The Faculty Chronicles

In this episode, you will hear Dr. Rebecca Edgeworth from Touro University Nevada (Director of the Community Medicine internship) speak about her experiences working with the Physician Assistant students to increase their awareness about barriers to healthcare, access and cultural competence.

What is The Faculty Chronicles?

The Faculty Chronicles (TFC) podcast, sponsored by the Touro Center for Excellence in Teaching and Learning (CETL), is about building community, connection, and conversation. It will bring to life the stories behind the great works of Touro faculty, across disciplines in all our schools, focusing on classroom innovation in teaching and learning, science, business, medicine, education, wellness and more.

00:00:01:05 - 00:00:37:17
Speaker 1
Hello and welcome to the Faculty Chronicles TFC, a podcast sponsored by the Touro Center on Excellence in Teaching and Learning and the Office of the Provost. Your TFC podcast hosts AMI, Professor Gina Bardwell and Dr. Elizabeth Ni Across academic disciplines, tural faculty are producing great work and the faculty Chronicle's wants you to hear all about it. TFC Podcasts will highlight faculty chatting about their favorite project in research, teaching, learning, science, medicine, technology and so much more.

00:00:38:01 - 00:00:56:21
Speaker 1
So let's get busy building community connection and continuous conversation to a wide. Our next Faculty Chronicle guest is on deck waiting to chat Hello everyone.

00:00:57:08 - 00:01:32:00
Speaker 2
Welcome to a new episode of The Faculty Chronicles. I'm Elizabeth Uni chair and associate professor in the Department of Social, Behavioral and Administrative Sciences and the entire College of Pharmacy in New York. Our guest for the day is Dr. Rebecca Edgewood, assistant professor and Associate Medical Center in New York. Rebecca Edgeworth is an internal medicine physician who went to medical school at the University of South Florida School of Medicine, and she did her training in Las Vegas through the University of Nevada.

00:01:32:13 - 00:02:03:14
Speaker 2
She has worked exclusively in primary care of underserved and wonderful populations as a volunteer, a medical director of the Ft. Minnick and various other medical events in the Las Vegas Penny Dr. Edgeworth has worked as a clinical object faculty with our university in Arizona since 2001 and as a full time assistant professor since 2009. She leads the Community Outreach Program for the Physician Assistant Studies at the Department of the College of Health and Human Services.

00:02:04:07 - 00:02:26:10
Speaker 2
And States. Dr. Edgeworth teaches next generation of medical professionals the skills and compassion needed to provide excellent care to those populations who need the most help and have the least access to medical care, including uninsured immigrants, homeless and domestic violence victims. Welcome to the show.

00:02:27:04 - 00:02:28:02
Speaker 3
Thank you for having me.

00:02:28:18 - 00:02:39:05
Speaker 2
So you won the Tour or Presidential Award for service? So tell us a little bit about your work at total and maybe even how you reached Toro.

00:02:40:16 - 00:03:12:03
Speaker 3
So I came to Toro from I was asked to teach for Toro to teach clinically when I was the medical director of a clinic, a free clinic for people who are uninsured. And I really enjoy teaching. I taught medical students and residents and physician assistants. I very much enjoy teaching and I really enjoy community outreach When I was given the chance to work full time for Toro, doing nothing but the things I love, which is teaching and community outreach, I jumped at the opportunity.

00:03:12:11 - 00:03:21:10
Speaker 2
So can you tell us a little bit about your journey to Toro later to develop this interest in underserved and vulnerable populations?

00:03:21:24 - 00:03:44:16
Speaker 3
Well, my training was here in Las Vegas and it's at the county hospital at UMC. That is a lot of underserved populations. And I always just had an interest in not just the medical and medically complex cases. As an internist, I love people who have diabetes and hypertension and heart disease and and that sort of thing. I enjoy people as a puzzle.

00:03:44:21 - 00:04:08:13
Speaker 3
But I also really enjoyed all the different cultural differences that come together to really impact our health. So when I was at our program, the program here was very large. 76 residents in the program at a time in internal medicine. It was extremely diverse. So I first really got to learn a lot about cultural competence from my colleagues.

00:04:08:20 - 00:04:35:00
Speaker 3
I had a lot of colleagues that were from every continent you could think of in every country, some of which were practicing physicians in their country. And then they came here to do their residency and move to America. So I got to learn quite a bit about that. And then Las Vegas in general is so incredibly diverse. We have lots of different populations that make up our patient pool, and that isn't even including the people who come to visit Las Vegas.

00:04:35:06 - 00:04:36:19
Speaker 3
So lots of different things.

00:04:37:14 - 00:05:04:10
Speaker 2
Your practice or with your residency at the county hospital, you. So all these people. You also had different colleagues who came from different countries. So you got exposed to all those things and then you became interested in solving this and one of a population. But now that you're working at Toronto right now, how are you being able to demonstrate all of these barriers to care or barriers to access to your students?

00:05:04:11 - 00:05:11:04
Speaker 2
What are some of the strategies that you use so that our students are exposed to what happened with this population?

00:05:12:05 - 00:05:32:23
Speaker 3
Well, in our program where we teach the physician assistants, and I'm sure in most programs we try to expose them early to the concepts of implicit bias and how important it is to learn about different cultures. I tell my students that when I was a medical student, myself, fortunately, it's much more common to teach you about cultural competence now.

00:05:33:04 - 00:05:57:09
Speaker 3
I don't remember having formal training in that, but I tell people that I really thought when I was a medical student that if I could speak every language, that I could talk anybody into doing anything. I really honestly thought that. And it turns out that you really need to understand. You don't need to understand every nuance. And in fact, the word cultural competence suggests that there is a point at which you are competent.

00:05:57:15 - 00:06:23:20
Speaker 3
And that's not really the case. It's an ongoing process, and you're always learning more about your patients and intersectionality and all of the different things that come into cultural competence. But I let people know if you don't understand people's culture, if you don't understand where they're coming from, you won't understand their barriers and you really won't be a very effective practitioner because you're not going to be able to convince people to do things just by telling them to do so.

00:06:25:05 - 00:06:40:10
Speaker 2
So can you give us an example of a barrier to access or care for our non-medical listeners, an example of a barrier to care and maybe intervention that your use in order to overcome that barrier to care?

00:06:41:03 - 00:07:06:12
Speaker 3
The state of Nevada is where we're doing much better, but we are always on kind of the low list of people of access to care as far as how many practitioners we have. So we deal with a lot of populations that have higher priorities than their medical care, unfortunately, such as where they're going to stay the night, where they're going to get their food, things like that.

00:07:06:18 - 00:07:35:03
Speaker 3
We have a rather large homeless population here in Las Vegas. And so for homeless populations, they very well qualify for Medicaid They may even have a Medicaid card on them. But if we don't come to where they are, the likelihood of them accessing medical care is very low. And typically they will wait until a problem is a very big problem and then they'll access medical care by calling 911.

00:07:35:12 - 00:08:08:21
Speaker 3
So some of our programs are with the mobile medical unit and also with going out with harm reduction teams. We go to the people. There's people who live here and unsheltered homeless people live in tunnels here or in the desert or on the outskirts of town. And we literally bring our medical care to them and help them. Sometimes all we can do is some wound care or some really good advice or tell people this is a serious problem or this could be a serious problem and you need to get more care.

00:08:09:02 - 00:08:18:22
Speaker 3
Sometimes just the access, the barrier of transportation, getting to where you need to be or accessing technology to make an appointment can be too much for some people.

00:08:20:00 - 00:08:37:11
Speaker 2
So each year of the student start going to the population. I think in the beginning they are in the classroom learning things and then at some point they have to start the clinics. So at what point in their education they start going to the people and start meeting them when they are.

00:08:38:05 - 00:09:09:22
Speaker 3
In the program? They have about 18 months of didactic lecture and then there's a full year of 12 months of rotations. We start them very early after their first trimester, their first session. We encourage them, don't require them to go out and do volunteer opportunities so they can start using the skills that they're learning right there. And then vital signs and physical exam they can start learning those right away as volunteers during didactic.

00:09:10:04 - 00:09:37:02
Speaker 3
They don't do it more than once a month. And there's people who choose to do it every month during the clinical year, just as there is a required internal medicine, family practice, OB-GYN, pediatrics rotations. One of the required rotations we have is called Community Medicine, and that's where I have one whole month to teach the students about populations that they may not have a lot of access to during their normal life.

00:09:37:09 - 00:10:04:07
Speaker 3
Almost every single student goes through the program. Sometimes they do kind of a sort of an elective instead. But during my months with them, we expose them to domestic violence victims, LGBTQ patients, we people struggling with substance use we take them to free clinics that for people who are uninsured, we expose them to a lot of different populations that they might not have had access to previously.

00:10:05:06 - 00:10:32:11
Speaker 2
When you get these two beds, I think when someone is going to med school on a program, this may not be on the top of their mind. And so when they started community medicine, by the time they finish it, how does their attitude or how does their awareness of these issues change? Do you see a big jump in their attitude towards this people and their affinity in serving this kind of population?

00:10:33:05 - 00:11:00:07
Speaker 3
I absolutely do. I will say it's interesting. We do a sort of an exit interview with people and ask people, why did you choose our program? Why did you choose to grow Nevada? And people list academics first, but they list our community outreach a second. So the people coming into our program, we were already choosing people who have an affinity towards helping the population and and helping people who really need need care.

00:11:00:13 - 00:11:30:01
Speaker 3
And I think that most students go into medical school and school thinking that they really want to help people and really want to be effective practitioners. So I don't I can't talk people into loving their their neighbor more. That's not really what what I can do as a as a professor, but as an educator, I can tell I can teach people to be a little more compassionate instead of just seeing somebody who has all kinds of messed up when they show up in the emergency room.

00:11:30:01 - 00:11:56:01
Speaker 3
And they're in a terrible situation medically. I can show them where they live. I can show them what their priorities are and how it is that people got to be where they are. And this may be the only chance they have to drive around and see these kinds of conditions. And these are really impactful experiences that I talked to people who graduated years ago, and they they still remember these experiences.

00:11:56:01 - 00:12:04:24
Speaker 3
So I think it makes people. I would like to think more compassionate, but it certainly teaches people to be more effective as practitioners also.

00:12:05:09 - 00:12:28:05
Speaker 2
I think it's such a beautiful service that we are doing our students, especially on helping students see that and understanding what it is. And, you know, some of the tools that we use like implicit bias and cultural competence. So I want to go back to the cultural competency. Again, you touched on that a little bit and you said that we need to be aware or be culturally competent to be effective practitioner.

00:12:28:19 - 00:12:34:23
Speaker 2
Can you give us some examples for our listeners about cultural competence? What is cultural competence?

00:12:36:01 - 00:13:05:23
Speaker 3
Cultural competence, which has to start with addressing our own implicit bias, cultural competence is, I think, just being the awareness that there are people that have different ideas and different priorities and different ways of thinking about things. And I just think that if we're not thinking ahead as to what people are motivated by, we'll never be able to motivate them to take better care of themselves.

00:13:06:08 - 00:13:28:13
Speaker 3
And we should treat everyone with the same amount of compassion. We should treat people as though they're are family members with that much love and compassion. But if we don't meet people where they are, that's a lot of different things. And that really goes beyond just race and ethnicity. It goes towards what people were exposed to, what people find important.

00:13:28:19 - 00:13:54:03
Speaker 3
And so cultural competence isn't just being able to take care of Ethiopian populations, which we have quite a bit of in Las Vegas. It's also being able to take care of older folks or LGBTQ populations. There's there's just a lot of different cultural nuances that if we can just be open to being more proficient we'll be far, far better practitioners.

00:13:55:08 - 00:14:17:03
Speaker 2
That's great. Awesome. Tomorrow, we have other colleges that help you, of course, be how to be a program and sciences program, pharmacy program. These are places where our faculty and students will be able to come out and maybe do the community innovation or work with your team as what it is. But how can a regular or faculty member.

00:14:17:22 - 00:14:34:10
Speaker 2
Not necessarily one in a health good school. How can they bring the need for cultures, competence and sense of duty to their own classrooms? Can you give them some examples as to how they can impact the students on the need of cultural competence?

00:14:35:16 - 00:15:05:20
Speaker 3
There's a lot of ways that people can talk about their own culture, and that's we have a very diverse faculty, and that's where I learned a lot, is talking to my colleagues and talking to people about their own culture and how that might impact health care. But I think it also begins with Inter-professional education. We bringing together pharmacy together with medicine, together with studies and OT, and we can learn a lot from each other that way as well.

00:15:06:06 - 00:15:49:01
Speaker 3
I think the students learn about hearing the same thing in different voices from different people's experience. I think there's a lot of opportunities. I would also say that even during didactic, when it seems like cultural competence isn't at the forefront. I would say that there are subtle ways that we can include more information for students, and that might just be when we were coming up with clinical examples or social examples or even just slide decks that have what an African-Americans disease process physically looks like versus a lot of slide decks are really oriented toward showing pathology on bright people, for example.

00:15:49:06 - 00:16:14:10
Speaker 3
And it's hard to define disease. Pictures of people with different ethnicities, people of color. So I think there's a lot of ways you can at being mindful of cultural competence when you're putting together even basic slides, I think goes a long way towards teaching people how important this is. We are very intentional at Tau University in Nevada about having some a few large events each year.

00:16:14:18 - 00:16:39:23
Speaker 3
Most all of our students are really interested in doing community outreach. It brings us all together when we do large events. We do a large event each year called Project Homeless Connect, which we don't share the event. It's shared by a local organization about homeless lions, but we chair the medical dental section at tomorrow, so we're able to bring together our students, students, APM students.

00:16:39:23 - 00:17:04:19
Speaker 3
Anyone who wants to participate comes, and it's a it's a large one day event. We encourage people to come and do what they do best. So Oty is check people for their balance, and we address a lot of different needs in the community all at the same time at that event. We encourage as many people as want to participate even people in other colleges like education, certainly have something to offer the population.

00:17:05:09 - 00:17:33:23
Speaker 2
Great. Hopefully our listeners hearing this can reach out to you and find out ways in which they can be a support to their own community. Because of course, in New York and thankfully we still have the same kind of population, the homeless population, the population. It's a lot in these companies and students. Well, thank you so much for talking to us today about your service in your community and teaching your students how to serve the community better and up to you.

00:17:34:06 - 00:17:55:18
Speaker 2
And I think the one word that you kept seeing, which is so meaningful, is meeting the patient with the hour. It is so important. In fact, I think if every practitioner starts thinking like that, it can reduce that barrier to access and care to a great extent. Well, thank you so much for giving that idea into our heads and talking to us about it.

00:17:56:04 - 00:18:05:19
Speaker 2
It was a pleasure having you with this. Thank you to our listeners before another episode of the faculty signing off is and is becoming.

00:18:08:00 - 00:18:34:19
Speaker 1
Thank you for tuning in to the Faculty Chronicles TFC Pearls podcast featuring the projects and work of faculty throughout the tural college and University System. TFC is sponsored by the Office of the Provost and Kettl, the Center for Excellence in Teaching and Learning. We hope you like what you heard and we'll keep listening. So join us next time on the Faculty Chronicles as we highlight and share faculty achievement.

00:18:35:01 - 00:18:39:17
Speaker 1
That build community connection and continuous conversation.