Cultural Competency Training: Current Efforts at the University of Hawaii John A. Burns School of Medicine Martina L. Kamaka, MD Department of Native Hawaiian Health LIME II, September 23-25, 2007

The Department of Native Hawaiian Health Created in October 2003 Vision: Ku Pono: Hawaii Maoli achieving optimal health and wellness Mission: To be center of excellence in education, research and quality health care practices committed to the optimal health and wellness of Hawaii Maoli, their families and communities that embraces traditional Hawaiian values and practices.

The Department of Native Hawaiian Health (DNHH) Incorporated two existing programs –Imi Hoola (post baccalaureate program) –NHCOE (Native Hawaiian Center of Excellence) Key differences: –Community advisory board Help keep focus on vision and mission –Multidisciplinary faculty –Only medical school department in US committed solely to indigenous health

DNHH Educational Efforts Post baccalaureate program: Imi Hoola Recruitment and Retention Medical Student Curriculum –Cultural “Competency” focus –Lectures –Workshops –Problem Based Learning –Cultural immersion –Electives

The Imi Hoola Program Imi Hoola (those who seek to heal) began in 1973 – Funded by US federal government Competitive, preparatory program for medical school –Focus on a successful application –Targeted underrepresented minorities In 1996 becomes a post baccalaureate program –Federal funding changes –Provisional medical school acceptance to 10 students –In 1990’s, expanded to include financially, educationally and socially disadvantaged students

Profile of Imi Hoola Medical School Graduates Profile of Imi Hoola Medical School Graduates (n=188) 1.Ethnicity Native Hawaiian 40% Filipino 24.5% Samoan 7% Micronesian 12% 2.Gender Male 59% Female 41% 3.Specialty (2002 data) Primary Care 76% Specialty Care 24% 4.Practice Location Hawaii 45% (50% in rural communities) Greater Pacific 5% (Micronesia, Samoa) Continental US 24% Still in Residency 21% (32% in Hawaii)

I mi Hoola Retention Services for Medical Students Tutoring program: –Started in % of former Imi Hoola students failed the USMLE 1 on first attempt Prior to 2003, average of 30% failure rate on first attempt –Meet every 2 weeks during 1 st and 2 nd year of medical school –Meet for two hours –Review course material, review questions Results –First and Second year Unit Pass rates Improved –USMLE part 1 pass rates Past 3 years, 100% passed on first attempt Future directions –Expand tutoring into 3 rd and 4 th years –USMLE 2 exam prep –Student mentorships

DNNH Recruitment Efforts DNHH part of a recruitment team –Members include JABSOM, Imi Hoola, DNHH, AHEC –Visits with secondary school and college students –Increase cost effectiveness, reach Assists with science enrichment programs with UH Manoa (i.e.: Na Pua Noeau) Summer research internships Challenges: –Funding support –Coordinating efforts –Need for a central place for students: Mentoring, applications, advising, financial aid

DNHH Medical School Curricular Efforts

Cultural Competency in the Curricula Focus Groups –Question: How can the medical school improve student cultural competency training? Stakeholders: Native Hawaiian patients, physicians and students Lecture: Introduction to Native Hawaiian Health- new initiative –One hour lecture for first year –Topic: “Ola” Native Hawaiian health from a cultural and historical viewpoint, Hawaiian values

Four Hour Workshop (first year students) –Overview NH health & health disparities –Cultural trauma –Self discovery: small group discussions –The patient-physician interaction –Traditional healing Problem Based Learning Family Stream (units 2 through 4)-new initiative –Unit 2: elderly NH male, retired with diabetes. Importance of family (effect on illness, treatment) Culturally appropriate treatment Role of traditional healing –Proposed future PBL case: son of the first patient Mental health and substance abuse Issues such as access to land, water rights Cultural trauma

Cultural Immersion Weekend

Immersion Experience Pilot study –Students selected randomly –Group size ranges from 7-15 Curricular components: –Intense weekend experience –Self discovery exercises, small group discussions –Native Hawaiian cultural activities Participating in protocol Visiting a community health center Learning about how a healthy ahupuaa relates to health (mountain to sea land division), working in the taro patch (loi) Sessions with traditional healers Canoe paddling, navigation and stargazing Cultural access to Makua Valley

Community Health: Research and Clinical Practice (BIOM 512,513,514 Elective) –Year long elective 4 hours weekly –Basic research methodology –Encouraged to pursue research focusing on Native Hawaiian health Bench vs. community based –Research mentor –Lectures: Native Hawaiian health/health disparities Traditional healing Cultural competence in research and clinical practice Community based participatory research

DNHH 1 st Year Elective Title: Native Hawaiian Health and Healing Duration: 10 weeks, 2 hours per week (offered twice a year) Faculty: Traditional healers, faculty with cultural expertise Topics: –Intro to NH health & Culture General concepts i.e. Ola, Lokahi (balance) –Traditional diet –Land issues/ahupuaa field trip to fishpond –Traditional healing Laau Lapaau, Laau Kahea, Hooponopono, Lomilomi,

DNHH 4 th Year Elective Title: Health Care in Native Hawaiian Communities (NHH 545 elective) Began in 2003 (previously an internal medicine elective) 4 week duration 4-8 students/year (5 international students so far) Tailored to student needs –i.e.: a student interested in OB is assigned to work with an OB and a midwife Discussion/Lecture sessions Clinical care at community health centers with large Native Hawaiian populations Work with traditional healers/cultural specialists –Lomilomi, Laau Kahea, Laau Lapaau

Challenges/Future Plans Curriculum –Inclusion of coursework into the third and fourth year Financial sustainability –Institutionalization of some, not all programs –Dependence on Grants –Faculty Assessment –Revision of assessment tools –Development of a “cultural” standardized patient –Summative assessment needed near graduation

Mahalo!!! For information contact: /JABSOM edu