1. The Cultural Medicine Passport
A Portfolio Documentation of the Learner’s Journey toward Culturally Responsive Care
Jeff does his disclosure
Jeffrey Ring, Ph.D. & Julie Nyquist, Ph.D.

2. Session Objectives
After the session participants should be better able to:
Articulate strong rationale for teaching Culturally Responsive Care to own learners
Adapt the WMMC Curriculum for Culturally Responsive Health Care to own setting
Discuss the role of reflection and use of journals in a cultural competence curriculum
Use a “passport” or other form of journaling in tracking and assessing culturally responsive care in the context of the ACGME competencies
Jeff

3. Curriculum for Culturally Responsive Health Care - Ring, Nyquist et. al.
33 Session Curriculum
Opens with introductory sessions each year
Same 10 topics repeat each year
Book provides
Session outlines and instructions
Descriptions of teaching techniques
Cultural Exercises
Resources
Julie

4. Underlying Principles
Builds awareness, knowledge and skills for culturally responsive care
Detailed instructions provided for each session – including teaching techniques
Each session a separate entity
Reflection and Commitment to Change built into every Session
Annual review of all Commitments

5. Objectives Organized into Units
Unit I - Intro to Culture and CC
Unit II – Key Cultural Concepts
Unit III – Bias, Stereotyping, Culture and Clinical Decision Making
Unit IV – Health and Health Care Disparities
Unit V – CC in Patient Care
Unit VI – CC and Community Action

6. Journals (e.g. Cultural Medicine Passport)
Definition - a “notebook” in which experience is documented across time.
In CC Curriculum - a place to write reflections and commitments to change from individual sessions
Key to success
Willing learners
Faculty feedback
Periodic review and reflection on growth

7. Benefits of Reflection
Gain insight into attitudes
Expose patterns of reasoning
Connect thought with action (motives)
Allow learner to construct professional identity
Provide alternate perspectives on experiences
Assist learners in internalizing the habit of questioning themselves
Reflection “in practice” & “on practice”

8. Cultural Medicine Passport
Name __________________
Date: Fac Sig:
Introduction to Culture 06/30/09 _______
Cultural Med Workshop 07/06/08 _______
Neighborhood Study 07/06/08 _______
Family Genograms 07/09/08 _______
07/13/09 _______
07/16/09 _______
Personality Preferences 07/10/09 _______
Web-based Training 07/15/09 _______
End of Life Issues 07/17/09 _______
Resident Well Being 07/20/09 _______
You and Your Patients 07/22/09 _______
White Memorial Medical Center
Family Medicine Residency Program
The Art of Healing
(Cultural Competence Curriculum)
 Orientation
Passport
July 2009
Funded by The California Endowment

9. Cultural Medicine Passport
Used during one-month intern orientation
Place for faculty signatures and “passport stamps”
Includes thought-provoking quotes
Learners address specific questions related to each relevant curriculum activity
Feedback provided each week
Used to track learner participation and level of engagement with material offered

10. Exercise – Why Culturally Responsive Care?
2 pm

11. Time to write in your “Passport”

12. 2 by 2 Exercise
2:10 pm

13. Time to write in your “Passport”

14. Portfolios as “Trackers”
Definition – a purposeful collection of evidence gathered by individual learners
Engages learners actively in own learning
Encourages reflection (All Domains)
Can be used to track growth across time
Can be used to document achievement of advanced ACGME competencies
One study – 5 entries, 2 raters per entry
2:35

15. Cake Mix Portfolio
Includes reflective commentaries to address criteria, which provides evidence that learners have achieved the learning outcomes.
The whole is greater than the sum of parts.

16. Cake Mix Portfolio
Example: A final portfolio with a table of contents of required items, with the addition of a personal reflection about why each item has been selected
Advantages:
• Can ensure an entry for each program objective
• Can provide insight into higher cognitive levels - analysis, synthesis and evaluation and affective levels - valuing, organizing and characterizing

17. Example – Task – Doctoring in a Multi-Cultural Society
Q: Discuss some of the challenges and opportunities of diversity in health care? Initial: The rich diversity of patients in our population provides both opportunities and challenges. Comment: Please expand. What do you see as the key challenges & opportunities you will face?
Jeff - 240

18. Example – Continued – Doctoring in a Multi-Cultural Society
Redone: Diversity in healthcare can pose barriers to delivery. It is possible that more homogeneous societies have better outcomes in health because homogeneity poses fewer barriers and consequently more ease of management. Perhaps, identifying and addressing barriers inherent in diverse patient populations is the key to success. But, healthcare systems cannot be held solely accountable.

19. Example – Continued – Doctoring in a Multi-Cultural Society
Redone (cont): The prevailing culture is dysfunctional and I think that this is where we will get the biggest effect per dollar. Change the culture – diet, exercise, birth control, etc. Recruit Hollywood and the most powerful global influence will assist. Comment: Nice, rich analytical thinking. Next time I would would like to hear more about you.

20. Hints for Feedback on Passport
Encourage I/my/me statements rather than people/one/you
Affirm learner’s comment, encourage to next level, remind that can seek help

21. Hints for Feedback on Passport
Can use both the Cognitive and Affective Domains (head and heart)
Reflections can be very “Cognitive” showing “comprehension” of a concept or at a higher level “analysis” of the concept
Reflections can be very “Affective” showing a movement from “responding” to “valuing” to fully integrating an important concept into daily behavior

22. Time to share your Passport in a think-pair-share exercise with a partner. Use what you have learned about providing feedback to make a note on each entry (affirm first). Then discuss
2:45

23. Thoughts on Feedback
3PM

24. Teaching Techniques Used

25. Final Thoughts
Resources are available to help you teach culturally responsive care
Consider using journals as part of your overall documentation system
Your feedback is essential to your learners

26. Commitments
Reflection is required as part of your life long development as a teacher
Commitment to a act makes growth more likely to happen.
Take a few moments and write down, in your passport, at least two things that you plan to do differently based on what you learned here.

27. Portfolio References
Jarvis RM. O'Sullivan PS. McClain T. Clardy JA. Can one portfolio measure the six ACGME general competencies?. Academic Psychiatry. 28(3):190-6, 2004.
O’Sullivan PS. et al, Demonstration of Portfolios to Assess Competency of Residents; Advances in Health Sciences Education 9: , 2004
Webb C. et al; Models of Portfolios, Medical Education, 36: , 2002.
Zubizarreta IJ. The Learning Portfolio. Anker Publishing Company Inc. Bolton, MA, 2004.