Transcript Overview: Post-stroke fatigue

How to teach for a
culturally competent
world
PAMELA H. MITCHELL
4TH ANNUAL CULTURAL COMPETENCE CONFERENCE, MARCH 27, 2015
TEXAS TECH UNIVERSITY
Objectives

Explore the many cultures involved in interprofessional teaching and
practice

Identify one’s own experiences with cultural stereotyping in teaching and
learning

Evaluate multiple approaches to inclusivity in interprofessional teaching
The many cultures involved in
interprofessional teaching and practice

Cultural awareness

Gender

Race

Ethnicity

Geographic

Sociopolitical

Professional and interprofessional
culture
Cultural Competence: Definition and
Conceptual Framework
Cultural competence requires that organizations:

have a defined set of values and principles, and demonstrate behaviors, attitudes,
policies and structures that enable them to work effectively cross-culturally.

have the capacity to (1) value diversity, (2) conduct self-assessment, (3) manage the
dynamics of difference, (4) acquire and institutionalize cultural knowledge and (5) adapt
to diversity and the cultural contexts of the communities they serve.

incorporate the above in all aspects of policy making, administration, practice, service
delivery and involve systematically consumers, key stakeholders and communities.

Cultural competence is a developmental process that evolves over an extended period.
Both individuals and organizations are at various levels of awareness, knowledge and skills
along the cultural competence continuum. (adapted from Cross et al., 1989)
http://nccc.georgetown.edu/foundations/frameworks.html#ccdefinition.
Definitions ”The idea of more effective cross-cultural capabilities
is captured in many terms similar to
cultural competence. Cultural knowledge, cultural
awareness, and cultural sensitivity all convey
the idea of improving cross-cultural capacity, as
illustrated in the following definitions:
Cultural Knowledge: Familiarization with selected
cultural characteristics, history, values,
belief systems, and behaviors of the members of
another ethnic group (Adams, 1995).
Cultural Awareness: developing sensitivity and
understanding of another ethnic group.
This usually involves internal changes in terms of
attitudes and values. Awareness and sensitivity
also refer to the qualities of openness and
flexibility that people develop in relation to
others. Cultural awareness must be
supplemented with cultural knowledge(Adams,
1995).
Cultural Sensitivity: Knowing that cultural
differences as well as similarities exist, without
assigning values, i.e., better or worse,
right or wrong, to those cultural differences
(National Maternal and Child Health Center on
Cultural Competency, 1997)”
http://cecp.air.org/cultural/Q_howdifferent.htm, retrieved March 7,2015
Center for effective collaboration and practice
Cultural awareness

Acknowledge cultural differences and be aware of how these impact care.

Recognize how one’s own culture impacts one’s thoughts and actions.

Understand cultural differences at the practice level, when patients and
providers bring unique histories.

Make a conscious effort to understand the meaning of the other’s behavior
within the context of his or her culture.

Health care providers should gain information as they can, but comprehensive
knowledge is not attainable. Providers should how obtain information needed
in the moment to reach a patient care goal.

(Cross et al., 1989, pp. 32-35)
Cultural safety

“Cultural safety aims to improve the health status and wellbeing of New
Zealanders and applies to all relationships through: 1) an emphasis on
health gains and positive health and wellbeing outcomes; 2)
acknowledging the beliefs and practices of those who differ from them.
For example, this may be by: age or generation, gender, sexual
orientation, occupation and socio-economic status, ethnic origin or
migrant experience, religious or spiritual belief, disability”

Arose from concerns of Maori students and families about lack of
understqnding of their culture by non-Maori providers of health care
http://en.wikipedia.org/wiki/Cultural_safety, retrieved March 7, 2015
Core competencies for interprofessional
collaborative practice

Values & Ethics (VE3). Embrace
cultural diversity and individual
differences characterizing patients,
populations, and health care teams.

Values and Ethics (VE4). Respect the
unique cultures, values,
roles/responsibilities, and expertise of
other health professions.
(Interprofessional Education
Collaborative Expert Panel, 2011, p. 19).
UW School of Nursing Principles of
Inclusion

We affirm the inherent dignity of each individual and group.

We affirm that group differences are socially, culturally, and historically constructed and
hierarchically arranged, resulting in the inequitable distribution of resources among
groups. This construction and distribution can be changed and we commit to change it.

We affirm our commitment to address difference, privilege and power at the School of
Nursing. We will address privilege and power using anti-racist and anti-oppression
principles of on-going education, open dialogue, skill building, challenging the status quo,
and accountability to people of color and other social groups.

We affirm our commitment to increase the numbers of faculty, students and staff from
underrepresented groups, and to support their leadership within the school.

We affirm our commitment to work toward a climate of inclusiveness on all levels of the
School of Nursing.
http://nursing.uw.edu/about/diversity
Core principles UW School of
medicine
After participating in and completing their medical education and training offered by the
University of Washington School of Medicine, every medical student should be able to:

Become aware of his/her own assumptions about human behavior, values, biases,
preconceived notions, and personal limitations that may impact his/her clinical decision
making and care of his/her patients.

Understand the world view of culturally diverse populations (values, assumptions,
practices, communication styles, group norms, biases, experiences, perspectives, etc. of
culturally diverse faculty, colleagues, staff, patients and her/his families, and the
communities they are from).

Develop and practice appropriate, relevant and sensitive strategies and skills in working
with culturally diverse populations.

Understand that the process in becoming cultural proficient is a continuum.

Advocate on behalf of the needs of the diverse populations they work with.
The culturally competent …. Student

Is one who has moved toward being culturally aware, and is sensitive to his/her
own cultural heritage and to valuing and respecting differences.

a. The student has begun the process of exploring his/her own values, standards and
assumptions about human behavior and quality of life.

b. Rather than being ethnocentric and believing in the superiority of his/her group’s
cultural heritage (customs, traditions, language, ability, religion or spirituality, quality
of life), there is acceptance and respect for cultural differences and multiple
identities.

c. The student understands that individual and group (social) identities are a product
of where we are in our personal development and in what context, capacity and
environment in which we are engaged.
From: Core Guiding Principles for Cultural Competence for Medical Education
David Acosta, MD, Amen Tsegai, MA, Victoria Gardner, EdD, Pam Racansky, MA Version 2.0, March 31,
2011 http://depts.washington.edu/cedi/new/PDF/CoreGuidingPrinciples.pdf, last retrieved March 10,
2015
Health care team as a culture

“team” creates a new culture with
group norms for values and behavior.

The cultural values:

shared goals,

clear roles,

mutual trust,

effective communication, and

measurable processes and outcomes

full inclusion of patients as team
members
Multiple approaches to inclusivity

Some resources

Some experiential exercises in context


Cultural competence training should encompass interactions with the patient in the context
of the team, rather than individual interactions as is often the focus. Such training could
begin in a simulated setting with a standardized patient, but could also be accomplished in
student experiences in the clinical setting in learning activities with objectives clearly
focused on cultural competence. (from Buchanan et al,
http://collaborate.uw.edu/blogs/main-blog/teaching-cultural-competence-for-the-healthcare-team.html)
IPE exercises
Learning about difference
The study of diversity fosters understanding of cultural traditions, histories, and influences; sharpens
critical and analytic thinking; explores sources of inequality in society; and encourages a vibrant
intellectual community free of bias and prejudice.
http://www.washington.edu/diversity/learningabout-difference/
Resources
http://nccc.georgetown.edu/foundations/frameworks.html#ccdefinition.
http://collaborate.uw.edu/
Your own cultural identity

What cultural identities do you have?

I am a woman

A nurse and academic leader

The daughter of people who came of age in
the Great Depression

The granddaughter of immigrants

The wife of a retired physician

The mother of 3 accomplished sons

And grandmother to 3 adorable children

Hans Jacob Holtzklau came to America in
1714 He was our American immigrant
ancestor. Jacob changed the spelling of our
name by signing his will Jacob Holtzclaw.
14 individuals with families totaling 42 persons
from the town of Siegen and Muesen in the
principality of Nassau-Siegen, Germany to
come to Virginia. The First Germanna Colony
arrived in Virginia at Tappahannock in the
spring of 1714, and then came up the
Rappahannock River where they settled 20
miles west of Fredericksburg at a location that
would be called Fort Germanna.
UW Center for Health Sciences Interprofessional Education….
http://collaborate.uw.edu/educators-toolkit/faculty-development-training-toolkit/ipe-faculty-development-learning-activity-int
Identify own experience in cultural
stereotyping

Let’s play interprofessional pictionary
Role Clarity and Responsibility
Stereotyping and Biases
• Stereotyping related to professional roles, demographic
& cultural differences affect the health professions
• Stereotypes help create ideas about a profession’s worth
known as “disparity diversity” (Edmondson & Roloff,
2009), eroding mutual respect.
• Inaccurate perceptions about diversity prevent
professions from taking advantage of the full scope of
abilities that working together offers to improve health
care.
Roles Across Professions
•
•
•
•
•
•
•
•
Expert
Communicator
Educator
Advocate
Professional
Collaborator
Manager
Leader
Medicine
Nursing
Pharmacy
Physical Therapy
Dentistry
Social Work
Public Health
Physician Assistant
“We may look in the same direction,
even at the ‘same lines’, and not see
what our colleagues sees.”
(McKee, 2003)
Interprofessional Pictionary
• As a team, decide who the health care
professional is based on information provided
• Draw a representation of the health care
professional without using letters or numbers
• Be prepared to share how everyone has
contributed to the drawing
• After each team finishes drawing, the other
teams should guess the profession prior to
discussion
IP Pictionary: Reflection
•
•
•
•
What assumptions am I making?
Where did I learn these values?
What values/beliefs orient me?
How might someone whose role is different than
mine look at this?
• Why do I feel threatened when I am challenged
on this?
(McKee, 2003)
Interprofessional Pictionary
• Acknowledgements:
 IP Pictionary Game developed by Debbie Kwan at the
Educating Health Professionals for Interprofessional
Care, University of Toronto (Ehpic 2011 Certificate
Course)
 http://www.ipe.utoronto.ca/
 Edited and revised as Faculty Development Toolkit to
teach IPE Competency Domain: role clarity by the
University of Washington Macy Grant Team
 Core competencies for interprofessional collaborative
practice (IPEC, 2011)
Interprofessional Pictionary –
Represent this professional



Team up with 3 or 4 people from
different professions: decide who the
health care professional is based on
information provided in the box on the
right
Draw a representation of the health
care professional without using letters
or numbers

Training Requirements: Doctoral
Degree

Usual Practice settings: Hospitals
(inpatient and outpatient care),
Community Settings, Clinics

Scope of Practice includes: Health
and medication education, treatment
consultation, prescribe under
protocol, administer medications,
provide immunizations

Unusual Practice setting: NASA
Be prepared to share how everyone
has contributed to the drawing
More Resources
http://ethnomed.org/
http://ethnomed.org/culture
Web Resources

http://odt.uwmc.washington.edu/pdfs/RespectThroughUnderstanding.pdf
- slide set

http://depts.washington.edu/ethnomed/HMCproject/hmcproject_talk_03
02/F_EthnoMed%20Home%20Page.htm

http://ethnomed.org/ethnomed/about/
IPE Faculty Development Training
Learning Activity: Barnga


Barnga is a simulation game that helps players
address challenges they may face when
interacting with a different profession’s
culture. Each group of players receives a
slightly different set of instructions for a card
game (ace is the weakest or strongest, spades
are the trumps cards or there is no trump card,
etc.) The winner and loser of each group will
then rotate to play with another group; the
players are not told that the rules of the game
are different in this new “culture” and will be
forced to resolve communication problems
with people who do not share their
understanding of the rules.
Developed by: Educational psychologist
Sivasailam “Thiagi” Thiagarajan, PhD.
Total time needed for the activity is 90 minutes.
Barnga covers IPE competencies in all four
domains.

Materials needed:

Some pencils and blank sheets of paper.

A bell.

A deck of cards for each table. Each deck
must be modified so that it includes only the
following cards: Cards 2-7 in each suit as well
as all four aces.

The instructions to play “Five Tricks” (Appendix
1, all ten versions of the game).

A copy of the “Discussion Guidesheet”
(Appendix 3) for the facilitator.
http://collaborate.uw.edu/educators-toolkit/faculty-development-trainingtoolkit/ipe-faculty-development-training-learning-a-1
Your preferred teaching tools

What approaches have you found helpful?

What aspect of cultural competence are these aimed at?
References

Acosta, D, Tsegai, A, Gardner, V, Racansky, P (2011) Core guiding principles for cultural competence for
medical education. University of Washington School of Medicine
http://depts.washington.edu/cedi/new/PDF/CoreGuidingPrinciples.pdf, last retrieved March 10, 2015

Buchanan, DT (3014) Teaching Cultural Competence for the Health Care Team. Center for Health Sciences
Interprofessional Educational blog, Updated on July 16th, 2014 at 2:12 pm,
http://collaborate.uw.edu/blogs/main-blog/teaching-cultural-competence-for-the-health-care-team.html, last
retrieved March 7, 2015

Cross, T. L., Bazron, B. J., Dennis, K. W., Isaacs, M. R. (1989). Towards a culturally competent system of care: A
monograph on effective services for minority children who are severely emotionally disturbed. Washington, D.
C.: National Institute of Mental Health, Child and Adolescent Service System Program.

Interprofessional Education Collaborative Expert Panel. (2011) Core competencies for interprofessional
collaborative practice: Report of an expert panel. Washington, D.C.: Interprofessional Education Collaborative.
https://ipecollaborative.org/uploads/IPEC-Core-Competencies.pdf, last retrieved March 10, 2015

Mitchell, P., Hall, L., & Gaines, M. (2012). A social compact for advancing team-based high-value health
care. Health Affairs Blog. Retrieved from http://healthaffairs.org/blog/2012/05/04/a-social-compact-foradvancing-team-based-high-value-health-care/
References

Mitchell, P., Hall, L., & Gaines, M. (2012). A social compact for advancing team-based high-value health
care. Health Affairs Blog. Retrieved from http://healthaffairs.org/blog/2012/05/04/a-social-compact-foradvancing-team-based-high-value-health-care/ Last retrieved March 10, 2015

Mitchell, P., Wynia, M., Golden, R., McNellis, B., Okun, S., Webb, E.,… Von Kohorn, I. (2012). Core principles &
values of effective team-based health care. Washington, D. C.: Institute of Medicine.
(http://iom.edu/Home/Global/Perspectives/2012/TeamBasedCare.aspx, last retrieved March 10, 2015)

National Center for Cultural Competence. (nd). Conceptual frameworks/models, guiding values and
principles. Retrieved from http://nccc.georgetown.edu/foundations/frameworks.html#ccdefinition. Last
retrieved March 10, 2015

Okun, S, Schoenbaum, SC, Andrews, D, Chidambaran, P, Chollette, V et al (2014). Patients and health care
teams forging effective partnerships. Washington DC: Institute of Medicine discussion paper,
)http://iom.edu/Global/Perspectives/2014/PatientsasPartners.aspx), last retrieved March 10, 2015