Russell Lim, M.D. (middle), accepts an award on behalf of the UC Davis
Diversity Advisory Committee from the American College of Psychiatrists
presented by Robert Fernandez, M.D., the first vice president of the college
(left), and David Folks, M.D., chair of the Committee on the Education Award.
The award lauds the Diversity Advisory Committee for creating a model
curriculum for medical students, residents, fellows, and faculty at UC
Credit: Herman Farrer Photography
By combining clinical experience with carefully planned didactics,
educators at the University of California (UC), Davis, have created an
award-winning program to address the cultural needs of patients in the
ethnically diverse Sacramento area.
"Our goal is to improve the quality of patient care by teaching
medical students, residents, and faculty culturally appropriate diagnosis and
treatment," Russell Lim, M.D., told Psychiatric News. Lim is an
associate clinical professor and director of diversity education and training
in the UC Davis Department of Psychiatry and Behavioral Sciences.
"The curriculum links clinical services for ethnic minorities, as
well as supervision by culturally competent attendings, and the administrative
support of our department. Residents get to apply what they learn, and what
they learn is reinforced in supervision," he noted.
Psychiatry faculty and residents developed the Diversity Advisory Committee
in 1999 to enhance diversity education for medical students, residents, and
fellows at UC Davis School of Medicine. Committee members immediately began to
develop different aspects of the curriculum. They also recruit minority
medical students and residents to the school's Department of Psychiatry and
In March, the Diversity Advisory Committee received the American College of
Psychiatrists' Award for Creativity in Psychiatric Education at the
organization's annual meeting in Rancho Mirage, Calif.
The UC Davis psychiatry program includes a specialized curriculum for
medical students, four-year residency curricula in cultural psychiatry and in
religion and spirituality, and specialized training for child and adolescent
fellows and faculty in cultural diversity. In addition, the department
sponsors minority fellows through the APA/SAMHSA and APA/AstraZeneca minority
Prior to the establishment of the committee, the department offered only
one six-session course in cultural issues to PGY-2 residents.
UC Davis medical students are the first to benefit from the cultural
After the UC Davis Medical School received a $150,000, three-year grant
from the Association of American Medical Colleges several years ago to study
the incorporation of cultural principles in medical school education,
Diversity Advisory Committee Vice Chair Hendry Ton, M.D., a co-investigator
for the grant, used the funding to implement the cultural training for medical
"We wanted to align the new material with what they were already
experiencing as medical students," Ton told Psychiatric News.
Ton is an assistant professor of psychiatry and director of education at the
Center for Health Disparities at the UC Davis School of Medicine.
For instance, medical students meet in small groups for their first three
years of school, so their first experience in learning about culture takes
place in a small-group format, Ton said. "The students begin by learning
about culture as a shared phenomenon."
In one exercise, first-year students are instructed, for example, to ask an
elder member of their family what foods were an essential part of family life
through the years and whether recipes had to be modified after the family came
to the United States due to the lack of availability of certain ingredients.
The exercise culminates in a culinary adventure for all, as students prepare
the recipes handed down in their families.
The students also query older family members about the meaning of illness
and death within the family, Ton said, which helps them understand patients'"
illness narratives"—how they have been socialized to view
illness. There is also a series of seminars on "broader societal issues
such as racism and how they affect health care," he noted.
Second-year students attend a seminar on the impact of language on clinical
interaction and use of interpreters with standardized patients. Third-year
students apply what they have learned to clinical interactions with
During their psychiatry clerkships, medical students attend a lecture on
the influence of culture on diagnosis and treatment, and in OB/GYN clerkships
they learn how to complete a cultural assessment with patients on the labor
and delivery service.
There is also a course for fourth-year students called "Culture,
Medicine, and Society," which combines didactics and clinical
Ton acknowledged that the students sometimes run into problems with
applying what they have learned in clinical settings. Students' preceptors may
not be culturally competent, he noted, or clinic administrators balk at the
use of interpreters in certain instances.
With those difficulties in mind, Ton has formulated a 16-hour course for
health care administrators and clinicians on enabling their organizations to
adopt more culturally and linguistically appropriate standards so that medical
students and residents have an easier time applying what they've learned to
Since the Diversity Advisory Committee came to be, psychiatry residents
have benefited from the enhanced curriculum.
For instance, PGY-1 psychiatry residents participate in a five-session
introduction to cultural psychiatry. PGY-2 residents take an 11-session course
in which they learn about mental illness and cultural norms and ways in which
people from different racial and ethnic groups may experience symptoms of
mental illness and metabolize certain medications.
Gay/lesbian/bisexual/transgender issues are also part of the PGY-2
PGY-3 residents take a course titled "Psychotherapy and Cultural
Experience" led by Lim, in which residents learn about key issues in
psychotherapy and about personal experiences of faculty with immigration,
acculturation, and racism. Residents watch a videotape by the late Irma Bland,
M.D., on conducting psychotherapy with African-American patients.
PGY-4 residents take a course in advanced cultural psychiatry led by Lim
and David Gellerman, M.D., Ph.D., and learn how to apply the"
DSM-IV-TR Outline for Cultural Formulation" to a patient
from their caseloads and write about the case for discussion with a cultural
consultant from the Sacramento area, Lim said.
"Residents are often surprised to discover information they did not
gather from the patient," thanks to insights offered by the consultant,
According to Lim, Sacramento provides plenty of opportunities to work with
patients from different racial and ethnic backgrounds. Dubbed "America's
most integrated city" in 2002 by Time magazine, the city is
home to a large population of Spanish-speaking residents, as well as Asian,
Russian, and Eastern-European immigrants.
In addition to learning about different cultures, psychiatry residents
receive training in religion and spirituality throughout their four-year
PGY-1 residents learn how to conduct a spiritual assessment and delve into
patients' views on death and dying, said Gellerman, who developed the religion
and spirituality curriculum. Residents also learn how religion and
spirituality may be relevant for those with problems related to substance
abuse or posttraumatic stress disorder.
PGY-3 residents learn how to discuss spirituality during psychotherapy, and
PGY-4 residents discuss more esoteric topics such as transpersonal psychiatry
or pain management through meditation.
Gellerman supervises medical students, interns, and senior psychiatry
residents rotating through the mental health consultation and liaison service
at the Sacramento VA Medical Center.
In addition, for the first time last year, child and adolescent psychiatry
fellows at UC Davis benefited from the curriculum through a 12-week course
called "Family, Culture, Gender, and Society." During the course,
according to David Rue, M.D., who developed it with the help of other faculty
members, fellows complete clinical rotations at mental health clinics
throughout Sacramento and work with families from a wide variety of racial and
During the course, faculty instruct fellows on the diagnosis and treatment
of children of immigrants from different racial and ethnic backgrounds
(including undocumented families and children).
The course also instructs fellows on working with children of same-sex
The chair of the UC Davis psychiatry department, Robert Hales, M.D.,
provides the Diversity Advisory Committee with a yearly budget to invite
experts in cultural psychiatry to present at grand rounds so that faculty can
stay abreast of cultural issues as well. Hales is also editor in chief of
American Psychiatric Publishing Inc.
There are also faculty development seminars in which experts on cultural
psychiatry train faculty for half-day sessions on topics such as
ethnopsychopharmacology and the mental health of refugees.
To stimulate discussion on cultural issues between faculty and committee
members, the committee began a journal club and a monthly case conference
using the "DSM-IV-TR Outline for Cultural
"Our mission was to improve cultural competence in education and thus
reduce mental health disparities in our patients," Lim said. "I
think we're accomplishing that with this curriculum, as our residents are
better trained to work with ethnic minority patients, who in turn receive
better care." ▪