Can you teach someone to care for a person who is profoundly different from them?
Can you teach someone to provide care that isn’t simply accepting of differences, but actually tends to all the ways those differences are impacting a patient’s health?
The faculty at Samford University’s McWhorter School of Pharmacy can. In fact, they must. They’re required to do so by the accreditation body that sets the standards for the education of pharmacists.
In addition to teaching students information like the physicochemical properties of drugs or the mathematical calculations involved in dosing, pharmacy programs are required to help their students develop complex interpersonal skills such as cultural and structural humility, advocacy, and interprofessional collaboration. The Accreditation Council for Pharmacy Education requires that all pharmacy programs prepare students to provide “whole-person care.”
Whole-person care, according to the World Health Organization, requires that providers learn to see that a patient’s health is not just the result of biomedical factors. Psychosocial, cultural, and environmental forces also shape our well-being. Providing whole-person care means crafting treatment plans that address all of those forces. It’s impossible to provide this kind of integrated care without strong interpersonal skills. Graduates of accredited pharmacy schools—like other institutions that train health care professionals—must know how to “actively engage, listen, and communicate” and “to mitigate health disparities by considering, recognizing, and navigating cultural and structural factors.”
How, exactly, does an institution help students engage with each patient as a person with their own needs, beliefs, and cultural norms and as a person whose health might be impacted by structural forces like environmental racism or anti-fat bias? The McWhorter School of Pharmacy offers a helpful model in teaching people to care in complex, comprehensive ways for people who are different from them.
The “other culture” assignment
Jonathan Thigpen has come up with creative, impactful strategies for teaching these skills during his tenure as assistant dean of Samford University’s McWhorter School of Pharmacy.
Thigpen and his colleagues have crafted a curriculum in whole-person care that runs throughout a doctoral student’s time at Samford. One of the assignments he gives first-year students—the “other culture” assignment—is emblematic of this work. Thigpen created the assignment in response to an unsettling observation. Across many years of teaching, he noticed in his students a growing reluctance to get out of their comfort zones. He says he saw an “increasing unwillingness to try something new, to take a risk, to put yourself out there.” It was disconcerting because, as Thigpen says, “you have to be able to do that as a health care provider.”
The assignment involves:
- Visiting a site or event that is part of an “other” culture. It can be any culture about which the student is curious; it just has to be different from the student’s own background. The student should ask permission to attend if necessary.
- Staying immersed and present for at least one hour. The student must go have an individual experience. They can’t bring a friend or go with a group of people from class. The student must stay off of their phone and avoid taking photos, pictures, and notes or do anything else that might take them out of the experience or make them seem like a “tourist” in the place.
- Writing a two- to three-page reflection essay. The reflection should connect the student’s experience to topics they have discussed in class, covered in readings, or analyzed in other assignments.
The results were remarkable. Samford is a private Christian university outside Birmingham, Alabama, and many of Thigpen’s students use this assignment as an opportunity to experience a new faith community. Protestant students have attended Catholic services. Catholics have attended Protestant services. Other students have chosen to experience events or spaces associated with classes, races, and genders other than their own. One young woman went to a car auction, an event that’s typically more popular with men. Another student who has a white-collar career ate lunch at a blue-collar cafeteria.
Sometimes the “other” culture a student chooses to experience is one that they’ve been taught to fear or avoid. One student grew up with a family member who had a gambling problem, and they had been warned of the dangers of gambling for as long as they could remember. They had never stepped foot inside a casino but harbored plenty of curiosity. This assignment afforded them the opportunity to better understand a place that held such charge for their family.
Overwhelmingly, students report having positive experiences and share significant insights about the power of connecting with different people and cultures. An international student who chose to visit a cattle stockyard in Texas noticed there’s a big difference between consuming media about a place and interacting with it themselves. In their paper, they observed, “Even though I have heard and seen a lot about Texas, it felt so different when I experienced it in real life. I think to know a culture, it is not enough to just watch their movies or read about them in magazines. What we feel and experience when interacting with them or join[ing] some of their traditional events is so much more valuable.”
When a white student visited a Black church, they realized that encountering other cultures can be easier than expected. They noted, “This experience taught me that all my anxiety about being in a different cultural setting was my own issue. I was surrounded by people different from me, yet everyone treated me like family. No one cared about the color of my skin, and I realized that my initial fears had been unnecessary. I had worried that my presence might be disrespectful, but, instead, I was welcomed with kindness.”
After administering the “other culture” assignment for many years, Thigpen made an unexpected observation. Students don’t need to encounter a dramatically different culture or bridge an emotionally charged divide in order for the cross-cultural experience to have a deep impact. Sometimes crossing a small bridge can create big change.
Take Briana Watson’s story. Watson decided to visit a European antique store that happened to be owned by a member of the Samford faculty—a white woman of European descent. Watson is Black and hails from a small town a few hours outside of Birmingham.
Watson recalled feeling a bit guarded as she first entered the store. Her body remembered childhood excursions to stores full of delicate items, being told to hold still and don’t touch anything. But when she stepped through the doors, her professor warmly welcomed her and the tension melted away. Watson and the professor struck up a conversation and discovered they share more in common than they expected.
“There was so much to unpack beyond the antiques,” Watson said. “She comes from a military family as do I,” she remembered, “so really connecting over the understanding of service and the love of service and the work ethic that comes behind that started to bridge the gap.”
Watson started the day thinking I’m going to see my professor, but, by the end of the visit, she had a level of connection and trust that became the foundation for a deep, long-lasting relationship. Watson ended up returning to the store many times. This professor became one of her most trusted mentors, and they even went to Spain together on a study abroad trip.
The experience helped Watson develop an awareness of the ways in which the roles of professor and student or pharmacist and patient can create a structure or hierarchy that isn’t always useful when you need to build trust or ask for support. She explained, “I think when we’re always in these structured learning environments, we tend to look at our relationships as that structured dynamic, too. After breaking away from that and . . . getting to know more about her culture, we’re more inclined now to ask her questions if we need help. We’re more inclined to just sit in her office and talk now.”
The experience also gave Watson a chance to reflect on how someone creates an interpersonal encounter that actually feels welcoming and fosters connection. She wants to carry those lessons into her work as a pharmacist. “What stuck with me the most,” she said, “is how I have to be intentional about creating that space with anyone, whether it be a friend or a patient. . . . It’s more about leaning in and asking the follow-ups and being intentional and also having the humility to accept viewpoints that are different than your own. It’s like, OK, this is the person that I want to be in the world and I’m going to make strides towards that.”
Noticing who we want to be in the world and taking repeated action to become that version of ourselves are important components of character development. It’s clear that Watson engaged with the “other culture” assignment as a character-building experience. That’s no accident.
Designing for character development
Character scientist Elise Dykhuis notes several features built into Thigpen’s assignment that make it more likely that students have a character-building experience instead of a simply memorable one, whether you’re looking to strengthen your own capacity to care across differences or you’re responsible for helping develop the character of others.
Establish trust and relevance. If you’re designing an experience for someone else and especially if you’re making it mandatory, like Thigpen does, take the time to build a foundation of trust. All Samford pharmacy first-year students take the “Foundations of Health and Pharmacy” series, and this assignment comes toward the end of the semester, after students have been through lectures and readings about bias and cultural humility. Thigpen has had time to build trust with his class, demonstrating the curiosity, intellectual humility, patience, and empathy that he wants his students to exercise.
He has also introduced why this experience is relevant to their professional development. He establishes it as an opportunity to do something that researchers call “self-expansion.” Research finds that there are many benefits to understanding difference not only as something to tolerate or to manage, but as an opportunity to learn, to broaden one’s perspective, and to expand the self. When people have strong motives to self-expand and they anticipate growth from an interaction, they report greater interest in engaging with people from different groups and they show patterns consistent with more high-quality contact in their interactions with people from different groups.
Leverage curiosity and autonomy. This assignment is driven by curiosity. Thigpen asks his students to consider their own curiosities. Are there cultures or groups of people that have stoked their curiosity? Curiosity gives students the leverage to get over the barrier of discomfort and take the first step. Students are also afforded the autonomy to choose the experience they want to have. Dykhuis explains that, according to self-determination theory, autonomy is one of the key factors “when we’re thinking about what we can use to promote intrinsic motivation in the long run, which is what we really need as adults in order to change something about ourselves or develop ourselves.”
Reflect. Thigpen’s reflection paper is key to the assignment’s efficacy. Dykhuis notes that multiple literatures about self-development stress the importance of reflecting on an experience right after it happens, but we often struggle to provide ourselves with the opportunity to do it. If we pause, reflect, and make meaning after an encounter, we’re more likely to let ourselves be changed by it.
Prioritize encouragement and enjoyment. Thigpen’s assignment is a one-time experience, but there are things we can add to the experience to help encourage longer-term development. As Dykhuis and her colleagues explain, the personality and character change research says if we want people to change or develop on their own long-term, encouragement and enjoyment are key. Encouragement comes from being integrated into a community and forming relationships. When we’re part of a community of other practitioners and practitioners-in-training (like the pharmacy students are), we’re reminded to stick with it. When we build connections to people whom we care about, they help keep us accountable. Plus, we’re surrounded by people modeling the attitudes and skills we want to develop.
Don’t forget the fun. Many students report that once they muster up the courage to try their first formal bridging encounter, they realize that it’s not as hard as they thought it would be. It’s actually quite enjoyable to connect with people who are different from them and to have new experiences.
No one is going to learn how to provide whole-person care over the course of one semester. It could take an entire career of deep dedication to live up to the standard of care that professional organizations like the American Association of Colleges of Pharmacy and the American Pharmacists Association set for their fields. The systemic factors that shape social determinants of health are complex and dynamic. The contexts in which health care providers meet and tend to patients are ever-changing. However, when we focus on developing the character strengths we need to connect across differences, we can keep building our capacity to meet and care for people where they are, in their full complexity. And, as a bonus, we get to bring the courage, curiosity, intellectual humility, patience, and empathy that we’ve cultivated into other areas of our lives, as well. How fun is that?!