The Santa Rosa Family Medicine Residency Program is committed to train residents who are dedicated to work with the underserved of Sonoma County. We recognize that a patient’s health is largely determined by that person’s cultural milieu. Our patient population comes from all walks of life, whether ethnically, religiously, sexual orientation-wise, economically or otherwise. Because of the patients we serve, all residents graduate with a high aptitude in navigating the interaction between diversity and medicine. The Residency Program prides itself in prioritizing diversity-related experiences and education. In recent years, there has been a development of several exciting new and old initiatives created to improve our understanding of the cultural contexts within which our patients live.
Our clinic possesses a very exciting mix of different groups of patients. Linguistically, over forty percent of the patients we serve are monolingual Spanish speakers, many of whom are agricultural workers in Sonoma County. Individual resident practices vary markedly - some of our fluent Spanish-speaking resident physicians choose to see as many as 80% monolingual Spanish speakers in their clinics. When residents rotate through their obstetrical months, the percentage of monolingual Spanish speaking patients can increase up to fifty percent.
Some other major ethnic groups represented within our patient population include Vietnamese, Laotian, Cambodian, Chinese, Eritrean, and Ethiopian communities. Languages recently represented by our resident and faculty physicians include Spanish, French, German, Mandarin Chinese, Japanese, Portuguese, Vietnamese, and Hebrew.
We believe patients have the right to receive exceptional care in their own language and recognize that well-trained bicultural physicians are important in communities traditionally underrepresented in medicine. Although bilingual/bicultural residents are highly valued by our patient population, monolingual residents thrive as well. In our clinic setting, monolingual residents have the opportunity to enhance their foreign language skills through the support of our bilingual/bicultural staff, translator phone services, language courses, and elective opportunities.
The Latino community is well represented among the core faculty, community attendings, and clinical staff. All medical assistants and float coordinators, and some nurses are fluent in Spanish. We also have a nurse fluent in Mandarin and Cambodian. These staff members are frequently available whenever cultural/language interpretations are needed.
Many of the below programs were designed and produced by residents of our program. A group of residents especially interested in the promotion of diversity and medicine continue to meet under the guidance of Dr. Gonzalez and Dr. Mariah Hansen on a regular basis to discuss old, current, and new ideas.
We believe that we cannot adequately serve the needs of a culturally and linguistically diverse patient population without providing excellent training in community medicine. The residency has a strong tradition of community involvement. For example, it has shown long-term commitment to the teen parent population in Sonoma County by working with the teen parents through educational presentations and follow-up care. We have also been involved with the homeless and uninsured community by volunteering at the Brookwood homeless clinic, Jewish Free Clinic, and the St. Joseph’s mobile clinic. Residents have also been involved with faculty member Dr. Enrique Gonzalez’ Spanish radio talk-show, and are looking to participate more in local Latino and Vietnamese health fairs. Additionally, the Santa Rosa program has often had residents become involved with local high school mentoring groups that focus on increasing the number of health care professionals from underrepresented minority groups.
In early 2010, the residency developed and implemented a new curriculum that aims to train our residents in the skills of culturally responsive health care. Throughout the three years of residency training, residents will work alongside staff and faculty to nurture our diverse cultural backgrounds while exploring others. Skills include effective use of interpreter services, expanded cultural awareness, fostering a patient-physician relationship across cultural differences, and understanding the impact of cultural competency in improving health care delivery.
Examples of the curriculum to develop these skills include a cultural self-exploration assignment to encourage recognition of residents’ own potential for bias and stereotyping and to create a forum for personal insight. In another valuable exercise, residents create a cultural case presentation which illustrates how access to health services, historical events, political forces, the local environment, and institutional factors (including racism and discrimination) that impact health and underlie health and health care disparities.
The curriculum also includes didactic lectures on such cultural topics as Cambodian health beliefs, medically sensitive care to transgender patients, cross-cultural issues in end-of-life care, and a cooking/nutritional demo highlighting healthy adaptations to traditional Latino recipes. Recently, these didactic lectures have been paired with a matching movie in our Cultural Cinema series (ie. lecture on LGBTI health and “Southern Comfort” or panel on Latino culture and “Voces Innocente.”) While this is just a sample of this exciting new curricular development, the overarching aim is to empower our residents to provide culturally relevant care.
Spanish Language Course and Lunch en Espanol
In response to resident demand, the residency created an 8-week Spanish language course that runs in the first two months of the residency year. This is primarily run by our clinic’s chief medical officer, Dr. Francisco Trilla. The class is created to fulfill the personalized linguistic needs of each resident through various role-play scenarios. Each intern class and any other resident able to make the commitment are invited to partake in the course.
Another residency initiative designed to raise our linguistic competency has been the “Lunchtime en Espanol” events every other month. These residency/clinic-funded lunches are designed to allow the residents to interact with clinical staff (MAs, float coordinators, etc) in a reciprocal manner – the residents teach the clinical staff about basic medical matters while the staff give the residents an opportunity to practice their Spanish.
Formed and run by 2009 graduate Dr. Suegee Tammar-Mattis, the LGBTI clinic provides comprehensive primary care for the Sonoma County lesbian, gay, bisexual, transsexual, intergender population. Residents are more than welcome to participate in the clinic.
Latino Health Forum
A tradition organized by Dr. Gonzalez for nineteen years, the annual Latino Health Forum has become a large community event that aims to educate providers about issues related to Latino-American health. Past themes have included “Raising Healthy Children,” “Reducing the Risk of Chronic Disease,” “Fortifying our Cultural Competencies.”
Health and Human Rights
2010 graduate Dr. Lucia Roncalli has been training residents in doing medical and psychological evaluations of people who have survived torture and are applying for asylum in the United States. With support, residents learn how to do the evaluations, how to write for court and testify. They develop skills to use with highly traumatized people who come for primary care. Dr. Roncalli and these trained residents have been engaged in patient advocacy in the pursuit of social justice through the gathering of evidence about abuses and torture suffered by refugees seeking asylum in California. Without their work, these refugees would have very little prospect of obtaining asylum.
Cambodian women’s group
Also founded by Dr. Roncalli, the Cambodian women’s group is a weekly wellness gathering organized around the concept of somatic experiencing. It has allowed this group of women to form a tight-knit community with each other, which has helped them work through some of the mental health issues that stem from their experiencing the Khmer Rouge.
Ideas to Come!!
There are several exciting projects coming down the pipeline including (1) a project looking to enhance linguistic competence among Sonoma County specialty offices (2) Asian Health Forum (3) Cambodian high school mentoring group (4) community health screenings (5) present health topics on radio and TV programming (6) increase cross-cultural video precepting time with Dr. Gonzalez