Welcome to ReachMD. This activity, entitled “Conversations in Health Equity: Developing Cultural Humility Training for Latino Communities” is provided by Prova Education.
I originally wanted to be a farmer. I got that inspiration from my abuelito. My mom was a single mom for the early part of my childhood, so I was raised by my abuelitos, and so a majority of my childhood was actually in Mexico on my abuelitos’ farm. So growing up and even now, that’s my sanctuary. So I went into college fascinated by biology and also inspired by my abuelitos’ health journey. And then I went and had my own health journey after I graduated from UC Irvine. But in that time, I wanted to reconnect with my roots and because a lot of that was lost in undergrad. It was a very stressful journey for me, so I wanted to explore different career options then. Farming was one of those, and I actually got to volunteer and work at a farm, and now I get to do that as a medical student.
This is not your typical med student background story, yet we love it so much and couldn’t be prouder of students like Alejandra.
I’m Dr. Chuck Vega and this is ReachMD.
And I’m Alejandra Hurtado.
Welcome to everyone. And, Alejandra, your personal story highlights something that our clinicians listening may or may not be able to relate to. Can you tell us how you became involved in our Program in Medical Education for the Latino Community, or PRIME-LC, and why cultural humility training for Latino communities is so important?
I first heard about PRIME-LC after attending a pre-health conference my second year in college, and I met a wonderful mentor and PRIME-LC alumni, Dr. Marco Angulo, at that conference – all the way in Davis, and I was undergrad at UC Irvine. And when I heard and learned about his journey and learned that he was here at UC Irvine, I was so excited because I had never met a Latino physician. So it was very inspiring to meet someone with my cultural background, and so began a really great relationship with Dr. Angulo, and his wife Anabel. And in undergrad I also got to volunteer as a Spanish medical interpreter at one of the student-run free clinics, and that’s where I actually met current PRIME-LC medical students. They were first-years. Now they’re off at Mayo Clinic, doing surgery and they were so inspirational and so supportive throughout my journey and encouraged me to pursue medicine and really helped me believe that I really belonged here and that patients really needed more Spanish-speaking physicians to help them.
That’s certainly true. We see great needs in our Latino community, and you are exactly the person we want to help answer those needs.
PRIME-LC begins from a place of cultural humility, with a particular dedication to the Latino community. PRIME-LC is a 5-year Program of Excellence within the School of Medicine, and we take students who have a strong background in the Latino community and want to do more with their healthcare career. Of course they want to be excellent clinicians, but what we’re looking for is real leaders and folks who want to improve health disparities. And essentially what PRIME-LC does is we do give our students skills and knowledge that helps them achieve those goals, but I think we’re also in the business of providing inspiration and a North Star support system for them to thrive in medical school, and even thereafter, because there are a lot of challenges.
So, Alejandra, maybe from your perspective, maybe you can tell the audience how the PRIME-LC curriculum is helping to mold your professional experience, and how do you think that your culture and your background is shaping the type of clinician you want to become?
So, yes. PRIME-LC does an incredible job training their medical students to be future physician leaders and advocates for Latino communities, and one aspect that PRIME-LC does that really well is by incorporating Chicano Latino Studies class into our curriculum. And it’s been one of the classes I look forward to the most because it helps me understand our culture in an academic sense, and helps me realize that this is a pattern, this is a part of not just my family, but just the Hispanic culture. So it’s been really fun to even discuss that. We have class about every other month, and it’s in small group discussions, so it’s really great to hear everyone’s perspective after the readings and just from their own experience. And it just really helps highlight how important it is even coming from that community, that Hispanic culture, really important to understand our patients, because they face barriers that other populations don’t whether that’s language barriers, status barriers, education barriers, literacy barriers. So it’s been really great to further understand and try to help them the best that we can. So I really appreciate PRIME-LC for having the Chicano Latino Studies be a part of our curriculum and also a really great reminder that we’re lifelong learners, and I think that’s one reason that a lot of us chose a career in medicine.
Chicano Latino Studies is taught by psychologists and by anthropologists, and it’s a wonderful lens to hold up and take a critical look at the way we provide healthcare and some of the underpinnings of health disparities for Latino communities. And it runs for 3 years throughout our curriculum. Now, our students, of course, still have to take all the regular medical student classes, so one thing I want our audience to be very clear on is you still have to take Pathology, you still do Foundations in Clinical Medicine and Pharmacology, and you rotate through all the regular curriculum that we have, through surgery, OB-GYN, et cetera, but we do put an imprint of Latino culture and health disparities throughout the curriculum. So it’s a longitudinal program where, for example, in Clinical Foundations when you learn to take a history, a lot of those histories are going to be taken in Spanish. And they’re going to have issues around lack of access to health insurance, poverty, some of the cultural themes that we see routinely in communities like Santa Ana, California. And so those are woven in, and that’s where that skill-building comes in.
PRIME-LC is also unique in that it features a curriculum before you even enter medical school, so we give the students a full month of PRIME-LC curriculum before they enter medical school. It also has an experience in Latin America, a clinical rotation there, and it is a 5-year program because all students are required to get a master’s degree in addition to their MD. So it’s extra work, and medical school is enough work as it is, but we right-sized it so that it fits into students’ schedules.
I just want to share a couple statistics about the PRIME-LC program. You know, we’ve been around since 2004. We now have 148 graduates. We have about 12 students per year in the program, and the statistics really speak very well for what we’re doing. 95% of our graduates who are out of residency and fellowship are working in a federally qualified health center, an FQHC look-alike, or a safety net hospital or some other county-based system. Two-thirds of our graduates are seeing majority low income Latino patients, and 70% are doing some type of leadership or service work outside of their regular practice. And so these numbers are really outstanding, and remember, PRIME-LC, we don’t put any type of limitation on what specialty you go into or where you can work after graduation. It’s really done, I think, to put – on the students to fulfill their ambitions. If they want to be a plastic surgeon, a family doctor, an anesthesiologist, whatever, we want them to do that, but we want them to serve the community because the community’s need is so strong. And so I think we’re really only starting to understand the power of programs such as PRIME-LC.
And no pressure, Alejandra, but tell me about your aspirations after you graduate from PRIME.
After I graduate from PRIME, I’m really looking forward to being a community doctor. As I mentioned, Dr. Marco Angulo was a huge influence of wanting to be in medicine and also the kind of physician I want to be once I graduate. I shadowed him for a couple years at his clinic, when he was the CMO at Serve the People in Santa Ana, which is a federally qualified health center. And it was a beautiful, tiny community clinic; it looked like an apartment complex. Downstairs was the clinic; upstairs was optometrist office, a dentist, lawyer office. So that’s what I want to help build and create. I want to create more community clinics where resources outside of just medicine is accessible and available to our patients who need it and where they feel safe and comfortable and people speak their language, and that they trust the people who are trying to help them. I also really like the aspect of community medicine as far as really investing movements in the community. As a medical student, I’ve been able to help start a – we call it Veggie-RX, where we provide free-of-cost organically locally grown vegetables from a community garden or urban farm in Santa Ana. I think it’s a third of an acre, and yet it’s able to help provide produce for 10 families. So that has been such an inspiration to continue work like that and help create and build more of those community farms because what I’ve seen and what I’m really passionate about is just increasing accessibility to healthy, organic vegetables because a lot of times when I was volunteering, we would counsel on healthy nutrition, healthy eating. But a lot of times they would tell me that it’s not on sale. All I can afford is this, or I don’t even have a fridge to keep this in. So that really also helped shape my lens, all of these barriers to better health. So I just want to help continue grassroot movements to help mitigate those barriers.
Very inspirational, absolutely. And it’s clear you want to serve the people.
So for those of you who are just tuning in you’re listening to ReachMD. I’m Dr. Chuck Vega, and I’m delighted to be joined today by a second-year medical student, Alejandra Hurtado. We’re delving deeper into the impact of our training program, PRIME-LC, and we’re looking at other resources that can improve our efforts to create a more inclusive health system and create equity, particularly for marginalized groups.
And I think that I’ll just make a couple comments here, because I think for most clinicians, you’re not going to start a program like PRIME-LC. This took a lot of effort, and it was very new and novel, so it was very touch-and-go, actually, at the outset, whether PRIME would actually exist or not. And now it’s very established and we actually have established PRIME programs of different types at all of the University of California Medical School campuses.
More locally, what can you do? Well, I think that, first of all, there are some resources. You don’t have to just build things yourself. The Association of American Medical Colleges has great information on its website, looking at health disparities and the healthcare workforce, how to get involved with medicine as a social justice issue. I would also draw your attention to the National Hispanic Medical Association. That’s a national organization that puts out a lot of publications about health for Latinos and has ways that you can get involved personally.
Alejandra, do you have anything to add, other ways that practicing clinicians could get more involved?
I think providing spaces, programs, pipeline programs are really, really important for students who are first generation in college but also first generation in medicine. No one in my family is a physician, and I’m the first to also graduate from college, so it’s been a very interesting journey for me and figuring it out on my own. But also, I have found amazing mentors who have really helped me along the way.
I think it’s also very sustaining for you, as a professional and as a human being, to be able to mentor and assist that next generation to make a better environment for taking care of people and to create better health outcomes.
Unfortunately, that’s all the time we have today, so I want to thank our audience for listening in. We know you’re busy, and hopefully you found this helpful to your practice and inspirational, too, would be great. Thank you very much, Alejandra, for sharing your experiences and insight. You and your fellow students continue to give me hope for our future.
Thank you so much, Dr. Vega, for giving me the opportunity to share my story and hopefully inspire other physicians to help our Latino communities have better access to healthcare.
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