At Creighton University, the focus on cura personalis, or the Jesuit concern for the whole person, is an integral part of education. Service to others, the inalienable value of each person and the appreciation of ethnic and cultural diversity are also core values. For the Creighton University School of Medicine, cultural and diversity competency is a required element of clinical skills, one that ultimately leads to better patient care and better physicians.

Although that competency has been informally part of the School of Medicine curriculum since its inception in 1892, the school formally created a Health Sciences Multicultural and Community Affairs department in 2000. That office not only supports cultural sensitivity in all of Creighton’s health sciences professional schools (medicine, nursing, dentistry, pharmacy and other health professions), but also has as its mission increased recruitment and retention of diverse students and faculty.

“We know, for instance, that minority medical students are more likely than non-minorities to practice in underserved areas and will ultimately be critical to addressing health care disparities in our nation,” said Sade Kosoko-Lasaki, associate vice president for Health Sciences – Multicultural and Community Affairs, and chief of Ophthalmology. “We strive also to immerse our students in various training and cultural experiences that support their diversity understanding and sensitivities.”

These efforts received an infusion of support in 2002, when the School of Medicine received a $2.3 million grant from the U.S. Health Resources and Services Administration (HRSA) Center of Excellence to recruit diverse faculty and students, encourage research and incorporate diversity into the curriculum. Co-investigator for that grant was William B. Jeffries, associate dean for medical education and associate professor of pharmacology.

“We had specific objectives that add depth and dimension to our evidence-based approach to medicine,” said Jeffries.

Those objectives include: developing a minority health resource center to serve as a resource for cultural diversity; increasing the educational holdings for the School of Medicine (journals, books, anatomical models and more)—the initial goal was to double the assets, but the school was able to triple its materials; and integrating diversity into the existing curriculum.

Integrating diversity into the curriculum added about 38 additional hours of teaching and clinical work to existing courses via lectures, role-playing, discussions, web-based information and hands-on training. For example, students learn how to question patients using interpreters or to understand how religious beliefs or cultural practices might affect treatment and care options. Even physical reactions to inquiries or patient medical histories can be influenced by cultural differences.

“When Caucasians are embarrassed, they often blush and their cheeks turn red. When African-Americans blush, their eyeballs turn red. Students need those insights to provide better patient care,” said Kosoko-Lasaki.

The School of Medicine also uses diverse anatomical models and cadavers and web-enabled presentations to highlight varying body modifications by cultural groups.

“We actually characterize our efforts as transcultural. Everyone needs to be educated. Not only the student who is learning and/or providing the care, but also the patient who is receiving the care,” Jeffries added.

Service to Others
As a Jesuit, Catholic university, one of the biggest components of the curriculum enhancements has been a tradition at Creighton for 128 years: service to others. Students have a multitude of opportunities to serve marginalized or diverse populations through clinics not only in the Omaha community but throughout the world. They include:

• The Institute for Latin American Concern (ILAC). For more than 30 years, Creighton health sciences students have provided assistance, health care and education for the underserved of the Dominican Republic.
• Project CURA (Creighton Medical United in Relief Assistance) is run by first-year students who provide health education and disease prevention to medically underserved populations in Omaha, India, Peru, Kenya, Cambodia and Pine Ridge, S.D.
• The Magis Clinic was founded by Creighton medical students in 2004 to provide outpatient health care for the homeless and underinsured at a local shelter, the Siena Francis House. The clinic works with other organizations to provide acute care and follow-up, physical exams, lab tests, medications, specialty clinics and referrals. Medical students and physicians volunteer at the clinic, seeing about 20 patients each Saturday.

The belief is that students gain an understanding of their own cultural limitations by broadening their exposure to diverse patient populations.

“Our students embrace our efforts because they realize that their competence is enhanced,” said Jeffries. “A student can still have diverse views (religious, cultural, etc.), but first and foremost, there is a patient who needs care.”