner with Office of Minority Affairs
- Criminal Statistics 2000 & 2001. SUNY Downstate University Police Department On-Campus and Off-Campus Logs.
- Flores G. Culture and the patient-physician relationship: achieving cultural competency in health care. J Pediatr. 2000 Jan; 136(1): 14-23.
- Smedley BD, Stith AY, Nelson A (eds). Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Washington, DC: National Academies Press, 2002. 30.
- US Department of Health and Human Services. Healthy people 2010. Washington: Department of Health and Human and Servicies; 2000.
- U.S. Department of Health and Human Services. Health disparities experienced by black or African-American-United States. MMWR Morb Mortal Wkly Rep 2005; 54:1-3
- Heron S, Stettner E, Haley L. Racial and ethnic disparities in the emergency department: A public health perspective. Emerg Med Clin N Am 2006; 24:905-23.
- American College of Emergency Physician Access to Emergency Medical Services Act of 2007. www.acep.org/webportal/Advocacy/fed/accessems/emsfactsheet.htm
- Association of American Medical Colleges. 2005 -Minority Students in Education: Facts and Figures. Washington, DC: AAMC, 2005
- Perina D, Collier R, Thomas H, et al. Report of the Task Force on Residency Training Information (2006-2007), American Board of Emergency Medicine. Annal Emerg Med 2007; 49:698-714