1. Bruce Britton M.D. Agatha Parks-Savage ED.D. Christine Matson M.D.
Educational Strategies to Train Medical Students on Eliminating Contextual Barriers to Health Care
Bruce Britton M.D.
Agatha Parks-Savage ED.D.
Christine Matson M.D.

2. ExPRESS Grant- Objectives
Highlight Cultural/Contextual Issues by Developing:
Target Areas of Adolescent, Women’s and Geriatric Health
Standardized Patient Cases to Highlight Cultural/Contextual Issues in Target Groups
Elective Rotation Experiences to Highlight Cultural/Contextual issues.

3. ExPRESS Grant- Objectives cont.
Student Project Curriculum that Improves Health Literacy/Quality of Care at Preceptor’s Office
Community and Public Health Electives that Highlight Health Disparities and Minority Health Issues

4. ExPRESS Grant-Methods
Pre/Post Clerkship Validated Instrument to Assess Cultural Competency
Cultural/Context Didactic/Discussion at Beginning and End of Clerkship
Didactics on Common Women’s Health Issues, Adolescent, and Geriatric topics with Video Examples of Culture/Context Affecting Care

5. ExPRESS Grant-Methods cont.
Six Standardized Patient Cases Highlighting Culture/Context in Target Areas
ExPRESS Forum Introducing Community Resources in Place that Address Health Disparities

6. Campinha-Bacote Inventory Assessing the Process of Cultural Competence Among Healthcare Professionals
Self-administered survey, self report by learners
Assesses learner’s perspective on understanding of
Definitions of cultural and contextual competency
Ethnic/cultural variations affecting health
Personal limits and barriers to competence
Commitment to culturally competent practice
Range:
incompetent (25-50) aware (51-74)
competent (75-90) proficient (91-100)

7. Inventory pre/post results
Culturally Aware=Red ≈ 47%
Culturally Competent=Blue ≈ 52%
Culturally Proficient=Green ≈ 1%
Culturally Aware=Red ≈ 81%
Culturally Competent=Blue ≈ 19%

8. ExPRESS-Future Efforts
Student Evaluations
Faculty Evaluations
Curriculum Adjustments
Bacote Inventory Follow-Up

9. Future Efforts: Student Evaluations
Cultural Contextual Competence Overview
Cancer & the Female Pt. & Case-based Video
Adolescent Obesity & Case-based Video
The 3 D’ in Geriatrics & Case-based Video

10. Student Evaluations of the Four Didactics
Poor, Fair, Good, Very Good, Excellent
N=33
56% Relevant Information
44% Excellent Overall

11. Student Evaluations: Comments
“Videos were helpful”
“Videos were a waste of time”
“Videos are never a good teaching tool”
“Use less time”
“Seen and heard this lecture before”
“One of few shelf relevant lectures”

12. Future Efforts: Challenges for the Faculty
1. Time: Can it be done in 6 hours?
2. Student’s Developmental Level
3. Best Practice for Enhancing Cultural Competence

13. Future Efforts: Future Curriculum Adjustments
1. Discontinue the Use of the Didactic Video Cases
2. Use iClicker with Cultural/Contextual Cases
3. The iClicker:
a. Can be used for small groups (5-15) or for groups with 100+ participants.
b. Provides anonymity.
c. Creates a forum for group discussion.
d. Objective measurement of content mastery.
*iClicker Demonstration

14. Sample iClicker Question
1. Which of the following describes your level of comfort talking with an ethnically and socioculturally different person from yourself?
Very Comfortable
Comfortable
Uncomfortable
Very Uncomfortable

15. Sample iClicker Question
2. Which of the following statement(s) is(are) true regarding the care of senior adult African-Americans?
a. Matriarchal
b. Multigenerational households
c. A and B are correct
d. None of the above

16. Completion of ExPRESS
Applying Curriculum Changes for Incoming MS3 Class of 2009
Re-administer Bacote Inventory to Class of 2008 and 2009 Midway Through MS4 Year