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Internal Medicine’s Cultural Competency Program: “Bring Back the Humanism”

Krista Edelman

Krista Edelman, M’11

A patient doesn’t fill his prescriptions. Another doesn’t exercise, worsening chronic conditions. Still another is always late to appointments.

It’s frustrating for physicians, and easy to assume these patients just don’t care. But there are other sides to these stories, and an innovative program is helping interns find them.

“When there’s a disconnect between providers and patients, we sometimes don’t realize the issues that are affecting patients so they cannot adhere to a treatment plan,” said Bennett Lee, M’94, ambulatory clerkship director and associate professor in the Department of Internal Medicine. “We were thinking about how to really engage the interns with their patients and make sure they understand what a privilege it is to take care of them.”

Chief Resident Krista Edelman, M’11, along with Lee and Stephanie Call, M.D., M.S.P.H., associate chair for education in the Department of Internal Medicine, developed a cultural competency program, a four-week rotation designed to help the department’s interns:

  • Discover social and physical environments affecting health.
  • Reflect on how a better understanding of health is affected by the conditions in which patients are born, live, work and age.
  • Communicate and share these experiences.
Residents must learn sensitivity and responsiveness to a diverse patient population, including but not limited to diversity in gender, age, culture, race, religion, disabilities, and sexual orientation.

The program began in 2014, and about 30 interns have completed it so far. “The experience has been eye-opening,” said Edelman.

The interns are encouraged to go beyond standard medical examination questions to try to understand patients’ lives. They ask about family dynamics, income and whether or not they have convenient ways to obtain healthy food and necessary medicines.

They then go out into the community, sometimes using public transportation, and explore the neighborhoods where their patients live. Edelman prompts them to look around and see:

  • Are there signs of disrepair (broken windows, graffiti, overgrown grass)?
  • Are there parks or recreational areas in the neighborhood?
  • What supermarkets are available and do they carry affordable fresh produce, meat and other healthy food?
  • Are there functioning street lights or a sidewalk?
  • Where is the closest bus stop?

What they’re finding is changing the way they practice medicine and view patients, said Edelman. “They’ve taken photos of the food available, which might be something like a packet of bologna and potato chips, maybe an onion. It’s a revelation for these physicians, who wonder why patients aren’t eating more fruits and vegetables.

“Seeing the neighborhoods where the patients live, they come back and say, ‘I don’t think I would feel comfortable walking there alone either, let alone a 60-year old female patient.”

Interns might discover that a patient has to travel several miles in a wheelchair to get a prescription filled, or is too frightened to go out or maybe has to depend on three city buses to get to a physician’s appointment.

“In medical school, people are so keyed in to the science of how to take care of folks that sometimes they lose track of the idea that this is a person,” said Lee. “You need to ask, ‘how do I communicate with them? How do I understand?’”

Watch a digital story

Mrs. Hope
by Christina “Nina” Vitto, M.D., resident in the Emergency Medicine-Internal Medicine combined residency program

The culmination of the cultural competency program is creating a reflection piece on the experience, usually a digital video on a subject or patient who affected interns deeply.

Edelman believes this reflection will make them better, more compassionate physicians.  She’s also heartened by recent updates to the MCAT exam that tests prospective medical students.  In 2015, the exam was expanded to include a section on behavioral and socio-cultural factors.

“My parents are social workers, and I’ve always had a passion for the service in medicine,” she said. “It’s easy to get so jaded when you’re working long hours and patients come in who are obviously neglecting their health.

“But that’s not acceptable for physicians. I want to bring back the humanism.”

By Lisa Crutchfield


Third- year student Braveen Ragunanthan honored with national public health award

Braveen Ragunanthan with Cmdr. Ray Ford

Third- year student Braveen Ragunanthan with award presenter Cmdr. Ray Ford.

Braveen Ragunanthan has been interested in public health and social justice for as long as he can remember. After witnessing extreme poverty in Sri Lanka and India on family trips as a young boy, he began to think about the systems that created such hardship and, more importantly, ways to combat it. These experiences, he says, “ultimately showed me that working in public health closely aligned to my moral sense of purpose.”

In recognition of his dedication to serving the less fortunate, Ragunanthan was honored by the U.S. Public Health Service Physician Professional Advisory Committee with its 2015 Excellence in Public Health Award. The national award recognizes medical students who demonstrate their commitment to improving public health. He received the award at the School of Medicine’s student Honors Day ceremony in May.

Since those childhood trips, Ragunanthan has traveled widely to learn more about what it takes to make a difference in communities around the world. As an undergraduate student at Duke, he spent summers in the Mississippi Delta, at the epicenter of the HIV/AIDS crisis in South Africa and battling neglected tropical diseases in Ethiopia. He says that these trips instilled in him the belief that “all people of all backgrounds, regardless of their circumstances, deserve a chance to enjoy a healthy life.”

Since enrolling in the School of Medicine, he has interned with the World Health Organization in Geneva, Switzerland and participated in the School of Medicine’s International/ Inner-City/ Rural Preceptorship (I2CRP). This four-year program focuses on equipping medical students with the knowledge, skills and values needed to provide compassionate care to underserved communities. He says that his time in the program has helped him develop the clinical skills that are crucial in this field.

For Ragunanthan, the award is further inspiration to keep working towards larger goals. “Eventually I plan to work as a primary care physician in a medically underserved community and health professional shortage area. I am interested in grassroots community organizing and the potential of working in the space of public health to positively impact communities. I hope to be a champion of preventive medicine and work on health heavily through initiatives that exist beyond the walls of the clinic.”

His next step is taking a year off from medical school to pursue a master’s degree in public health from Johns Hopkins University’s Bloomberg School of Public Health. After completing the degree, he plans to return to the MCV Campus to finish his final year of the M.D. program and graduate with the Class of 2017.

By Jack Carmichael


Class of 74’s Tom Kerkering shares tragedies and challenges of fighting Ebola

Tom Kerkering, M’74

Tom Kerkering, M’74, returned to campus to talk about his experiences fighting Ebola in West Africa.

Thomas Kerkering, M’74, H’79, points to a picture of the tree that was ground zero for the recent Ebola epidemic. A two-year-old child playing near the tree caught Ebola from bat guano, and from there the virus spread to infect over 20,000 people in Guinea, Liberia and Sierra Leone and claim more than 10,000 lives.

The tree is just the beginning — of the outbreak and of Kerkering’s tale. As the keynote speaker of the VCU Global Health Showcase 2015, he would go on to tell some of the tragic, personal stories of the Ebola outbreak that he experienced during his time fighting the virus in West Africa. He offered an insider’s view on how devastating the outbreak was given the cultural differences and realities of providing health care in West Africa.

Long before the term global health was coined, Kerkering put it into practice. For decades the infectious disease specialist has traveled the world. First from a home base on the MCV Campus, later from East Carolina University and now from Virginia Tech’s Carilion School of Medicine, where the professor of internal medicine is also chief of infectious disease at the Carilion Clinic.

Fighting ebola with protective gear

From Tom Kerkering’s blog: There are no dull moments.

Fighting the Ebola virus was a challenge, said Kerkering, not only because of the lack of infrastructure and supplies in the affected countries, but also because of the nature of the virus itself.

“Ebola is unique, because it stood the Hippocratic Oath on its head,” he said. “We were all trained, and we all took an oath to see that the patient comes first. But with Ebola, the safety of the health care worker is paramount. If health care workers get infected, not only is there one less person to help the sick, but they risk infecting more people in the community.”

Kerkering dedicated his presentation to his “his fellow health care workers in West Africa, many of whom are no longer alive.” He feels a deep connection with the people he met during his time fighting Ebola. There was a 78 percent mortality rate among infected health care workers during his time in Africa – of the 138 workers who fell ill at his treatment center, 108 died. A video shot at the treatment center where Kerkering worked showed his friends and fellow heath care workers, many of whom had since succumbed to the virus.

Photo of a medical tent

From Tom Kerkering’s blog: Carilion physician helping fight the spread of Ebola in Africa.

Kerkering talked about the difficulties of accessing patients in remote locations, the tragedies of families ripped apart by the virus and the few miraculous recoveries that he witnessed. He met a couple who had to leave their three young sons behind and travel hours to the Ebola treatment facility. The father passed away, but the mother recovered and was able to return to her family and her village. “Nothing is absolute with Ebola,” he explained, “we don’t know why the virus kills some people and spares others.”

Kerkering also examined some of the precautions employed by health care workers to protect themselves from infection. When working with patients, health care workers donned protective suits that completely covered their bodies and left no exposed skin. The 20-minute process of taking off this protective gear was the window of highest possibility for infection. It made the most menial tasks complicated and time consuming. Kerkering and his colleagues had to develop special procedures for dealing with an itchy nose, a sneeze or a fly caught under the protective equipment – proof that when dealing with such a highly infectious disease even the mundane can be dangerous.

Informational billboard about Ebola

From Tom Kerkering’s blog: Ebola turns the Hippocratic Oath on its head.

Kerkering urged his audience to consider how response to the Ebola outbreak could have been improved. He said that many academic medical centers in the U.S. lacked a framework for responding to the outbreak of an infectious diseases as virulent and lethal as Ebola, and as a result their reaction was often too little and too late.

At the peak of the outbreak in Africa, a consistent lack of beds, ambulances and medical supplies crippled the health care worker’s ability to slow the disease. In many cases support arrived so late that it was no longer needed – treatment centers sat empty and supplies went unused after the number of cases had declined. He hopes that the lessons learned from Ebola can be applied to better prepare for the next outbreak of an infectious disease, and that the personal tragedies he witnessed in Sierra Leone can be better avoided in the future.

Kerkering wrote three blog entries about his experiences while in Sierra Leone. Follow the links below to learn more about his time fighting the Ebola crisis.

Carilion physician helping fight the spread of Ebola in Africa

There are no dull moments

Ebola turns the Hippocratic Oath on its head

By Jack Carmichael


MD-PhD alumnus Gerald Feldman named president of American College of Medical Genetics and Genomics

Gerald L. Feldman

Gerald L. “Jerry” Feldman, M’84, PhD’ 82

The American College of Medical Genetics and Genomics (ACMG) has named Gerald L. “Jerry” Feldman, M’84, PhD’ 82, president of the national organization for clinical and laboratory genetics professionals. During his two-year term, Feldman plans to embrace new technologies and treatments and improve organizational structure as the field of medical genetics continues to expand.

“Dr. Feldman has a long history with ACMG, and through his extensive committee work, he’s taken an active role in steering us to where we are today,” said Michael S. Watson, executive director of the ACMG, in a news release from his organization. “His institutional knowledge and experience working across the full spectrum of clinical genetics services and education will help our organization going forward, in an era when genomic information promises to play a bigger role in medicine than it ever has before.”

Feldman spent two years as president-elect of the ACMG, serving on various committees and taskforces while preparing for his role as president of the organization. Feldman also works as a professor of molecular genetics, pathology and pediatrics at Wayne State University in Detroit, Mich., where he directs the medical genetics residency and fellowship programs and serves as medical director of the Genetic Counseling Graduate Program.

His principal research focuses on diagnosing and managing patients with genetic disorders. He is co-investigator for the NIH program Inborn Errors of Metabolism Collaborative, which collects data and studies best practices in service of children with rare genetic disorders which prevent them from metabolizing certain fats, proteins and sugars.

Feldman also serves in several clinical roles, among them program director and lead investigator of the Newborn Screening Management Program at the Children’s Hospital of Michigan and director of clinical genetic services at Wayne State. Feldman’s combination of experience in clinical care, education and research makes him uniquely qualified to represent the diverse body of ACMG members.

“The era of the genetic and genomic revolution is here,” said Feldman. “New technologies, new treatments and identification of new genetic disorders will improve patient care in ways we could not have even envisioned a few years ago. I look forward to serving as president of the organization that is leading these efforts.”

The ACMG has more than 1,750 members, among them biochemical, clinical, medical and molecular geneticists, genetic counselors and other health care professionals. As the only nationally recognized medical organization dedicated to improving health through the practice of medical genetics and genomics, the organization seeks to promote medical genetics education, research and access while advocating for its members and other providers of medical genetics services and their patients.

By Jack Carmichael