McMaster med school aims to better train doctors on diversity
McMaster University’s Faculty of Health Sciences is scrubbing in for a fresh look at diversity in its undergraduate medical program. This summer it created a new Chair of Diversity and Engagement, with an initial mandate of reviewing med school admissions and curricula.
On July 1st, psychiatrist Dr. Albina Veltman officially began the part-time role, bringing with her years of clinical practice working with people with severe mental illness, developmental disabilities and those struggling with gender and sexuality discrimination in Hamilton’s communities.
This Chair “is a really great fit for what my passion has always been… working with traditionally marginalized and underserviced populations…” Dr. Veltman says beaming with pride.
“Sometimes diversity is presumed to be ethnoracial diversity… that’s only one part of it. We are talking about diversity from a very broad perspective. So that would include ethnoracial, religious, lesbian, gay, bisexual, transgender and queer (LGBTQ) issues, disability of various sorts – physical, developmental, mental health – very, very broad culture.”
In the short-term, she plans to build partnerships both within and outside McMaster, including the Aboriginal Students in Health Sciences (ASHA) office, De dwa da dehs nye>s Aboriginal Health Centre, The LGBTQ Community Wellness Centre of Hamilton, the Hamilton Centre for Civic Inclusion, and more to be identified.
'We’re still doing things that we were doing 100 years ago,” Massarella says
One of her first allies is likely to be Dr. Carys Massarella, an E.R. surgeon at St. Joseph’s Hospital and transgender care specialist at Quest Community Health Centre in St. Catherines. Dr. Massarella, the first transgender person to be president of a medical staff in the world, is clear of what lies ahead for her colleague.
“What first pops to mind is that medicine is a conservative profession by nature, and that change in medicine, although you think it’s a fast paced change-oriented field, it’s not as fast as you think. We’re still doing things that we were doing 100 years ago.”
Dr. Massarella points to a 2011 JAMA survey of Canadian and American medical schools that showed students receive only 4 hours of training on LGBTQ issues.
“That’s not sufficient by any means to teach the full spectrum of either cultural sensitivity toward LGBTQ folks, or even related health care… a lot more needs to be done.”
“The biggest complaint you hear from LGBT folks is that they don’t know if they should tell their doctor, they don’t know if their doctor would understand.”
The lack of understanding from doctors who have little lived experience or training in the social and cultural realities of their patients is a fear shared across different communities. Constance McKnight, Executive Director of De dwa da dehs nye>s echoes this sentiment. She says that Aboriginal "people feel comfortable” being able to access services at her centre.
“And being able to relate, in the way that the doctor can relate to their realities…a better understanding of their lifestyle and social determinants of health,” makes a world of difference in improving the health of her community.
School created Aboriginal admissions process
Dr. Karen Hill was the fourth Indigenous graduate from McMaster (Class of 2003) in the 40 year history of its M.D. program. She’s a past director of ASHS and now runs Juddah's Place, a co-operative clinical and traditional healing practice at Six Nations. With her help, the medical school created an Aboriginal Admissions process in the 2000s.
Despite this achievement, she says that Health Sciences sets itself apart in a way that leaves Aboriginal, immigrant and other racialized medical students, to deny whole parts of themselves that are important to both medical learning and health care.
Following an initiative by the Hereditary Chiefs of Six Nations in the 1990s, the rest of the university has moved forward on Aboriginal inclusion.
“I guess there’s a lot of paternalism, that’s the way you could describe it. …For [Health Sciences] to understand or recognize that for any group, including the Indigenous people, we can decide for ourselves. We can do good work for ourselves. We don’t need a white person in there leading the whole thing.”
Dr. Hill describes the reluctance of McMaster Health Sciences to collaborate equitably with communities as detrimental to Aboriginal students in ways that continue Residential School dynamics. ”They just revert back to the way that it was before there were any supports in place at all. And that reverting back is you just pretend that you’re not indigenous and you try to blend in as much as you can, so that you don’t create too many down waves. And yeah, students are getting through the program, but not in a healthy way.”
She suggests Dr. Veltman “focus on support services, such as ASHS, ensuring they are structured and administered in a culturally safe manner in line with the broader mandate and work of the Indigenous Education Council” at McMaster.
The need for healthy, positive spaces for diverse groups, in both medical education and practice is a refrain that inaugural Chair Veltman may have to face early on, starting with curriculum.
“I’d like to see positive space training for anybody who enters into medical school, or university for that matter, but also for Faculty as well. What’s most important is that people understand how to make the space they work in a positive space for LGBTQ folks,” ** suggests Dr. Massarella.
Such a template may go a long way for others too.