Culture Pearls: A Primer on CrossCultural Competence

1
Culture PearlsA Primer on Cross-Cultural
Competence

• Benjamin Hoffman MD
• Department of Pediatrics
• University of New Mexico

2
Objectives

• By the end of this discussion, you should be able
  to
• Define Culture and Cultural Relativism
• Define and Give Examples of Ethnosensitivity and
  Cultural Stereotypes
• Explain the Role of Self- Reflection in Cultural
  Competence

3
What is Culture?
4
What is Culture?

• The system of shared beliefs, values, customs,
  behaviors and artifacts
• Used by members of a society to cope with the
  world and with one another
• Transmitted from generation to generation through
  learning.

5
What is Your Culture ?

• List cultural groups to which you belong
• 3 minutes
• Ethnic, Racial, Professional, Religious, Gender,
  Sexuality

6
What is Competence?

• Having requisite or adequate ability or qualities
• Do we mean cognizance?
• Knowledgeable of something, especially through
  personal experience

7
Cultural Relativism

• Cultural knowledge is acquired through learning
• Cultural behaviors are acquired through
  unconscious processes
• No culture is better, more advanced or less
  primitive than any other
• Cultural traits have meaning primarily within the
  context of a particular culture

8
(No Transcript)
9
Assessing Ethnosensitivity
CULTURALLY SENSITIVE
MINIMIZATION
CULTURALLY EGOCENTRIC Fear, Denial, Superiority
10
Example The Non-English Speaker
It must be incredibly difficult to get medical
care when you dont know the language.
Why would he be nervous if Ive used an
interpreter?
I cant believe hes been here for three years
and doesnt speak English. Its not my problem.
11
Stereotypes

• A conventional, formulaic, and oversimplified
  conception, opinion, or image.
• By-product of fear and minimization
• Potentially damaging to patient-doctor
  relationship

12
(No Transcript)
13
(No Transcript)
14
(No Transcript)
15
(No Transcript)
16
(No Transcript)
17
(No Transcript)
18
Recognizing Culture

• What We Know
• We Have Culture
• Learners Have Culture
• Patients Have Culture
• What We Do Not Know
• Differential Experiences
• Values and Stereotypes
• Desire to Bridge Differences

19
Know Thyself

• Preconceived biases
• Experience with given cultures and groups
• Your position on the ethnosensitivity spectrum

20
5 Myths That Prevent Cultural Cognizance
Competence

• Myth 1
• A person will be able to deal with others of that
  population in a culturally competent way simply
  by virtue of membership in that group
• Different values
• May not be trusted

21
Myth 2

• A member of a minority community is capable of
  representing that community
• Is there a Hispanic Community?
• Native New Mexicans
• Immigrants
• Mexico
• Central America
• Puerto Rico
• Cuba
• Desert Island

22
Myth 3

• American Culture is the dominant culture
• Assume majority culture is human culture and
  implicitly acceptable to all.
• Internalization of norms

23
Myth 4

• Key cultural differences are lifestyle, language,
  foods, and other visible evidence of diversity.
• Eating crème brule while wearing a beret, smoking
  a cigarette and acting indifferent does make you
  French!
• Trust and respect breakers are generally not
  obvious
• Expectations, values, communication styles are
  more invisible

24
Myth 5

• Cultural competence can be acquired through
  working with people who are different form us.
• Working with someone from a different ethnic
  group does not necessarily lead to uncovering
  differences in communication styles,
  expectations, and values.

25
Goals What are we trying to achieve?

• Improved
• Patient
• Satisfaction
• Well-being
• Adherence
• Physician
• Satisfaction
• Effectiveness

26
ObjectivesHow are we going to get there?

• Cultural Sensitivity in Self
• Experiential
• Cognizance!
• Actively Achieving Cultural Competence
• Development of knowledge of impact that cultural
  beliefs have on clinical relationships
• Self-Reflection
• Acknowledgement of Biases
• Need to Encourage in Self

27
(No Transcript)
28
Framework

• Listen actively with empathy and respect
• Elicit the health beliefs of the patient
• Assess priorities, values and supports
• Recommend a plan of action with adequate
  explanation and understanding
• Negotiate by involving the patient in next steps
  and decisions

29
Listen

• Identify and greet
• Determine need for interpreter services
• Set tone
• Open-ended question
• Patience

30
Elicit

• Patients health beliefs
• Chief complaint
• Relation to behaviors
• What worries you the most?
• Have you started any treatment on your own or
  gotten advice from others?
• What do you think has caused the problem, and
  what do you think started it?
• How can I be of most help to you?

31
Assess

• Personal attributes and beliefs that may impact
  health and health behaviors
• Allopathic medicine may be foreign
• Role of family and elders in decision making
• May be too shy to discuss needs out of respect
  for physician
• Changes in community context
• Social stressors and supports
• Resource and access issues
• Literacy and language

32
Assess

• Id like to get to know you more today. Could you
  tell me about yourself?
• With whom do you live? Where do you work?
• What brought you to this country?
• How does medical care differ here?

• Do you have family and friends that help you with
  decisions or give you advice?
• Do you have any trouble reading medicine bottles
  or appointment cards?
• Is transportation a problem for you?

33
Recommend

• Plan of action with a rationale using language
  that the patient can easily understand
• Physicians greatly overestimate amount of
  information patients want
• Tend to Use Jargon
• Patients are often too embarrassed to admit this
• To make sure that we understand each other, can
  you tell me what it is I just explained to you?

34
Negotiate

• Plan of action with patient after recommendations
  discussed
• Now that we understand each other, lets come up
  with a plan that works for you.
• What do think should be the next steps?

35
Evaluation

• Success is spelled EMPATHY
• Self
• Reflection
• Attitudes
• Practice
• Critical experiences
• Patients
• Facilitate discussions
• Surveys

36
Self-Reflection

• Conscious reflection of own practice
• Re-evaluation of practice, attitudes
• Discuss with learners
• WHAT CAN I DO TO IMPROVE MY PRACTICE/TEACHING?????
  ?????