©2003 Community Faculty Development Center Teaching of Tomorrow Faculty Development Toolbox Slideshow Resources

©2003 Community Faculty Development Center Teaching Culture and Community in Primary Care: Assessing Learner Needs

©2003 Community Faculty Development Center Group Exercise  "The faculty and students must demonstrate an understanding of the manner in which people of diverse cultures and belief systems perceive health and illness and respond to various symptoms, diseases, and treatments. Medical students should learn to recognize and appropriately address gender and cultural biases in health care delivery, while considering first the health of the patient."  Why do you think this became a requirement of the LCME in 2000?  What role do community preceptors in meeting it?  What makes this challenging for you as a teacher?

©2003 Community Faculty Development Center Culture and Community: Goals of the Series  Make explicit to learners your expertise at developing relationships with patients.  Improved patient satisfaction.  Improved patient adherence.  Improved patient outcome.  Provide teaching tools for bridging the gap from medical culture to the cultures of the world.  Patient in cultural context  Patient in community  Provider as patient advocate

©2003 Community Faculty Development Center Learning Objectives By the end of the workshop, participants will be able to:  Articulate broad definitions of culture  Identify two reasons for incorporating objectives on culture in primary care teaching programs  Apply a framework for performing a cultural needs assessment in teaching  Identify teaching methods and styles that most effectively match the teaching of attitudes

©2003 Community Faculty Development Center Culture is…  the shared values, traditions, norms, customs, arts, folklore and institutions of a group of people. Culture shapes how people see their world and structure their community and family life.

©2003 Community Faculty Development Center Cultural affiliation can...  Determine a person’s values and attitudes about health issues  Determine interpretation and responses to messages  Be repeated and transmitted from one generation to another.

©2003 Community Faculty Development Center Types of Cultural Groups  Ethnicity & Race  Socio-Economic Groups  Physical Disabilities  Sexual Identity  Refugee/Immigrant Status  Age  Religion  Professional Group

©2003 Community Faculty Development Center GNOME: Needs Assessment  Certainty: Learners have culture  Uncertainties: –Experiences of difference and diversity –Predetermined values or stereotypes –Desire to bridge difference –Awareness of institutional oppression or privilege

©2003 Community Faculty Development Center CULTURALLY SENSITIVE Assessing Ethnosensitivity CULTURALLY EGOCENTRIC MINIMIZATION

©2003 Community Faculty Development Center Example: The Non-English Speaker “It must be incredibly difficult to get medical care when you don’t know the language.” “Why would he be nervous if I’ve used an interpreter?” “I can’t believe he’s been here for three years and doesn’t speak English. It’s not my problem.”

©2003 Community Faculty Development Center ETHNOSENSITIVE Assessing Ethnosensitivity ETHNOCENTRIC FEAR

©2003 Community Faculty Development Center Fear  General –“Other students told me: Be careful! It’s not safe over there.”  Specific –“I’ve never dealt with someone with AIDS. Should I wear gloves and a mask?

©2003 Community Faculty Development Center ETHNOSENSITIVE Assessing Ethnosensitivity ETHNOCENTRIC FEAR OVERGENERALIZE

©2003 Community Faculty Development Center Over-generalization  Stereotyping –“She kept using her hands while she talked. She reminded me of my friend’s grandmother. I thought it was Prince Spaghetti Day!”  Culture blindness or denial of difference –“I never thought he could be a drug user. He looks and acts so intelligent.”

©2003 Community Faculty Development Center ETHNOSENSITIVE Assessing Ethnosensitivity FEAR SUPERIORITY OVERGENERALIZE ETHNOCENTRIC

©2003 Community Faculty Development Center Superiority  Negative stereotyping –“He was so rude and macho. I don’t understand why Puerto Rican women put up with that.”  Reversal –“American culture is so boring and crude. I find Vietnamese culture fascinating.”

©2003 Community Faculty Development Center CULTURALLY EGOCENTRIC ATTITUDINAL NEEDS CULTURALLY SENSITIVE Assessing Ethnosensitivity MINIMIZATION

©2003 Community Faculty Development Center What have you observed? You are observing a 3rd year medical student in his clerkship. You note that while he is technically accurate (always asking the cardinal 7, getting appropriate reviews of systems and performing a focused physical exam), you observe poor bonding with some of the patients.

©2003 Community Faculty Development Center Hypothesis: Attitude Need You observe poor bonding only occurs with poor patients. His questions seem to lack empathy. Behavior:Hypotheses: Bias against person on public assistance? Overwhelmed by needs? Feel superior? How will you assess your hypotheses?

©2003 Community Faculty Development Center Teaching culture and community: Assessment and Methods

©2003 Community Faculty Development Center Teaching culture and community: Assessing attitudes  Know yourself.  Assess your learner.  Work for change

©2003 Community Faculty Development Center Assessing Attitudes: Know Yourself:  Reflection on self  Reflection in practice  Reflection on practice

©2003 Community Faculty Development Center Assessing Attitudes: Assess your learner.  Facilitative style  Encourage reflection  Active listening

©2003 Community Faculty Development Center Reflective Practice “No human being ever learned from experience. Human beings learn from reflecting on their experience” P Viles

©2003 Community Faculty Development Center Assessing Attitudes: Working for Change.  Stages of Change –Precontemplation to Contemplation  Reflection –Assessment and Teaching Method  Life-long process

©2003 Community Faculty Development Center Cultural Humility “Cultural humility incorporates a lifelong commitment to self-evaluation and self-critique, to redressing the power imbalances in the patient-physician dynamic, and to developing mutually beneficial and nonpaternalistic clinical and advocacy partnerships with the communities on behalf of individuals and defined populations.” Tervalon, M and Murray-Garcia J