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Cultural Competency

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Cultural Competency The Evolution of Early, Integrated Education For Medical Students, Residents and Faculty at One Institution Maria L. Soto-Greene, M.D. – PowerPoint PPT presentation

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Title: Cultural Competency


1
Cultural Competency The Evolution of Early,
Integrated Education For Medical Students,
Residents and Faculty at One Institution
Maria L. Soto-Greene, M.D. Vice President,
Hispanic Serving Health Professions Schools,
Inc. Senior Associate Dean for Education Director,
Hispanic Center of Excellence New Jersey Medical
School Newark, New Jersey
2
Overview
  • Developing, integrating, and evaluating a
    cultural competency curriculum for
  • Medical students
  • Medical residents
  • Faculty
  • Hospital interpreters

3
Overall Goal
  • Adapted from the Promoting, Reinforcing, and
    Improving
  • Medical Education (PRIME) project by the American
  • Medical Student Association (AMSA) and HRSA with
  • expectation that
  • Students will learn about culture and diversitys
    role in medicine
  • Students will learn the importance of being
    culturally competent
  • Students will develop cultural and linguistic
    competency through participation in a variety of
    clinical experiences while completing a community
    learning experience

4
Comprehensive Curriculum
  • 1st year
  • Art of Medicine Course
  • History Physical Exam Course
  • Administration of the Health BELIEF Attitude
    Survey
  • 2nd year
  • Communications exercise during the Introduction
    to Clinical Medicine course
  • Teach students how to conduct a triadic interview

5
Comprehensive Curriculum (contd)
  • 3rd year
  • Expansion of training into third year clerkships
    with concomitant faculty training.
  • 4th year
  • Graduation Objective Structured Clinical
    Examination (OSCE) that assesses our graduates
    cultural and linguistic competency skills.
  • Re-administering the Health BELIEF Attitude
    Survey.

6
The Art of Medicine begins with the
communication between a physician and the
patient.
  • Introduced new components to the history
  • Trained H P faculty on these additional
    components
  • Introduced the appropriate use of an interpreter
  • Integrated these components into the ambulatory
    preceptorships in the community

7
Students Views
  • The Health BELIEF Attitude Survey is an
    instrument used to assess how important students
    consider obtaining a patients health care view
    points.
  • This survey was developed and piloted at UTHSC at
    San Antonio by their HCOE, a HSHPS member, and
    Society of Teachers of Family Medicine
    Foundation.

8
ETHNIC A Framework for Culturally Competent
Clinical Practice
  • E Explanation
  • What do you think may be the reason you have
    these symptoms?
  • What do friends, family, and others say about
    these symptoms?
  • Do you know anyone else who has had or who has
    this kind of problem?
  • Have you heard about/read/seen it on
    TV/radio/newspaper?
  • (If the patient cannot offer an explanation,
    ask what most concerns them about their
    problems).
  • Developed by Steven J. Levin, M.D.
  • Robert C. Like, M.D., M.S., Jan E. Gottlieb,
    M.P.H.
  • Department of Family Medicine
  • UMDNJ-Robert Wood Johnson Medical School

9
ETHNIC Contd
  • T Treatment What kinds of medicines, home
    remedies or other treatments have you tried
    for this illness?
  • Is there anything you eat, drink or do (or
    avoid) on a regular basis to stay healthy?
    Tell me about it.
  • What kind of treatment are you seeking from
    me?
  • H Healers Have you sought any advice from
    alternative/folk healers, friends or other
    people (non-doctors) for help with your
    problems? Tell me about it.
  • Developed by Steven J. Levin, M.D.
  • Robert C. Like, M.D., M.S., Jan E. Gottlieb,
    M.P.H.
  • Department of Family Medicine
  • UMDNJ-Robert Wood Johnson Medical School

10
ETHNIC Contd
  • N Negotiate Negotiate options that will be
    mutually acceptable to you and your patient
    and that do not contradict, but rather
    incorporate your patients beliefs.
  • I Intervention Determine an intervention with
    your patient. May include incorporation of
    alternative treatments, spirituality, and
    healers as well as other cultural practices
    (e.g. food eaten or avoided in general and when
    sick).
  • C Collaboration Collaborate with the patient,
    family members, other health care team
    members, healers and community resources.
  • Developed by Steven J. Levin, M.D.
  • Robert C. Like, M.D., M.S., Jan E. Gottlieb,
    M.P.H.
  • Department of Family Medicine
  • UMDNJ-Robert Wood Johnson Medical School

11
Introduction of Culture
  • Glossary of Cultural Terms
  • Case studies from the AMSA project
  • Cultural and Spiritual Beliefs
  • Complementary and Alternative Medicine (CAM)

12
Definition of Culture
  • We adopted, with some modification, the broader
    definition
  • of cultural and linguistic competency recommended
    by
  • HRSA in its publication Cultural Competence
    Works 2001.
  • Cultural Linguistic is a set of congruent
    behaviors, attitudes, policies and procedures
    that come together in a system, agency or among
    professionals which enable they system, agency,
    or those professionals to work effectively and
    efficiently in cross-cultural and diverse
    linguistic situations on a continuous basis.

13
INTERPRET
  • I Prior to session, introductions take place.
    Interpreter introduces her/himself to provider.
    Provider introduces interpreter to patient.
  • N Interpreter tells provider if patient says
    she/he is a non-citizen or an illegal immigrant.
  • T The provider and interpreter should develop
    trust between themselves
  • and with the patient.
  • E To achieve effectiveness, provider talks
    directly to patient in the first person speaks
    in small segment and clarifies technical terms.
    Interpreter is linguistically competent speaks
    simply and clearly in the first person explains
    cultural and linguistic topics interprets
    everything said without adding or deleting
    stops provider and patient if they are speaking
    too long and refrains from offering advice.

14
INTERPRET (contd)
  • R The provider has the lead role. When working
    with an untrained interpreter, the provider is
    also responsible for explaining the
    interpreters roles and duties as outlined on
    this card to the interpreter.
  • P Proper positioning is crucial. Provider
    faces patient. Interpreter sits beside and
    slightly behind patient. Avoid triangular
    dynamics.
  • R Useful resources include the following
  • Diversity Rx http//www.DiversityRX.org
  • Bilingual Dictionaries http//www.ibdltd.com
  • MA Medical Interpreter Assoc.
    http//www.mmia.org
  • E The provider and interpreter put ethics into
    practice. They exercise confidentiality and a
    non-judgmental attitude.
  • T A culturally competent triadic interview
    involves an ample timeframe. Learn to work
    effectively and efficiently.

15
Third year medical students
  • Began by pilot testing a cross cultural
    curriculum with 40 third year medical students
    during their medicine clerkship.
  • Assessed level of competency at baseline and
    after the curriculum using 2 modalities.

16
Medical Student Objective Structured Clinical
Examination
17
Results
  • Students in the cross cultural curriculum had
    higher exam scores and higher levels of
    confidence and satisfaction. All 40 students had
    the same level of interest in cross cultural
    issues.
  • Goal to develop an integrated third year medical
    student curriculum that emphasis sociocultural
    issues throughout their rotations.

18
Graduation Objective Structured Clinical
Examination (OSCE)
  • At the core of this examination is the
    doctor-patient communication.
  • OSCEs are used to assess the core skills,
    knowledge and attitudes of tomorrows physicians
    including more recently in licensure.
  • Specifically, our OSCE will test a students
    ability to communicate using cross cultural
    principles.

19
Cultural Competency Training Medical Residents
  • Assess level of need and competency at
    baseline.
  • Assess effectiveness of curriculum with the goal
    of implementing a formal cultural competency
    residency training program.
  • A determinant of success is whether the medical
    resident trained receives increased patient
    satisfaction when working with diverse cultural
    groups.

20
Medical Residents
21
Medical Interpreter Training
  • Pilot project funded by the State of NJ to train
    volunteer hospital medical interpreters.
  • 16 interpreters participated in a one day medical
    interpreting and cultural competency training
    program.
  • curriculum focused on attitudes, knowledge, and
    skills

22
Medical Interpreter Training Program Results
and Outcomes
  • Trained interpreters received high patient and
    physician satisfaction scores in the clinical
    setting.
  • Trained interpreters found that physicians do not
    know how to use an interpreter appropriately.
  • An Interpreter Training Curriculum was submitted
    to the State of NJ.
  • University Hospital now funds a program to train
    all interpreters.

23
Clinicians must check their own pulse and
become aware of personal attitudes, beliefs,
biases, and behaviors that may influence
(consciously or unconsciously) the care of their
patients.
24
Every clinical encounter is cross-cultural
  • No one way to treat a racial or ethnic group
    given the great sociocultural diversity
  • Need to have a Framework of interventions that
    can be individualized
  • A one size fits all health care system cannot
    meet the needs of an increasingly diverse
    American population

25
Organizational and Health Care Policies
  • Develop a mission statement that articulates
    principles, rationale, and values for culturally
    and linguistically competent health care service
    delivery
  • Ensure consumer and community participation

26
Organizational and Health Care Policies (contd)
  • Implement processes that review policies and
    procedures to assess relevance of initiatives
    launched
  • Implement legislation that provides resources
    (i.e. funding from Titles VII VIII, NIH,
    private sector, etc.) that supports ongoing
    professional development and in-service training
    for culturally and linguistically diverse
    communities

27
Cultural Competency Training and Education
  • To succeed, we must have
  • Research Agendas
  • Evaluation Tools
  • Uniformity at all levels - both state and
    federal
  • Legislation with appropriate levels of funding
    to ensure that there is the level of training
    that ensures equal access and care for all
    Americans.
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