Transcript Slide 1

Minorities in Academic Healthcare
Career Education and Enhancement for Health
Care Research Diversity (CEED) Program
University of Pittsburgh School of Medicine
November 27, 2007
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Stephen B. Thomas, Ph.D.
Philip Hallen Professor of Community
Health & Social Justice
Director, Center for Minority Health
Graduate School of Public Health
University of Pittsburgh
www.cmh.pitt.edu
[email protected]
Overview
1. Racial differences in perceptions of
disparities in healthcare
2. Evidence of racial/ethnic health disparities
3. Ethnic and racial diversity of the US
population and of healthcare professionals
4. Strategies for effective cross-cultural
communication
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Do you think the average African American is better off,
worse off, or just about as well off as the average white
person in terms of access to health care?
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60
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Better Off
About the Same
Worse Off
No Opinion
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30
20
10
0
Whites
Source: Morin, 2001
African Americans
Accepting Evidence
Unequal Treatment:
Confronting Racial and
Ethnic Disparities
in Healthcare
Institute of Medicine
2000
Media Response to Unequal Treatment
New York Times, March 22, “Subtle Racism in Medicine”
“ . . . a disturbing new study by the Institute of
Medicine has concluded that even when members of
minority groups have the same incomes, insurance
coverage and medical conditions as whites, they
receive notably poorer care. Biases, prejudices and
negative racial stereotypes, the panel concludes, may
be misleading doctors and other health
professionals.”
Eliminating Health Disparities Among Racial and
Ethnic Minority Populations
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Infant Mortality
Cancer Screening and Management
Cardiovascular Disease
Diabetes
HIV Infection
Adult and Child Immunization
Mental Disorders
Centers for Disease Control and
Prevention’s Guiding Principle
"…The future health of the nation will be
determined to a large extent by how
effectively we work with communities to
reduce and eliminate health disparities
between non-minority and minority
populations experiencing disproportionate
burdens of disease, disability, and
premature death“ [2007]
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Council on Education for Public Health
(CEPH)
For more than a decade the accrediting CEPH
has mandated that schools of public health
should reflect the diversity of the regions in
which they are located. CEPH looks for
evidence of an institutional commitment to
diversity in mission statements and goals, and
expects to see plans implemented for the
recruitment of diverse faculty and students
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(CEPH, 2005).
The shortage of minority health professionals
in the U.S is a long-standing problem.
According to one national report, African
Americans, Hispanic Americans, and
American Indians as a group account for
almost 25 percent of the U.S. population, yet
represent less than 9 percent of nurses, 6
percent of physicians, and only 5 percent of
dentists (Sullivan, 2004). This
underrepresentation of minority health
professionals is also reflected in the faculty
profiles of schools of the health sciences. 11
US Population by Race and Ethnicity
Black
13.4%
American Indian & Alaskan
Native
1.5%
Asian
4.9%
Native Hawaiian & Other
Pacific Islander
0.3%
Non-Hispanic White
66%
Hispanic
14.4%
US Census Bureau. Available at: http://www.census.gov/Press-Release/www/releases/archives/population/006808.html
Accessed March 2, 2007.
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Physicians by Race/Ethnicity 2004
Unknown
36%
White
48%
Other
2%
American
Native/Alaskan
Native
Asian
0.06%
8%
Hispanic
3%
Black
2%
N=884,974 physicians.
American Medical Association. Available at: http://www.ama-assn.org/ama/pub/category/12930.html.
Accessed March 6, 2007.
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US Registered Nurse Population
by Race and Ethnicity
Black
5%
Hispanic
Asian or Pacific Islander 2%
3%
American Indian or
Alaskan Native
0.4%
Two or more races
2%
White
88%
N = 2,380,639.
US Department of Health and Human Services, Health Resources and Services Administration.
Available at: http://bhpr.hrsa.gov/healthworkforce/reports/rnpopulation/preliminaryfindings.htm.
Accessed March 25, 2007.
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Professional Pharmacy Degrees
Conferred 2004–2005
Foreign
2%
Other
3%
Asian Americans
20%
American Indian
1%
Hispanic
4%
Caucasians
61%
Black
9%
N=8049
American Association of Colleges of Pharmacy. Available at:
http://aacp.org/site/view.asp?TRACKID=&VID=2&CID=1285&DID=7369. Accessed March 25, 2007.
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September 2004
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Barriers Encountered by Minority Junior
Faculty in the Health Sciences
• Being treated as a “token hire” by their
White peers (Potts, 1992; Turner & Myers,
1999; Laden & Hagedorn, 2000);
• Experiencing racial discrimination and bias
(Johnsrud & Sadao, 1998; Peterson et al.,
2004; Price et al, 2005; Turner & Myers,
1999)
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Barriers Continued:
• Feelings of loneliness and isolation (Laden &
Hagedorn, 2000; Turner & Myers, 1999);
• Difficulty in obtaining research funding
(Antonio, 2002); a “chilly climate” on campus
(Turner & Myers, 1999);
• Being treated as “ethnic specialists” by their
colleagues—that is, being treated as experts
on minority matters rather than as experts in
their chosen fields (Garza, 1988).
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• Some minority faculty expressed the feeling
that their White colleagues devalue the
quality of their scholarship (Fenelon, 2003;
Thomas & Hollenshead, 2001; Turner &
Myers, 1999).
• When minority faculty conduct research and
publish in fields related to social justice or in
fields that serve their communities. The
White colleagues of these minority faculty
often view this kind of scholarship as selfserving or too “subjective” (Bernal &
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Villalpando, 2002).
Research Productivity
Several studies have documented a powerful
association between post-doctoral research training
fellowships and subsequent research productivity in
academic medicine (Kupfer et al. 2002; Kelley &
Randolph 1995; Pincus et al. 1995; Reynolds et al.
1998, 2003; Fischer & Zigmond 1998). The two factors
most consistently associated with dedicated research
status are having had a mentor and having spent at
least two years in a research-oriented post-doctoral
experience. Characteristics of successful post-doctoral
training programs also include personal contact with
senior investigators, an excellent mentoring
relationship, and an academic institution with a critical
mass of senior investigators.
Institutional Support Matters
The literature on the recruitment and retention of
minority faculty makes a strong case for mentoring
and post-hiring support (Padilla, 1994;CEPH 2006;
Sung 2003; Reynolds et al. 1998). In describing the
need for post-hiring support, Smith (2000) states that
“….the isolation, disinterest in diversity, and racism
that new minority faculty may suffer make getting
tenure a very challenging task.” Phillips (2002)
suggest that institutions offer mentoring programs,
support for teaching development and research
funding as post-hiring career development strategies.
Institutional Support Matters, Cont.
Fischer & Zigmond (1998) asserted that universities
must “…offer these individuals strategies for coping
with the present demands of scientific life if we are to
increase their participation in all fields of research”.
The Summer Research Career Development
Institute in Minority Health and Health Disparities
We have conducted and evaluated two Summer
SRCDI cohorts in collaboration with Jackson State
University EXPORT Center faculty. The SRCDI is
designed to further educate emerging minority
investigators concerning the “research survival skills”
required to be successful in securing faculty
appointments, independent funding and promotion.
The need for strategic career planning and guidance
arises to assist them to achieve funding for their
research as a basis for promotion and tenure.
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Lessons Learned from the Pittsburgh SRCDI
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Being a trainee or junior faculty member at a major
institution does not automatically mean that someone
⎯ a mentor, a senior faculty member, or even a
colleague ⎯ will tell you what is necessary for
success or impart the skills required to succeed.
The participants viewed the nurturing offered during
the Institute as highly valuable.
Despite the heterogeneity of the group’s scientific
interests, there were crosscutting themes related to
career development needs addressed by the SRCDI.
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Leadership
Matters
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News Alert: October 24, 2007
I am pleased to announce the appointment of Paula
Davis, M.A., to the newly-created position of assistant
vice chancellor for diversity for the Schools of the
Health Sciences, effective November 1, 2007. In her
new position, Ms. Davis will be responsible for working
with all six health sciences schools (Dental Medicine,
Health and Rehabilitation Sciences, Medicine, Nursing,
Pharmacy, and Public Health) on planning,
implementing, and monitoring diversity recruitment and
retention efforts for students and faculty.
Arthur S. Levine, M.D.
Senior Vice Chancellor for the Health Sciences
Dean, School of Medicine
Cross-Cultural Communication
Provider
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Expectations
Agendas
Concerns
Meanings
Values
Carrillo JE et al. Ann Intern Med. 1999;130:829–834.
Patient
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Culture
• Culture consists of shared values, beliefs,
and learned patterns of behaviors.
• Culture is shaped by various factors such
as proximity, education, gender, age, and
sexual preference.
Carrillo JE et al. Ann Intern Med. 1999;130:829–834.
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Cultural Groups
Ethnic
Racial
Social
Religious
US Department of Health and Human Services, Office of Minority Health. National Standards for Culturally
and Linguistically Appropriate Services in Health Care. Final Report, March 2001. Washington DC: US Dept of Health
and Human Services Washington, DC; 2001.
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Cultural Competence
The ability to understand
and respond effectively
to the cultural and linguistic
needs of patients during the
healthcare encounter
US Department of Health and Human Services, Office of Minority Health. National Standards for Culturally
and Linguistically Appropriate Services in Health Care. Final Report, March 2001. Washington DC: US Dept of Health
and Human Services; 2001.
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CAN WE TALK ?
Patient-Centered Care
Care that respects and responds
to individual patient
preferences, needs, and values
Institute of Medicine. Available at: http://books.nap.edu/catalog/10027.html. Accessed April 2, 2007.
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Factors That Impact Patient-Provider
Communication in the Clinical Setting
Communication Patient-Provider
Styles
Communication
Explanatory
Models of
Illness and
Disease
Ngo-Metzger Q et al. Cultural Competency and Quality of Care: Obtaining the Patient’s Perspective.
The Commonwealth Fund; October 2006. Commonwealth Fund publication 963.
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Patient-Provider Communication Styles
Verbal
• Directions
• Information
• Clarification
• Reassurance
• Agreement
Nonverbal
• Body language
• Facial expressions
• Gestures
Ngo-Metzger Q et al. Cultural Competency and Quality of Care: Obtaining the Patient’s Perspective.
The Commonwealth Fund; October 2006. Commonwealth Fund publication 963.
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Explanatory Model of Illness and Disease
The meaning of the illness for the patient
CAUSE
SEVERITY PROGNOSIS
EXPECTED
TREATMENT
= How the illness impacts the patient’s life
Carrillo JE et al. Ann Intern Med. 1999;130:829–834.
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Negotiating Treatment
Issues to Consider:
• The patient’s explanatory model
• Role of the family in decision-making
• Use of complementary and
alternative medicine (CAM)
Misra-Hebert AD. Cleve Clin J Med. 2003;70:289, 293, 296–298.
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Patients’ Perceptions of the
Healthcare System
Minority patients
Race-concordant
encounters
1. Cooper LA et al. Ann Intern Med. 2003;139:907–915.
2. Johnson RL et al. J Gen Intern Med. 2004;19:101–110.
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Communicating Across
Linguistic Barriers
US Limited English Proficient Population
2000: 7% of the population (21.4 Million)
2010 (projection):10% of the population
(28.4 Million)
US Census Bureau. Available at: http://www.census.gov/Press-Release/www/releases/archives/population/006808.html
Accessed March 2, 2007.
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Challenges of
Cross-Cultural Communication
• Minorities in ethnic-discordant
relationships with physicians report a
negative perception of the healthcare
system.1
• It is impractical to learn every aspect of
each culture that could influence the
clinical encounter.2
1. Johnson RL et al. J Gen Intern Med. 2004;19:101 - 110.
2. Carrillo JE et al. Ann Intern Med. 1999;130:829 - 834.
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Becoming Culturally Competent
Four Dimensions:
• Knowledge
• Attitudes
• Skills
• Behaviors
Beach MC et al. The Role and Relationship of Cultural Competence and Patient-Centeredness in Health Care Quality.
The Commonwealth Fund; October 2006. Commonwealth Fund publication 960.
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Cultural Competence Training Programs
Perception
of health
and illness
Individuals from diverse
cultures and beliefs
systems
Responses
to symptoms,
diseases, and
treatments
Liaison Committee on Medical Education. Available at http://www.lcme.org/functionslist.htm. Accessed May 20, 2007
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Cultural Competency Training:
Implementation Challenges
• Educational Barriers
• Professional Barriers
Hobgood C et al. Acad Emerg Med. 2006;13:1288–1295.
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A Balance: Avoiding Stereotypes
Acquiring
knowledge
of specific
cultural groups
Developing
attitudes and
skills not
specific to any
particular
group
Beach MC et al. The Role and Relationship of Cultural Competence and Patient-Centeredness in Health Care Quality.
The Commonwealth Fund; October 2006. Commonwealth Fund publication 960.
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Steps Toward Successful
Provider Cultural Competency
• Personal self-reflection
• Avoiding stereotyping
Like RC et al. Available at: http://www.stfm.org/corep.html. Accessed March 6, 2007.
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Cultural Competency Training:
Critical Steps
“…valid measures of competence are
used to assess progress and guide
improvement.”1
Connecting training with clinician
behavioral changes and these with
patient outcomes
1. Hobgood C et al. Acad Emerg Med. 2006;13(:1288 - 1295.
2. Thom DH et al. BMC Med Educ. 2006; 6:38.
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