Diversity and Pediatric Education
Danielle Laraque, MD, FAAP
Chair, Department of Pediatrics
Vice President, Maimonides Infants and Children's Hospital of Brooklyn
Coincident with our welcoming of Spring, we welcome a new pediatric intern class. And, in this month’s eConnection we feature the publication of an article addressing the issue of cross-cultural training of pediatric residents nationally and its relationship to resident satisfaction and preparedness to care for a diverse population of children. (1) The issue of diversity is not foreign to us at Maimonides Medical Center. Our child populations come from families, many of whom speak English as a second language whether foreign born or not, may be recent immigrants, may have different religious faiths and health practices, and may face many challenges with regard to acculturation and health literacy. Our commitment to our communities extends to broad community-based efforts to partner on health issues, the provision of translation services for over 60 languages, community-based locations of primary and subspecialty care services, compassionate, culturally-relevant and quality care, among other efforts. A reasonable question is whether or not our interns are indeed well matched to serve the diverse and challenging needs of the children in Southwest Brooklyn and beyond. We will not know the full answer to this question until we have had an opportunity to affect the training of these interns but we can gain some comfort and knowledge from the following observations and conclusions of the article cited.
First, a comparison of our incoming intern class with the random sample of residents queried in the American Academy of Pediatrics Third Year Resident Survey reveals similar gender distribution. Our group is culturally and racially more diverse than the national sample. Our interviews of our applicants revealed, that similarly to the national sample, many enter residency having delivered care to underserved populations. And while about 1/3 of the national sample had grown up in bi or multi-lingual families, the overwhelming number of our in-coming MMC residents speak more than one language and among them report speaking 20 different languages. Nationally, roughly 20% of residents reported being proficient in Spanish as compared to 25% of our incoming MMC interns.
Additionally, some important observations from the manuscript bear mentioning. First, while many residents come with strong pre-residency cultural experiences, residency offers a unique opportunity to increase resident sense of preparedness. Residents who had more cross-cultural experiences during residency (regardless of pre-residency experience) had increased self-efficacy in their sense of preparedness to care for diverse populations. They identified additional training needs inclusive of a greater need for training in global health and identified particular difficulty in caring for patients with limited English-proficiency, new immigrants, those with differing religious beliefs, and those using complementary and alternative medical approaches. These findings can be applied to the training of the pediatric residents at Maimonides with careful attention to the development of curricula to address these important areas. Evaluation of our residents over the 3-year period must also demonstrate their competence through direct observation in the delivery of clinical care as well as simulated cases and OSCEs (observed structured clinical encounters). Our residents must emerge with the skills to compassionately care for all our children thereby offering the possibility of improving health outcomes and child well-being.
As Chair of the Department of Pediatrics, I gain some comfort in knowing of our institution’s commitment to quality care for all children and adults. Our faculty and staff are multi-cultural/lingual and dedicated to the health of our communities. I take this opportunity to thank you all and to celebrate our successes in recruiting a fantastic incoming class of interns! We will monitor our progress in achieving the goals set by our Children’s Hospital mission, vision, values and strategic plan and report those findings to you. (www.maimonidesmed.org)
(1) Frintner, MP, Mendoza, FS, Dreyer BP, Cull WL, Laraque D. Resident Cross-Cultural Training, Satisfaction and Preparedness. Academic Pediatrics, 13(1):65-71. January 2013.