Researcher Calls for a More Diverse Medical Curriculum in American Universities

Trinity College Hartford // CC BY-SA by 4.0

BY JOY Y. T. CHANG

Khaoula Ben Haj Frej knows what being a minority is like.

Ben Haj Frej is one of the only two Muslim students at her university. Born and raised in the United States, she said she had encountered classmates who often were not sensitive to her culture and identity. A neuroscience major and pre-med student who graduated in Trinity College-Hartford, Ben Haj Frej recalled fellow students ask her whether she was a terrorist and the time they held an event “in support of Muslim women:” the female students decided to wear hijabs for one day to show solidarity.

“I know they meant good, but what about tomorrow? They were only going to wear it for one day, and it [hijab] is a part of me; it’s something I wear every day,” Ben Haj Frej said. She shared this story before going into her presentation at a panel at UN Women’s Commission on the Status of Women in New York City in mid-March of 2019.

While slights and misunderstandings were difficult to navigate, Ben Haj Frej said, a more fundamental problem exists in her education. Now a research technician at Dana-Farber Cancer Institute in Boston, she remembered a curriculum in her university that solely focused on professional and technical knowledge without addressing the different cultural and emotional needs of the country’s diverse population.

During her time as a pre-med student and a neuroscience major at Trinity College-Hartford for the past four years, Ben Haj Frej and her fellow medical students were introduced to almost every aspect of medicine. But they received no instruction on how to serve culturally different patients and address their ailments through a cultural lens.

Ben Haj Frej remembered one of her fellow student’s thesis. It was about the relation between pregnant women and the sizes of their newborn babies. Surprisingly, the study found that even though these women received the exact same treatment in the same hospital, their babies were all born in different sizes, which, Ben Haj Frej said, correlated directly with the mothers’ socio-economic status, according to Ben Haj Frej. The environment these women were living in was one of the factors that affected their health and that of their infants.

“And I started realizing, why is no one teaching us this?” Ben Haj Frej questioned.

There are studies about how socio-economic status – along with race, culture, faith and even immigration experience – influences patients’ health, but there is little education teaching pre-med students how to assess their needs and accommodate individual patients with suitable treatments.

“As a woman of color myself, I knew from my own experience and from the people I knew, and then to the studies that I’ve read – I saw there’s a difference. But it’s never really spoken about. It’s almost taboo,” Ben Haj Frej said. “We’re lucky enough that we’ve come far enough that we’re able to start discussing it. It’s just unfortunate that we’re not teaching them.”

She gave more examples of black women and Muslim women’s experience in the medical system. When African American women go into emergency care of a hospital, they are less likely to be diagnosed with cardiac arrest than men and women of other races. Thus, a lot of them ending up going into the health care system.

For Muslim women, it is a different scenario. A lot of the Muslim immigrant women, Ben Haj Frej said, face language and cultural barriers as a result of their upbringing and immigrant experience, they are not able to ask the questions they need to ask and are not able to get the support they need when they go into hospitals. It is a challenge for them to navigate an unfamiliar system in an environment different from the ones back home.

Cases like these constantly show up in public discussions and have been widely studied, but medical education as largely not addressed this. , however, the same attention is not found in medical education.

“Even just from a cultural standpoint – not even socio-economic – these issues do exist. But we don’t really talk about them in the classroom,” Ben Haj Frej continued.

“We’ll talk about hormones, we’ll talk about this and that, but we’re not really going to bring up race and gender because that’s separate, and I think that’s a big problem,” she said.

Khaoula Ben Haj Frej (middle) at the United Nations Commission on the Status of Women in March 2019

Noticing the gap between medical education and the need of America’s diverse population, she started looking for resources on her own. Aside from the curriculum in medical school, she also spent her free time taking political science courses. She said from both a student and a neuroscientist’s perspective, political science and sociology should be integrated into medical school curricula.

“We should learn not only professional knowledge. Political science should be a required subject of medical students, too,” said Ben Haj Frej.

Charles Swart, neuroscience professor at Trinity College-Hartford, said that he does not know how such an integration could work. He does not know what, for example, a “Cultural Neuroscience” course would consist of.

He said students of all majors in the university are required to take courses in humanities, art and social science. Swart acknowledged that currently within the neuroscience department, there is no course looking at the subject from a sociological perspective. There is no material addressing the intersection of neuroscience, gender, and race, either.

“It is important for medical practitioners to be culturally competent,” said Swart. “Medical schools also require cultural competence so our pre-med students make a significant effort to gain experiences through volunteering in the local community, study abroad and through other service activities.

Swart said that to broaden students’ education and train their cultural competency, the college encourages them to study abroad and has a requirement for four semesters of a second language beyond English.

But Trinity College is not the only university with a lack of a comprehensive medical education. In fact, the majority of medical schools, including the Vagelos College of Physicians and Surgeons at Columbia University, offers very few courses that focus on teaching students how to handle the different needs of their patients.

In the United States, the process to become a medical practitioner varies by specialty, but it takes students four years in an undergraduate program, four years in medical school and about three to seven years in residency training to become a licensed doctor. The structure of programs might be slightly different among universities, but curriculum in a four-year medical school often consists of four elements: fundamentals, major clinical areas, electives and a final scholarly project. None of these addresses the intersection of medical needs, race, gender and religious culture.

Ben Haj Frej said as a Muslim woman of color, there are not enough resources to prepare practitioners for treating women like her and for others, like for education of treatments for them, and the same thing also happens to indigenous women. There are not many statistics available about and for the indigenous communities about medical resources for indigenous women who are more likely to suffer from violent crimes and a lack of medical practitioners for their children.  and there is less pediatrics resource for them.

“There’s a gap between even knowing that women are faced with different hurdles. There’s a lack of consideration,” she said.


JOY Y. T. CHANG is from Taipei, Taiwan. A multimedia journalist based in New York and a M.S. candidate at Columbia Journalism School, she covers cross-strait relations and transitional justice. Twitter: @joytiunnchen

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