Teaching Cross-Cultural Communication Skills Online – A Mixed Method Evaluation of a Novel Curricular Element Amy L. Lee, MD Tufts University School of Medicine Christopher P. Morley, PhD, MA, CAS SUNY Upstate Medical University

Introduction Cultural Competency increasingly important and prevalent in medical school curriculum How effective is this curriculum in affecting student attitudes, skills, or knowledge? Can online modules add value to an existing longitudinal curriculum?

Curriculum Evaluated Mixed Method Evaluation Tufts Third Year Family Medicine Clerkship Students (173) received either: –Intervention: Online Module about cultural competency and health disparities Applied Learning Exercise practicing cross-cultural communication skills with patients –Regular Curriculum

PACT Problem: What do you think the problem is? Affect: How is this problem affecting the rest of you life? Concern: What concerns you the most about this problem? Treatment: Do you feel comfortable with this treatment plan?

Evaluation Methods Main Outcome: # of PACT questions asked by students during a communication Standardized Patient exercise, comparing intervention vs. control (ANOVA) Qualitative Evaluation: Student reactions to PACT questions; themes extracted from narrative essays Secondary/Follow-up: Differences in effect of curriculum on –students who entered primary care, or more generally, “high communication” specialties vs –those entering “low communication” specialties

Results N = 119 students (Intv: 59 || Cont: 60) –126/173 agreed to study, 7 incomplete data Students who completed the online module and PACT exercise asked significantly more PACT questions (p=0.049) during a communication-focused Standardized Patient exercise No difference in end of year OSCE scores

Results Table 1: Comparison of Online Intervention Group with Controls on PACT question usage, OSCE performance, and demographic characteristics across each group Intervention No (n=59)Yes (n=60) Mean (SD)Sig. # PACT questions asked2.1 (1.11)2.48 (0.98)0.049 OSCE History (50.51)567 (49.7)NS OSCE Physical (57.99) (49.84)NS OSCE Communication (39.8)580.6 (47.32)NS Mean Age27.49 (2.48)27.14 (1.94)NS Count (%)Sig. Male/Female31 (53%) / 28 (47%)37 (56%) / 29 (44%)NS White44 (75%)45 (69%)NS African-American2 (3%)4 (6%)NS South Asian6 (10%)6 (9%)NS East Asian7 (12%)10 (15%)NS Hispanic2 (3.4%)4 (6.2%)NS

Qualitative Results Improved Patient Outcomes PACT may help with adherence/compliance Personalized treatment plan Uncovered barriers Elicits medical knowledge gaps/prompts education PACT useful in determining etiology Discovered patient medical misconceptions Communication PACT questions enhanced communication Improved Patient Experience Establishes rapport/positive relationship Increased patient engagement Connection with patient perspective Increases trust Increased patient satisfaction Helped to address all patient concerns Religious beliefs recognized Positive Reaction May use PACT in the future PACT core ideas already in routine practice Applicable to all patients Increases efficiency Negative Reaction PACT model is formulaic PACT model not helpful PACT can be time consuming One or two questions sufficient Student Development Increased self-awareness of student biases Helped develop patient-centered focus Encouraged holistic approach Increased opportunity for empathy Open coding of narrative essays revealed a number of themes Both positive and negative reactions

Secondary Results Study curriculum had a greater impact on students who later chose a “high-communication” specialty –Family Medicine –other Primary Care –Emergency Medicine –Neurology –OB/GYN –PM&R –Psychiatry –Radiation Oncology

Secondary Results Specialty TypeMean # PACT Questions Asked During OSCE (Intervention) P value (ANOVA) Mean # PACT Questions Asked During OSCE (Control) P value (ANOVA) High Communication Specialty 2.71 p= NS Low Communication Family Medicine 3.75 p= NS Not Family Medicine Any Primary Care 2.52 NS 1.96 NS Not Primary Care High Communication Specialty (Excluding Primary Care) 3.08 P= NS Other

Conclusions PACT online intervention and skills training increased PACT question usage Student feedback largely supported the value of PACT usage in patient care

Conclusions USING MATCH DATA: –Students destined for Family Medicine or “High Communication” specialties showed highest impact of training –Aggregated category of all primary care selectors (Internal Medicine, Pediatrics & Family Medicine) no significant difference in number of PACT questions asked, regardless of intervention status Receptivity of individual students is key –Intrinsic Communication Styles and/or –receptivity to communication training associated with specialty choice

Discussion