A large national survey of several thousand resident physicians in seven medical specialties, including psychiatry, at United States academic health centers found that a large proportion of residents reported receiving little-or-no cross-cultural training in key areas (1). Approximately half reported receiving little training in understanding how to address patients from different cultures (1). Resident physicians' self-reported preparedness to deliver cross-cultural care lags well behind preparedness in other clinical and technical areas (1). This is particularly worrisome, because many high-profile reports continue to highlight ethno-racial disparities in health care (2). In this article, we provide evidence for a feasible model for a week-long summer course designed to provide training for psychiatry residents, clinicians, and researchers on key issues in African American mental health and the conduct of research. Disparities in educational attainments among African Americans have decreased, but still exist. The racial/ethnic minority portion of the U.S population continues to grow and is expected to become a majority by 2056 (3). However, there has been no corresponding increase in the number of minority clinicians/researchers (4, 5). A special supplemental report on racial/ethnic disparities in mental health identifies the support of “capacity-development” as one of six broad recommendations to reduce mental health disparities:

“Minorities are underrepresented as providers, researchers, and as administrators and policymakers and consumer and family organizations. Furthermore, many providers and researchers of all backgrounds are not fully aware of the impact of culture on mental health, mental illness, and mental health services (p 167)” (3). The deficit in minority clinicians and researchers actively engaged in mental health research is a cause for concern. The gaps in both mental health services and knowledge in these areas for minority population are a matter of interest, as well. The Summer School, through the collaborative efforts between Dartmouth Psychiatric Research Center (PRC) and Howard University, is intended to narrow this gap and enhance the pipeline supply of underrepresented minorities in the field of psychiatric research.

The Dartmouth–Howard Collaboration is a 5-year research and training center grant (PI: R. Whitley), awarded by the National Institute on Disability and Rehabilitation Research (NIDRR). Research activities supported by the grant focus on the psychiatric rehabilitation of African Americans with severe mental illnesses (and, often, comorbid substance use disorder). The collaboration brings together mental health researchers in psychiatry, anthropology, sociology, and social work from the Dartmouth PRC and Howard University. Details of the collaboration have been previously published (6). In addition to conducting research and generating new knowledge vis-à-vis African American mental health, a principal aim of the grant is to build research capacity in the African American scholarly community.

The Howard–Dartmouth Collaborative Summer School (HDCSS) is an annual, week-long, academic research training program. The first HDCSS was held in June 2009, and the second was held in June 2010. The third HDCSS was scheduled for June 2011. In keeping with the capacity-building aim of the Dartmouth–Howard Collaboration, we hope that such training programs will continue indefinitely into the future. The aim of the HDCSS is to provide trainees with the tools needed to become better researchers, clinicians, and scholars, especially as related to African American mental health. This is done through sessions and workshops that attempt to impart practical, methodological, and theoretical knowledge on the proper design, execution, and conduct of mental health-related research with African Americans. Participants have included graduate and medical students, psychiatry resident physicians, social workers, nurses, psychologists, and community researchers. After the Summer School, trainees and mentors maintain regular communication, thereby building on the collaborative foundation established during the week-long summer school. Seminars and workshops are led by faculty and senior personnel from Dartmouth PRC, Howard University, and other relevant organizations, including the National Institutes of Health and the Mellon Foundation.

The Curriculum was designed by senior investigators with varying disciplinary experience to provide essential information in two core areas: 1) African American mental health issues; and 2) knowledge about the conduct of research and methodologies. In other words, it was designed to focus on substantive as well as practical knowledge. The program consists of 4 days of workshops and seminars, as well as a 1-day field trip. The session is formatted with 3 sessions in a day; each session is 1½ hours long, with teachers encouraged to lecture no longer than 1 hour, so as to allow 30 minutes for questions and discussion. Two sessions are held in the morning and one in the afternoon. During lunch break and after the afternoon session, faculty and students are encouraged to mingle, to explore further issues and possibilities of collaboration. Sessions are interactive because active participation of the trainees is encouraged. A catered, in-house lunch is provided within the classroom itself in order to facilitate further discussion and collaboration.

In the last 2 years, we have arranged field trips to the District of Columbia's mental health facilities (including St Elizabeth's Hospital), core service agencies, and supportive housing for people in recovery. Field trips provide trainees with the chance to observe real-world conditions and develop a better understanding of the mental health system. The Summer School offers integrative sessions on African American culture and its relation to mental health research. Sessions examine issues surrounding the state of mental health of the African American community and disparities in access to care. Topics include historical perspectives in African American mental health care, core issues in African American health, cultural competence in health care, and critical approaches in religion and mental health.

Additional workshops address paradigmatic and theoretical approaches in the field of research, including interdisciplinary research, critical perspectives on mental health, and evidence-based medicine. The Summer School also focuses on imparting methodological and practical knowledge necessary for the correct conduct of research. Topics include an introduction to mental health research, responsible conduct of research, ethical treatment of human subjects, importance of pilot studies, comparison and combination of qualitative and quantitative research methods, and the concepts of evaluation, validity, and study design. The program assists the attendees in gaining knowledge of key skills for researchers, including critical issues in writing grant proposals and articles. Sessions on grantsmanship and publication address available grant mechanisms for new and established investigators. Social activity outside the classroom to promote interaction between organizers and participants is an added feature of the Summer School. This includes a Summer School dinner, informal coffee meetings, and after-class drinks. Through these interactions, ideas are exchanged and collegiality, further mentoring, and collaborative relationships are enhanced, as participants interact in a relaxed, informal atmosphere.

In the 2009 Summer School session, there were 37 participants. In the 2010 Summer School session, there were 40 participants. After each session, participants were asked to complete a questionnaire assessing speaker effectiveness, session content, and relevance on a 5-point satisfaction scale, where 1 is Poor and 5 is Excellent. Program evaluations indicated overall high satisfaction with the experience and knowledge gained from the Summer School. On average, the participants gave a rating of between 4 and 5 (“Very Good” and “Excellent”), an indication that the HDCSS sessions were very informative and provided an excellent opportunity for learning. Furthermore, qualitative comments from trainees indicated that the sessions were excellent, engaging, and interactive. The discussion-based format of the sessions allowed for growth and generation of thought that led to a better understanding of ethnic and cultural issues among African Americans. Attendees suggested that the knowledge learned was very helpful in their practice. The field trip provided first-hand-experience and interactive exchange of views between Summer School participants, consumers, and mental-health providers.

The Dartmouth–Howard Collaboration provides a model for a feasible training program that imparts knowledge regarding culture and mental health, and the conduct of mental health research, with particular attention to African American mental health. The HDCSS is unique in that it offers an intense, 1-week course delivered to several types of mental health professionals and trainees in research and practice. Many programs have short immersion courses or seminars on cultural psychiatry in general, notably at McGill University and Oregon State University (7, 8). Our endeavors represent a distinct approach, given the focus on African American culture and the design and conduct of mental health research. Our research group has emphasized a concept of culture informed by anthropological theory (6) instead of viewing culture as an assemblage of certain “traits” or as a synonym for race, ethnicity, nationality, or citizenship. This approach fosters an awareness of the diverse types of understanding of health and illness that exist cross-culturally, as well as a critical examination of the culture of medicine and its practitioners. To underscore the complexity and flexibility of “culture,” participants were encouraged to articulate their own cultural identities, made up of combinations of such realms as ethnicity, religion, class, gender, and education. We made an explicit effort to introduce Summer School participants to the concept that biomedicine itself is a culture. Accordingly, biomedical approaches to health and illness are understood to be products of a particular Western European and American historical and cultural trajectory (9). Participants were encouraged to reflect on the values and assumptions embedded within biomedical approaches.

Our program had some limitations. Although a week-long seminar certainly provides ample time to learn knowledge and skills, this approach could not be compared with more longitudinal didactic training in cultural psychiatry. Evaluations used in the study were devised by the authors and could not be formally tested for reliability and validity because of a lack of standardized assessments for the measurement of change in cultural sensitivity after educational intervention. Also, we do not have outcome data and therefore cannot determine the long-term impact of our summer school training program on participants.

The 4th annual Howard–Dartmouth Collaborative Summer School is scheduled on June 11–15, 2012, at the Louis Stokes Library, Howard University, Washington, DC. Individuals interested in future sessions may e-mail: HDCSS@howard.edu for further information and registration.