Medical Cultures Lab (MCL)

Mural PaintingThis summer, I received two grants from the National Institutes of Aging (NIH/NIA) to boost the scope and visibility of the Medical Cultures Lab (MCL), which I established at IHPS in 2015. MCL works to understand the culture of medicine and advance health equity. It is a voluntary intellectual community (not unlike IHPS) whose members support each other’s work in these areas. As founder and head, I pursue my own projects (with my research team) and help develop partnerships and resources to sustain MCL’s infrastructure. All members contribute to setting the Lab’s direction and deciding its activities with leadership from MCL co-directors Alissa Bernstein and Sarah Garrett.

 

NIA support will allow us to accelerate MCL’s work on medical culture and equity while opening up some exciting new training, research, and translational possibilities. The talent, breadth, and depth of the work done by MCL members were crucial in competing for these NIH awards:

 

  • Leadership to Enhance Aging Research and Innovation in Medical Culture (LEARN-MC): expand teaching and mentoring on medical culture at UCSF
  • Diverse Cultures, Ethnography, and Decisionmaking in Dementia – Implications for Medical Culture (DISCERN-MC): develop new approaches and methods to conduct research on culture and medicine in the context of health and aging

LEARN-MC is a K07 Academic Leadership Career Award. The goal is to establish new resources to support UCSF investigators, trainees, and students to conduct rigorous research on medical culture and aging — with a special emphasis on those using qualitative methods. LEARN-MC will allow us to establish MCL as a Center of Excellence for Research on Culture. Over the next few months, we will expand the MCL website to include essential literature for studying culture, best practices for qualitative research, and strategies for cultural analysis including manuscript and grant writing. LEARN-MC will partner with existing hubs for culture and aging at UCSF — the UCSF Pepper Center (geriatrics), Global Brain Health Institute (neurology), and Center for Aging in Diverse Communities (general medicine). We hope to avoid re-inventing the wheel as we support the incredible investigators and trainees in those units who are studying culture, medicine, and health. LEARN-MC will also support development of three new courses on techniques for research on medical culture, including how to translate research into policy and practice for equity. These courses will be online, asynchronous, and free of charge. MCL will back up the coursework with mentorship and guidance for investigators (including students, fellows, faculty, and staff) launching projects in the field.

 

For me personally, LEARN-MC is an exciting opportunity to focus more time on things I love: teaching qualitative methods, learning about medical culture, and building a community focused on equity.

 

I am as excited about new work for DISCERN-MC, which will develop new approaches for studying culture in the context of aging and dementia among diverse populations. I have been using ethnography to study culture since the 1990s and have long sought ways to improve the method. Understanding culture can inform policies so they are responsive to stakeholder needs, and it can support change in healthcare organizations. Rigorous research on culture is essential in work on equity as a means to ensure inclusiveness and authentic engagement while avoiding stereotypes and stigma. At UCSF, my work has mostly been on culture and cancer, but I’ve shifted towards aging, frailty, and neurology more recently – inspired by Emily Finlayson’s work on system-level strategies to reduce surgical suffering among older adults. Work with MCL members Alissa Bernstein, Liz Dzeng, and Krista Harrison has deepened my appreciation of the field, and my family experiences with Alzheimer’s disease and related dementias (ADRD) also informs my work.

 

DISCERN-MC uses comparative ethnography to examine how culture shapes the way individuals from diverse backgrounds make important decisions as they navigate the terrain of ADRD. Understanding this process can help inform development of policies that are more sensitive to the variety of ways in which ADRD is understood and managed within affected communities. In NIH-speak, DISCERN-MC is a DP1 mechanism — a Director’s Pioneer award to support high risk/high reward projects. NIA set up a DP1 call to elicit new ideas from behavioral and social scientists for ADRD research. Given the lack of diagnosis, effective treatment, or cure, experts have increasingly recognized the need to shift the culture surrounding this illness. New social and policy initiatives are urgently needed. As a high-risk project, DISCERN-MC faces some unusual hurdles. We don’t have the proper research tools to carry out this project, so our first task is to build on prior work (funded by PCORI) to develop new fieldwork methods and analytical software. COVID presents another hurdle as it means we can’t get in to the field for the time being. There are three other NIA DP1 awardees around the country. We have discovered our projects overlap quite a bit with a common focus on diverse and underserved populations, qualitative work, and prioritizing community needs.

 

I look forward to diving into this work on culture and equity and want to encourage anyone interested to learn more about MCL and meet the team.