Our guest blogger today is Gianna Ramos, a GE-National Medical Fellowship Primary Care Leadership Program (PCLP) Scholar. As a PCLP Scholar, Ramos had the opportunity to examine the challenges and rewards of working in primary care in Community Health Center. While working at Matthew Walker Comprehensive Health Center in Nashville, TN, Ramos focused on the needs of adolescent patients. 

Cultural competency has been an increasingly popular topic in medical school because of the diverse society in which we live and work.  At the David Geffen School of Medicine at UCLA, my current institution, there have been lectures and workshops on how to adequately address the cultural needs of patients. Certainly more education is needed, but the hands-on experience I had outside of my home institution was perhaps the most meaningful lesson in cultural competency.   I traveled to Nashville, TN, during the summer in between my first and second year of medical school, a long way from Los Angeles, and worked in a Community Health Center —  the Matthew Walker Comprehensive Health Center (MWCHC), as part of the General Electric and National Medical Fellowships Primary Care Leadership Program (PCLP).

Immersion, in my own experience, is the best way to develop the skills needed to become a culturally competent physician, and this program helped me do just that. Every day MWCHC serves mostly low income African American and Hispanic patients.  I worked in the pediatric department seeing patients that came in for anything from a well baby check up to STI screening. I worked alongside nurse practitioner students, and other medical students, to gain clinical experience in the exam room, listening to heart and lung sounds, checking for developmental milestones, talking about concussions and sports safety, and addressing childhood obesity. Previously, I had seen many diverse patients in my limited experience as a medical student in the LA County hospital system, but this was not the same.  Medicine in the south, and medicine in the west are surprisingly much different in practice.  For instance, I quickly learned that many parents stayed in the exam room throughout the entirety of their son or daughter’s visit, while in Los Angeles, we often ask parents of patients over the age of 13 to leave for a portion of the interview. In Nashville, patients were more respectful, but also engaged less in shared decision making, and took my word as authority without much questioning. It was these experiences that opened my eyes to the differences in how medicine is practiced and how necessary it is to always accommodate the culture of the patients.

I was able to conduct a small project as part of PCLP, which allowed me to gain a better understanding of what adolescent patients wanted from their healthcare provider, by attending a community health fair and asking attendees to participate in a survey. The health fair was a lot different than the ones I had volunteered at in Los Angeles. There was live reggae and rap music performed by community members at the health fair, something I had not seen before. This laid-back environment with a lot of community participation made it easy to survey the community at the health fair and get valuable feedback from the adolescent population. Ultimately, I was able to use the feedback to inform providers about services that adolescents wanted more of, like sex education, and in what ways the care they received was excellent.

PCLP was a great opportunity to not only immerse myself in another community, but to learn how, even within the United States, we can have such diverse patients and providers, and how important it is to be aware of our cultural differences and work toward a better mutual understanding and acceptance of one another.

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