1. Cultural Competence Culture is the widening of the mind and of the spirit --- Jawaharlal Nehru © 2002 Sayantani DasGupta

2. COMMUNITY PEDIATRICS

3. Workshop Goals n Define cultural competency and discuss rational for use/learning n Physician Culture - To explore the rich cultural backgrounds and potential biases that physicians bring to clinical encounters. n To discuss medical culture and the hidden curriculum. n To introduce second year residents to the cultural competency curriculum © 2002 Sayantani DasGupta

4. Norms n One person at a time n Respect the opinions of others - all opinions are valid n Share depending on your level of comfort n Confidentiality - don’t share information you may have learned about others n Have fun! © 2002 Sayantani DasGupta

5. Problem statement n 1. Racial and ethnic disparities in health care n 2. Many people who go to their doctor are not satisfied n 3. Most medical visits are not for biologically based illnesses © 2002 Sayantani DasGupta

6. The Name Game n Tell the story of your name and its origins n - ethnicity n - family history n - birthplace/where you are from © 2002 Sayantani DasGupta

7. Definitions n Race: Classification of individuals who possess distinctive physical characteristics that are transmitted genetically. n Ethnicity: Races or groups of people who are classed according to common background, languages, traits, customs, or appearance. © 2002 Sayantani DasGupta

8. Definitions n Cultural Group: People with common origins, customs, and styles of living; sense of identity and a shared language. No cultural group is homogenous, but contains diversity. © 2002 Sayantani DasGupta

9. Cultural Competency Synonyms: n Culturally effective health care n Culturally sensitive health care n Cross-cultural medicine n Multiculturalism

10. “Culturally Effective Healthcare:” n Appropriate physician knowledge, understanding, and appreciation of cultural distinctions n Takes into account the beliefs, values, actions, customs, and unique health care needs of distinct population groups n Strengthens the physician-patient relationship and maximizes the health status of patients

11. Increased Focus on Training n AAP n APA n AMA n STFM n LCME n State Legislatures n Department of Health and Human Services

12. AAP Committee on Pediatric Workforce policy statement n Advocates training at all levels –Medical school –Residency –Continuing Medical Education

13. Research: “Can Cultural Competency Reduce Racial and Ethnic Disparities?” n Racial and Ethnic disparity data n Data documenting increased satisfaction with Interpreter use n Data documenting increased trainee knowledge and skills

14. Physician Culture To know others, we must first know ourselves --- Adage © 2002 Sayantani DasGupta

15. Workshop Exercise n This exercise is designed to help you assess your own cultural heritage, including experiences that may influence your ability to work with patients from diverse backgrounds. n There are no right or wrong answers. © 2001 Sayantani DasGupta

16. Workshop Exercise n What ethnic group, socioeconomic class, religion, age group and community do you belong to? n What is the first experience you had with people from an ethnic group, religion, age group or community not your own? What was that experience like? How did you feel about it? © 2001 Sayantani DasGupta

17. Workshop Exercise n What socio-cultural factors in your background might contribute to your being rejected by others? Have you experienced prejudice from others? n What personal qualities do you have that will help you establish interpersonal relationships from other cultural groups? What personal qualities may be detrimental? © 2001 Sayantani DasGupta

18. Exercise Summary n What were the assumptions you made about your partners before they talked? Did you predict what they were going to say? n Was anything difficult to discuss? Did anything make you uncomfortable? n What did you learn? © 2001 Sayantani DasGupta

19. Awareness n Individual Cultural Heritage Includes provider’s own cultural family beliefs and upbringing re: health etiology, treatments and illness behaviors. n How does provider culture impact the health encounter?

20. Awareness n How does the provider’s culture impact the clinical encounter? –Arthur Kleinman’s work: Disease vs. Illness –Discordant explanatory models can disrupt the clinical encounter.

21. Individual Health Beliefs Exercise n What were some of the values in your family around health? n What were some of the beliefs and healing methods used?

22. Awareness n Biomedical Culture Not Value-Neutral Every Patient Encounter is a “Cross-Cultural Experience”

23. The Anger Issue n What are patients expectations of doctors? n What are our expectations of patients? n How do institutional policies increase this conflict?

24. Medical Culture n What are the positive values of medical culture? n What are the values of medical culture you would like to change? n How are these values passed on? n Have you ever been in an uncomfortable cultural situation among colleagues? © 2002 Sayantani DasGupta

25. The Hidden Curriculum n What was being taught that was consistent with biomedical curricula? n What was being taught that was outside the biomedical curriculum?

26. Curriculum n YR1: Introduction to Cultural Competency & Language Skills n YR2: Issues of Provider and Patient Culture n YR3: Communication Skills and Cultural Exchange © 2002 Sayantani DasGupta

27. Components of Teaching n Awareness n Knowledge n Skills

28. Intake Ethnography n An exercise designed to give a hands- on example of the hidden curriculum n Intake rounds will be both audio taped and you will take notes regarding the nature of the interaction. n Your observations will be discussed in a meeting subsequent to the experience. © 2002 Sayantani DasGupta

29. Wrap up n Name game n Definitions of Race, Ethnicity, Culture and cultural competence n Mandates and rational for learning about these issues n Individual health beliefs n Medical culture: Illness Vs Disease n Anger n Hidden Curriculum