Transcript Developing Best Practices in Cultural Competence Education

Cross-cultural Medical Education
at Stanford University
Clarence H. Braddock III, MD, MPH
Ronald D. Garcia, PhD
NIH(NHLBI) Sponsorship
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PI: CH Braddock III, MD, MPH
RFA Goal: “To enhance the ability of
physicians and other health
professionals to address disparities in
cardiovascular, pulmonary, hematologic,
and sleep disorders in a culturally
sensitive manner.”
Five-year grant (2004-2009)
AAMC Sponsorship
PI: Ronald D. Garcia, PhD
 GOAL: Develop an integrated model
curriculum throughout the preclinical
and clinical curriculum.
Challenges
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Access to time in the required
curriculum
Teaching resources
Development of cases
Evaluation
Leveraging opportunities
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Complimentary backgrounds
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Physician; bioethics, patient-physician
communication
Psychologist; leader in cross-cultural
medical education, diversity
Complimentary projects
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NHLBI - focus on preclinical students,
residents, faculty development
AAMC - focus on clinical students
Leveraging opportunities
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Combining resources
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Staff support
Needs assessment
Teaching activities
Critical mass
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“Cross-cultural Medical Education
Initiative”
Teaching Methods
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Interactive and experiential
Role plays
Workshop formats
Patient simulations
Web-based resources
Outcomes
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Teaching modules
Interpreters
 Communication models
 Patient simulations
Teaching methods
Simulations
Reflective experiences
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NHLBI Cultural Competence and
Health Disparities Education Collaborative
Who we are - What we’re doing
Clarence H. Braddock III, MD, MPH
Stanford University
NHLBI Health Disparities
Program
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Goal: “To enhance the ability of physicians
and other health professionals to address
disparities in cardiovascular, pulmonary,
hematologic, and sleep disorders in a
culturally sensitive manner.”
Funding: Five-year academic awards to
support faculty time for curriculum
development
Deliverables
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Curriculum development &
implementation
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Medical students
Residents
Practicing physicians
Evaluation
Dissemination to all U.S. medical
schools
NHLBI Cultural Competence and Health
Disparities Education Collaborative
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Mission Statement
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Our Collaborative seeks to develop curricula that
enhance the ability of physicians and other
health care professionals to address disparities
in the U.S. in a culturally sensitive manner.
Our ultimate goal is to develop, evaluate, and
disseminate a comprehensive cultural
competence curriculum to medical schools
throughout the U.S., thereby providing support
and leadership to medical educators nationwide.
Strategies
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Foster inter-institutional collaboration
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Annual collaboration & planning meeting
Monthly conference calls
Collaborative projects
Forge alliances with other organizations
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AAMC
OMH
Professional societies: STFM, SGIM, AMA
Current collaborative projects
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Curriculum needs assessment:
AAMC’s Tool for Assessing Cultural
Competence Training (TACCT)
Dissemination: Web Portal
Faculty development: Stanford Faculty
Development Center
Curriculum Dissemination
Web Portal Project
Web Portal: Goals
To provide:
 Resources for curriculum needs assessment and
development
 Platform to disseminate curricular materials
 Forum for medical educators to share curricular
materials
 Links to other supporting materials for cultural
competence education.
Faculty Development
Stanford Faculty Development Center
(SFDC)
Stanford Faculty Development Center
Dissemination Model
Nationally & internationally since 1986
Stanford Faculty Development Center
Professionalism in
Contemporary Practice
Program - 2003
Clinical Teaching
Program -1986
Seminar Facilitators
Previous Programs:
Seminar Participants
(Faculty & Residents)
Learners
Institution
• Preventive Medicine
• Medical Decision Making
• End-of-Life Care
• Geriatrics in Primary Care
SFDC: Professionalism in
Contemporary Practice
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One-month fellowship to enhance faculty teaching:
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Reflective practice,
Patient-centered care,
EBM,
QI, patient safety
Developed pilot module on cultural competence
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Review data on health disparities; definitions of race,
culture,cultural competence
Build skills in cross-cultural communication
Gain insight into personal biases
Develop effective strategies to teach cultural competence
Professionalism in Contemporary Practice
Defining
Professionalis
m
EvidenceBased
Practice
Reflective
Practice
Patient
Safety
Working in Teams
Shared Decision
Making
Quality
Improvement
Cultural
Competence
Cultural Competence Module
Learning Goals
Participants will be able to:
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Define cultural competence
Reflect on personal cultural attitudes
Describe how communication impacts health
disparities
Apply tools to improve cross-cultural communication
Reflect on specific ways you can use what you’ve
learned in this module to improve
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your teaching
your clinical practice
your institution
Health Belief and Attitudes
Survey (HBAS)
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15 items scored on 6-point Likert scale.
Items are distributed into four domains assessing the
learner’s attitudes towards:
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Opinion – Importance of assessing patients’ perspectives
and opinions
Belief – Importance of determining patients’ beliefs for
history taking and treatment
Context – Importance of assessing patients’ psychological
and cultural contexts
Quality – Importance of knowing the patients’ perspective
for providing good health care
Dobbie 2002
Design
HBAS
“Pre”
Cultural Competence Module
HBAS
“Retro-Pre” &
“Post”
HBAS: Results (RetroPre v Post):
Opinion
Belief
Mean
RetroPre
4.94
T-test
P-value
Post
Mean
RetroPre
4.69
-3.040
T-test
-5.516
0.002
P-value
<0.001
5.13
Post
5.06
HBAS: Results (RetroPre v Post)
Context
Quality
Mean
RetroPre
5.19
T-test
P-value
Post
Mean
RetroPre
4.64
-3.96
T-test
-2.6
<0.001
P-value
0.006
5.53
Post
4.93
Coming soon…
“Enhancing multicultural education & practice”
SFDC - In Development
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Health disparities – overview of evidence & causes
Definitions of culture, race, ethnicity
Reflective practice and self-awareness of beliefs and
biases
Linguistic barriers– use of interpreters, CLAS standards,
etc.
Exploring health beliefs & explanatory models of illness
Educational methods/resources
Evaluation & assessment methods & tools