Section: Module 11. Marginalization (Choose at least 5 lessons to complete from those available, based on your interests and educational and professional needs.) | Humanism in Health and Healthcare | NextGenU.org

  • Competencies covered in this module:

    Knowledge for Practice (AAMC) 

    • Demonstrate knowledge of established and evolving biomedical, clinical, epidemiological, and social-behavioral sciences, as well as the application of this knowledge to patient care. (AAMC 2)

    • Apply principles of epidemiological sciences to the identification of health problems, risk factors, treatment strategies, resources, and disease prevention/health promotion efforts for patients and populations. (AAMC 2.4)

    • Apply principles of social-behavioral sciences to provision of patient care, including assessment of the impact of psychosocial and cultural influences on health, disease, care seeking, care compliance, and barriers to and attitudes toward care. (AAMC 2.5)

    Professionalism (AAMC)

    • Demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles. (AAMC 5)

    • Demonstrate accountability to patients, society, and the profession. (AAMC 5.4)

    • Demonstrate sensitivity and responsiveness to a diverse patient population, including but not limited to diversity in gender, age, culture, race, religion, disabilities, and sexual orientation. (AAMC 5.5)

    Patient Care (AACOM) 

    • Demonstrate cultural awareness and sensitivity when communicating with the patient, family, and caregivers. (AACOM III. 5g)

    Professionalism: Cultural Competency (AACOM) 

    • Demonstrate awareness of and proper attention to issues of culture, religion, age, gender, sexual orientation, and mental and physical disabilities. (AACOM V. 7)

    • Demonstrate how to cope with differences in people in a constructive way. (AACOM V. 7d)

    Practice-Based Learning and Improvement (AACOM) 

    • Describe and apply systematic methods to improve population health. (AACOM VI. 5)

    • Identify the determinants of populations’ health. (AACOM VI. 5a)

    • Identify sources of disparities in populations’ health and access to care.  (AACOM VI. 5b)

    • Identify vulnerable or marginalized populations within those served, and respond appropriately. (AACOM VI. 5c)

    Cultural Competencies (AACOM) 

    • Demonstrate an understanding of the scope of culture and the elements that form and define it. (AACOM IX. 1)

    • Recognize personal and professional tendencies toward bias and stereotyping and work to counter them. (AACOM IX. 2)

    • Understand the public health implications of cultural competence in health care. (AACOM IX. 3)

    • Demonstrate familiarity with basic religious and cultural beliefs that affect patients’ understanding of the etiology of their illness and/or the efficacy of their treatment. (AACOM IX. 4)

    • Use the cultural profile and history in the treatment of individual patients and record them appropriately in the medical record. (AACOM IX. 10)

    • Use the cultural profile and history with individual patients to assess healthcare needs in the community. (AACOM IX. 11)

    Public Health Systems Competencies (AACOM) 

    • Assesses and address the determinants of health and illness factors contributing to health promotion and disease prevention. (AACOM X11. 2)

    • Apply basic public health principles, practices, and sciences to the practice of osteopathic medicine.(AACOM X11. 4)

    • Understand and apply knowledge of cultural differences to improve public health among divergent populations. (AACOM X11. 7)

    Global Health Competencies (AACOM)

    • Identify and treat individual patients with varying cultural beliefs regarding health, disease, and patient care. (AACOM XIII. 6)

    • Essential VII: Clinical Prevention and Population Health - Assess health/illness beliefs, values, attitudes, and practices of individuals, families, groups, communities, and populations. (AACN 3)

    Essential VIII: Professionalism and Professional Values (AACN 6)

    • Reflect on one’s own beliefs and values as they relate to professional practice. (AACN 6)

    • Professionalism: Demonstrate sensitivity and responsiveness to a diverse patient population, including but not limited to diversity in gender, age, culture, race, religion, disabilities, and sexual orientation (AAMC 5.5)

    • Module 11: Lesson 1: Global Health and Cross-Cultural Practice

      Learning Objectives:

      Upon completion of this lesson, you will be able to:

      • Articulate best practices for conducting ethical and humanistic global health work.

      • Analyze the ethical dilemmas inherent to global health work and offer insights into how to navigate the potential for harm by medical volunteers to underresourced countries by drawing on global health best practices.

      • Identify the causes and ethical dilemmas posed by medical “brain drain” (the migration of health professionals from relatively resource poor nations to wealthier nations with less actual need).

      Approximate time required for the readings for this lesson (at 144 words/minute): 2 hours and 45 minutes.

      Required Learning Resources and Activities
    • url icon
      Virtue and Care Ethics & Humanism in Medical Education: a Scoping Review URL
      Students must
      View

      Read the contents under the heading "Background, Results, and Discussion". (7 minutes)

      BMC Medical Education - 2022

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      More Harm Than Good? The Questionable Ethics of Medical Volunteering and International Student Placements URL
      Students must
      View

      Read the content from "Ethical Concerns in Medical Volunteering" until "Evaluating the outcome of medical volunteering on local health" (36 minutes)

      Tropical Diseases, Travel Medicine and Vaccines, published by BioMed Central - 2017

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      Medical “Brain Drain” and Health Care Worker Shortages: How Should International Training Programs Respond? URL
      Students must
      View

      Read the content under the heading from "Medical Brain Drain as Exploitation of Wealth Disparities" until "Funding and Policy Solutions to Medical Brain Drain" (12 minutes)

      AMA Journal of Ethics - 2016

    • Module 11: Lesson 2: Issues of Class and Poverty

      Learning Objectives:

      Upon completion of this lesson, you will be able to:

      • Articulate the impact of socioeconomic status on patients’ health status and health behaviors.

      • Demonstrate critical thinking about the needs of patients who face socioeconomic disadvantage and articulate creative approaches to clinical care that are sensitive to the challenges they face.

      Approximate time required for the readings for this lesson (at 144 words/minute): 1 hour and 33 minutes.

      Required Learning Resources and Activities
    • url icon
      Explaining Socioeconomic Disparities in Health Behaviours: A Review of Biopsychological Pathways Involving Stress and Inflammation URL
      Students must
      View

      Read the following sections "2.1. Social inequality in health" "2.2. Social inequality in stress" "2.3. Social inequality in health behaviours,"'5.2. Different SES indicators may reflect different types of resources and adversities which may tap into different causal explanations of health behaviours" (31 minutes)

      Science Direct- Neuroscience & Biobehavioral Reviews - 2021

    • Module 11: Lesson 3: Race/Ethnictiy and Health

      Learning Objectives:

      Upon completion of this lesson, you will be able to:

      • Identify racial or ethnic minorities in a society that are marginalized.

      • Identify multiple pathways by which structures of marginalization directed at ethnic and racial minorities lead to poorer health.

      Approximate time required for the readings for this lesson (at 144 words/minute): 1 hour and 9 minutes.

      Required Learning Resources and Activities
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      Racism and Health: Evidence and Needed Research URL
      Students must
      View

      Read the following sections: Abstract, Racism and Health, Racial Residential Segregation, Epidemiological Evidence Linking Segregation to Health, Cultural Racism, Cultural Racism and Health and Discrimination. (23 minutes)

      National Library of Medicine: National Centre for Biotechnology Information - 2019

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      Recommended Additional Readings
    • url icon
      Achieving Racial and Ethnic Equity in U.S. Health Care URL

      Read from the Introduction to Conclusion. (29 minutes)

      The Commonwealth Fund - 2021

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      Racial and Ethnic Differences in Presentation and Outcomes for Patients Hospitalized With COVID-19: Findings From the American Heart Association’s COVID-19 Cardiovascular Disease Registry URL

      Please read Introduction, Discussion, and Conclusion. (11 minutes)

      AHA Journals - 2020

    • forum icon
      Asynchronous Learning Activity 1: Race/Ethnicity and Health (270 minutes) Forum

      In this activity, you will compare and contrast the health status and experiences of two different races and discuss, focused on substance use disorders, how race influences a patient’s health status and experiences.

      Step 1. Select (10 minutes)

      Select one racial minority in your country or region. 

      Example: Hispanics in the United States

      Step 2. Compare and contrast (30 minutes)

      Compare and contrast your selected racial minority with a racial privileged or majority, i.e., “White” Americans, in terms of the following indicators:

      • Health status

      • Health care access and affordable coverage

      • Access to substance use and abuse care and treatment

      Step 3. Respond (210 minutes)

      Imagine yourself as a contributing writer for a medical journal, tasked to write an article for this month’s theme on Race and Health. 

      Prepare a 300-700 word article that discusses the following key components:

      • Difference between your selected racial minority and racially privileged group in terms of

        • Health status

        • Health care access and affordable coverage

        • Access to substance use and abuse care and treatment

      • Needs of the racial minority facing health disadvantages

      • Creative approaches to address the problem and promote racial health equity and better access to substance use and abuse care and treatment.

      Step 4. Submit (10 minutes)

      To submit your audio recording, click on the “Add a new discussion” button under this post and paste your work into the “Message” box. Make sure to reference others’ intellectual property when necessary. All references should follow 7th Edition APA formatting. For further instructions, see the resource on the Himmelfarb Health Sciences Library: APA citation resource (N.B. references are excluded from word counts).

      OPTIONAL Step 5: Interact (10 minutes)

      If you would like to, you can reply to your peers' posts in a respectful and professional manner. Ensure that your post engages your peers' ideas by including a reflection on their comments, sharing ideas of other potential difficulties and parties involved, or asking thought-provoking questions. If a peer comments on your posting, please reply. To post a reply, click “Reply” on a particular discussion, write your feedback and then click on “Post to forum.”

    • Module 11: Lesson 4: The Health of Immigrants, Refugees, and Displaced Persons

      Learning Objectives:

      Upon completion of this lesson, you will be able to:

      • Discuss different perspectives on the ethical obligation to provide health care to undocumented immigrants.

      • Articulate the impact of immigration and/or refugee status on patients’ health and their experiences with health and health care.

      • Demonstrate critical thinking about the needs of patients who face health disadvantages because of their immigrant/refugee status and articulate creative approaches to clinical care that are sensitive to the challenges they face.

      Approximate time required for the readings for this lesson (at 144 words/minute): 1 hour and 18 minutes.

      Required Learning Resources and Activities
    • url icon
      Access to Health Care for Illegal Migrants: Ethical Implications of a New Health Policy in the UK URL
      Students must
      View

      Read the entire article. (9 minutes)

      British Journal of General Practice - 2019

    • url icon
      Barriers to Accessing Health Care Among Undocumented Migrants in Sweden - a Principal Component Analysis URL
      Students must
      View

      Read the content under the heading "Background", "Barriers to health care", "Large need for health care and risk factors for illness" and "Discussion". (17 minutes)

      BMC Health Services Research - 2021

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      Recommended Additional Readings
    • url icon
      Immigration as a Social Determinant of Health URL

      Read the entire article. (4 minutes)

      Annual Review of Public Health - 2015

    • Module 11: Lesson 5: Gender and Health

      Learning Objectives:

      Upon completion of this lesson, you will be able to:

      • Articulate the impact of gender on patients’ health and their experiences with health and health care.

      • Demonstrate critical thinking about the needs of patients who face health disadvantages because of gender norms and associated stigmas and articulate creative approaches to clinical care that are sensitive to the challenges they face.

      Approximate time required for the readings for this lesson (at 144 words/minute): 1 hour and 6 minutes.

      Required Learning Resources and Activities
    • url icon
      Gender Disparities in Clinical Practice: Are There Any Solutions? Scoping Review of Interventions to Overcome or Reduce Gender Bias in Clinical Practice (2020) URL
      Students must
      View

      Read from the Introduction to Conclusion. (22 minutes)

      International Journal for Equity in Health - 2020

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      Recommended Additional Readings
    • url icon
      The Promises and Limitations of Gender-Transformative Health Programming with Men: Critical Reflections from the Field URL

      Read the entire article. (47 minutes)

      Informa UK Limited, Taylor & Francis Group - 2015

    • Module 11: Lesson 6: LGBTQ+ Persons and Health 

      Learning Objectives:

      Upon completion of this lesson, you will be able to:

      • Articulate the social and humanistic factors affecting the health of patients who identify as LGBTQ+, including their experiences in society at large, and the health care system in particular.

      • Demonstrate critical thinking about the needs of patients who face health disadvantages because of their identification as LGBTQ+ and associated stigmas and articulate creative approaches to clinical care that are sensitive to the challenges they face.

      Approximate time required for the readings for this lesson (at 144 words/minute): 1 hour and 24 minutes.

      Required Learning Resources and Activities
    • url icon
      Understanding the Health Needs of LGBT People URL
      Students must
      View

      Read the report. (28 minutes)

      National LGBT Health Education Center, A project of the Fenway Institute - 2016

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      Recommended Additional Readings
    • url icon
      Health Inequities in LGBT People and Nursing Interventions to Reduce Them: A Systematic Review (2021) URL

      Read the Introduction and Discussion. (23 minutes)

      International Journal of Environmental Research and Public Health - 2021

    • Module 11: Lesson 7: Incarcerated and Formerly Incarcerated Persons

      Learning Objectives:

      Upon completion of this lesson, you will be able to:

      • Articulate the social and humanistic factors affecting the health of patients who are incarcerated or formerly incarcerated, including their experiences in society at large, and the health care system in particular.

      • Describe ethical dilemmas that can emerge for clinical practitioners caring for patients who are incarcerated or were formerly incarcerated.

      • Demonstrate critical thinking about the needs of patients who face health disadvantages because of incarceration status and associated stigmas and articulate creative approaches to clinical care that are sensitive to the challenges they face.

      • Compare the difference between the minimum care a physician is obligated to provide within a criminal justice setting from the standard they are held to in the free world and describe measures that you could take as a physician to anticipate and meet the health needs of incarcerated or formerly incarcerated patients (see in particular the AMA Journal of Ethics case study.

      Approximate time required for the readings for this lesson (at 144 words/minute): 3 hours.

      Required Learning Resources and Activities
    • url icon
      Caring for Ex-prisoners Presents Management Challenges URL
      Students must
      View

      Read the entire article. (12 minutes)

      ACP Internist and American College of Physicians - 2017

    • url icon
      What Does Health Justice Look Like for People Returning from Incarceration? URL
      Students must
      View

      Read the content under the headings "Incarceration and Health in the United States" Assessing the Needs of All Persons and Populations Equally", "Recognize and Rectify Historical Health System Injustices, Advocate for the Provision of Resources According to Patient and Community Needs", "Conclusion" (11 minutes)

      American Medical Association - 2017

    • url icon
      Assessing Incarcerated Women’s Physical and Mental Health Status and Needs in a Swiss Prison: a Cross-Sectional Study URL
      Students must
      View

      Read the Background, Discussion, and Conclusion. (22 minutes)

      Health and Justice Journal - Biomedcentral.com - 2022

    • url icon
      "Who Should Make Decisions for Unrepresented Patients Who Are Incarcerated? " URL
      Students must
      View

      Read the entire article. (15 minutes)

      AMA Journal of Ethics - 2019

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      Recommended Additional Readings
    • url icon
      Linkages Between Health and Incarceration URL

      Read the entire article. (24 minutes)

      Sage, Association of Schools and Programs of Public Health - 2019

    • url icon
      Do Prisoners Trust the Healthcare System? URL

      Read the Background, Discussion, Limitations, and Conclusion. (17 minutes)

      Health and Justice Journal -Biomedcentral.com - 20221

    • Module 11: Lesson 8: Disability, Health, and Healthcare

      Learning Objectives:

      Upon completion of this lesson, you will be able to:

      • Articulate the social and humanistic factors affecting the health of patients who are living with disability.

      • Describe different models used for understanding disability and the advantages and disadvantages that come with seeing disability in terms of each of these models.

      • Demonstrate critical thinking about the clinical needs of patients who are living with disabilities and articulate creative approaches to clinical care that are sensitive to the challenges they face.

      Approximate time required for the readings for this lesson (at 144 words/minute): 1 hour and 33 minutes.

      Required Learning Resources and Activities
    • url icon
      Disability: Definitions, Models, Experience URL
      Students must
      View

      Read the content under the headings from "1. Models of Disability" until "1.3 Models, Decisions, and Policies". (18 minutes)

      The Stanford Encyclopedia of Philosophy - 2022

    • url icon
      Three Things Clinicians Should Know About Disability URL
      Students must
      View

      Read the entire article. (13 minutes)

      AMA Journal of Ethics: Illuminating the Art of Medicine - 2018

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      Recommended Additional Readings
    • url icon
      Prevalence of Disabilities and Health Care Access by Disability Status and Type Among Adults — United States, 2016 URL

      Read the entire report. (13 minutes)

      Centers for Disease Control and Prevention - 2016

    • Module 11: Lesson 9: Health, Humanism, and Aging

      Learning Objectives:

      Upon completion of this lesson, you will be able to:

      • Articulate the social and humanistic aspects of aging, particularly with respect to how older people experience aging.

      • Describe ways that ageism manifests in the health care setting at both systemic and clinical levels and articulate ways that practitioners can challenge ageism and its effects.

      Approximate time required for the readings for this lesson (at 144 words/minute): 1 hour and 24 minutes.

      Required Learning Resources and Activities
    • url icon
      Ageism in the Health Care System: Providers, Patients, and Systems URL
      Students must
      View

      Read the content under the headings, from " Introduction" until "13.2.4 Self-Ageism in the Health Care Setting". (28 minutes)

      Springer Link: International Perspectives on Aging Book - 2018

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      Recommended Additional Readings
    • url icon
      Inequalities in Later Life: The Issue and the Implications for Policy and Practice URL

      Read the report. (18 minutes)

      Centre for Ageing Better - 2017

    • url icon
      “Tho’ Much is Taken, Much Abides”: A Good Life Within Dementia URL

      Read the entire article. (21 minutes)

      Wiley Online Library- The Hastings Center Report - 2018

    • Module 11: Lesson 10: Children, Health, and Humanism

      Learning Objectives:

      Upon completion of this lesson, you will be able to:

      • Articulate the social and humanistic aspects of childhood, particularly with respect to how children experience illness.

      • Describe ways that clinical care for children can use humanistic practices to improve children's illness experiences and coping.

      Approximate time required for the readings for this lesson (at 144 words/minute): 2 hours and 3 minutes.

      Required Learning Resources and Activities
    • url icon
      Connecting a Sociology of Childhood Perspective with the Study of Child Health, Illness and Wellbeing: Introduction URL
      Students must
      View

      Read the content under the headings "Abstract", "Themes of this issue" "Theme 2: practices of children's health and wellbeing", "Theme 3 – Children as health actors". (23 minutes)

      Wiley Online Library- Sociology of Health and Illness Journal - 2015

    • url icon
      Minimizing Pediatric Healthcare-Induced Anxiety and Trauma URL
      Students must
      View

      Read the content from "Introduction" to " A new way to care". (18 minutes)

      World Journal of Clinical Pediatrics- NCBI - 2016

    • Module 11: Lesson 11: Religion/Spirituality and Health

      Learning Objectives:

      Upon completion of this lesson, you will be able to:

      • Articulate how religion and spirituality affect patient experiences of illness and their relationships with their health care practitioners.

      • Describe ways that clinical care for children can use humanistic practices to improve children's illness experiences and coping.

      Approximate time required for the readings for this lesson (at 144 words/minute): 9 hours and 22 minutes.

      Required Learning Resources and Activities
    • url icon
      How Should Clinicians Respond to Requests from Patients to Participate in Prayer? URL
      Students must
      View

      Read the webpage. (16 minutes)

      AMA Journal of Ethics - 2018

    • url icon
      Defining Spirituality in Healthcare: A Systematic Review and Conceptual Framework URL
      Students must
      View

      Read the content under the headings " Introduction" Connection: Narrower or Broader, Interpretation of Life: Meaning and Purpose, Beliefs, Practices, and Experiences, Spirituality Sensations, Spirituality as an Intrinsic Component of Human Beings and Proposed Framework for Spirituality in Healthcare. (22 minutes)

      Fronteirs in Psychology - 2021

    • url icon
      The Role of Spirituality and Religiosity in Healthcare During the COVID-19 Pandemic: An Integrative Review of the Scientific Literature URL
      Students must
      View

      Read the content under the headings "Abstract", "Background" and "Discussion" (12 minutes)

      Springer Nature Switzerland - Journal of Religion and Health - 2022

    • forum icon
      A journal submission on Race/ Ethnicity, Gender, and Health. (450 minutes) Forum
      Students must
      View
      Start discussions: 1

      General Instructions

      In this learning activity, you will compare and contrast the health status and experiences of two (2) different races and/or ethnic groups regarding mental health and substance use disorders and discuss how race/ethnicity influences a patient’s health status and experiences.

      Step 1: Select  

      Select one racial/ ethnic minority in your country or region. 

      • Examples include: Hispanics in the United States,  African Americans, Asian Americans etc.

      Step 2: Compare and contrast

      Compare and contrast your selected racial/ ethnic minority above with a racially privileged group or majority, i.e., “White” Americans etc., in terms of the following indicators:

      • Health status 
      • Healthcare access and affordable coverage
      • Access to substance use and abuse care and treatment

      Step 3: Respond 

      Imagine you are a contributing writer for a medical journal tasked with writing an article for this month’s issue on Race/Ethnicity, Gender, and Health. You are asked to write a piece that focuses explicitly on the health outcomes and experiences of the identified groups as it relates to Substance use and mental health. Prepare a 500-700 words written piece that discusses the following key components:

      • Differences between your selected racial/ethnic minority group and racially privileged group in terms of: 
      1. Health status 
          • Are they are eligible for coverage through the Health Insurance? 
          • Are there any special provisions in place for the minority groups?
          • What type of disadvantages/challenges does the selected group face in meeting their health needs? 
      2. Healthcare access and affordable coverage 
          • How does access to treatment differ according to a patient’s gender?
      3. Access to substance use and abuse care and treatment

      • Health needs of the racial/ethnic minority groups and any disadvantages they may face
      • Propose creative approaches to address the problem, promote health equity, and better access to substance use and abuse care and treatment.

      Step 4: Share 

      To share your work, click on the “Add a new discussion topic” button under this post and paste your work in the “Message” box. Make sure to reference others’ intellectual property when necessary. All references should follow 7th Edition APA formatting. For further instructions, see the resource on the Himmelfarb Health Sciences Library: APA citation resource (N.B. references are excluded from word counts).

      Step 5: Interact 

      Evaluate and categorize the work from one of your peers based on items A - E of the rubric below. Provide a rationale for the grade you have provided, as well as comments or suggestions for improvement. To post a reply, click “Reply” on a particular discussion, write your feedback and then click on “Post to forum.” You can use the list below as an example:

      Item A is  .…. because….  My suggestions for improvement are….
      Item B is  .…. because….  My suggestions for improvement are….
      Item C is  .…. because….  My suggestions for improvement are….
      Item D is  .…. because….  My suggestions for improvement are….
      Item E is  .…. because….  My suggestions for improvement are….

      OPTIONAL Step 6: Interact (10 minutes)

      If you would like to, you can reply to your peers' posts in a respectful and professional manner. Ensure that your post engages your peers' ideas by including a reflection on their comments, sharing ideas of other potential difficulties and parties involved, or asking thought-provoking questions. If a peer comments on your posting, please reply. To post a reply, click “Reply” on a particular discussion, write your feedback and then click on “Post to forum.”


    • quiz icon
      Quiz: Module 11
      Students must
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      Receive a grade
      Receive a passing grade

      To access the quiz, click on the name of the quiz provided above. On the following screen, click the attempt quiz button to respond to the questions.