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Self-Reflection in Multicultural Training: Be Careful What You Ask For

Murray-García, Jann L. MD, MPH; Harrell, Steven; García, Jorge A. MD, MS; Gizzi, Elio MD; Simms-Mackey, Pamela MD

Academic Medicine:

Self-reflection in multicultural education is an important means to develop self-awareness and ultimately to change professional behavior in favor of more equitable health care to diverse populations. As conceptualized by scholars in the field of psychology, racial identity theory is critical to understanding and planning for the potentially wide range of predictable reactions to provocative activities, including those negative reactions that do not necessarily herald a flaw in programming. Careful consideration of racial identity developmental phases can also assist program planners to optimally meet the needs of individual physician trainees in their ongoing constructive professional and personal development, and in strategically mobilizing and having ready the type of institutional leadership that supports trainees' change processes.

The authors focus on white physician trainees, the largest racial group of U.S. physicians and medical students. They first explain what they mean by the terms white and nonwhite. Racial identity theory is then applied, with true case examples, to explore such issues as where the self-proclaimed “color-blind” trainee fits into this theoretical schema, and how medical educators can best serve trainees who are resistant or indifferent to discussions of racism in medicine and equity in health care delivery. Ultimately, the authors' goal is to demonstrate that engendering genuine self-reflection can substantively improve the delivery of health care to the nation's diverse population. To help achieve that goal, they emphasize what to anticipate in effecting optimal trainee education and how to create an institutional climate supportive of individual change.

Author Information

Dr. Murray-García is a pediatrician and private health policy consultant in Davis, California, and affiliate member of the Center for Health Services Research in Primary Care, University of California, Davis.

Mr. Harrell is a professional facilitator and trainer and founder of ProActive Communications in Oakland, California.

Dr. García is associate professor of clinical internal medicine, Division of General Internal Medicine, University of California, Davis School of Medicine.

Dr. Gizzi is director, Craniofacial Center, Oakland Children's Hospital, Oakland, California.

Dr. Simms-Mackey is staff pediatrician, Division of Ambulatory Services, Oakland Children's Hospital, Oakland, California.

Correspondence should be addressed to Dr. Jorge A. García, Division of General Internal Medicine, University of California, Davis School of Medicine Medical Center, PSSB 4150 V Street, Suite 2400; Sacramento, California 95718-1460; telephone: (916) 734-7004; fax: (916) 734-2732; e-mail: 〈〉

© 2005 Association of American Medical Colleges