Teaching of Tomorrow Faculty Development Toolbox

©2003 Community Faculty Development Center

Teaching of TomorrowTeaching of TomorrowFaculty Development ToolboxFaculty Development Toolbox

Slideshow ResourcesSlideshow Resources


Teaching Culture and Community in Primary Care: Assessing Learner Needs


Group ExerciseGroup Exercise

"The faculty and students must demonstrate an "The faculty and students must demonstrate an understanding of the manner in which people of diverse understanding of the manner in which people of diverse cultures and belief systems perceive health and illness and cultures and belief systems perceive health and illness and respond to various symptoms, diseases, and treatments. respond to various symptoms, diseases, and treatments. Medical students should learn to recognize and Medical students should learn to recognize and appropriately address gender and cultural biases in health appropriately address gender and cultural biases in health care delivery, while considering first the health of the care delivery, while considering first the health of the patient."patient."

Why do you think this became a requirement of the LCME in Why do you think this became a requirement of the LCME in 2000?2000?

What role do community preceptors in meeting it?What role do community preceptors in meeting it? What makes this challenging for you as a teacher?What makes this challenging for you as a teacher?


Culture and Community:Culture and Community:Goals of the SeriesGoals of the Series

Make explicit to learners your expertise at Make explicit to learners your expertise at developing relationships with patientsdeveloping relationships with patients..

Improved patient satisfaction .Improved patient satisfaction . Improved patient adherence.Improved patient adherence. Improved patient outcome.Improved patient outcome.

Provide teaching tools for bridging the gap Provide teaching tools for bridging the gap from medical culture to the cultures of the from medical culture to the cultures of the world.world.

Patient in cultural contextPatient in cultural context Patient in communityPatient in community Provider as patient advocateProvider as patient advocate


Learning ObjectivesLearning Objectives

By the end of the workshop, participants will be able to:By the end of the workshop, participants will be able to: Articulate broad definitions of cultureArticulate broad definitions of culture

Identify two reasons for incorporating objectives on Identify two reasons for incorporating objectives on culture in primary care teaching programsculture in primary care teaching programs

Apply a framework for performing a cultural needs Apply a framework for performing a cultural needs assessment in teachingassessment in teaching

Identify teaching methods and styles that most Identify teaching methods and styles that most effectively match the teaching of attitudes effectively match the teaching of attitudes


Culture is…Culture is…

the shared values, the shared values, traditions, norms, traditions, norms, customs, arts, folklore customs, arts, folklore and institutions of a and institutions of a group of people. group of people. Culture shapes how Culture shapes how people see their world people see their world and structure their and structure their community and family community and family life.life.


Cultural affiliation can...Cultural affiliation can...

Determine a person’s Determine a person’s values and attitudes values and attitudes about health issuesabout health issues

Determine Determine interpretation and interpretation and responses to responses to messagesmessages

Be repeated and Be repeated and transmitted from one transmitted from one generation to another.generation to another.


Types of Cultural GroupsTypes of Cultural Groups

Ethnicity & RaceEthnicity & Race Socio-Economic GroupsSocio-Economic Groups Physical DisabilitiesPhysical Disabilities Sexual IdentitySexual Identity Refugee/Immigrant StatusRefugee/Immigrant Status AgeAge ReligionReligion Professional GroupProfessional Group


GNOME: GNOME: NNeeds Assessmenteeds Assessment

Certainty: Learners have cultureCertainty: Learners have culture Uncertainties:Uncertainties:

– Experiences of difference and diversityExperiences of difference and diversity– Predetermined values or stereotypesPredetermined values or stereotypes– Desire to bridge differenceDesire to bridge difference– Awareness of institutional oppression or Awareness of institutional oppression or

privilegeprivilege


CULTURALLY SENSITIVECULTURALLY SENSITIVE

Assessing EthnosensitivityAssessing Ethnosensitivity

CULTURALLY EGOCENTRICCULTURALLY EGOCENTRIC

MINIMIZATIONMINIMIZATION


Example: The Non-English Speaker

“It must be incredibly difficult to get medical care when you don’t know the language.”

“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?”

“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.”

“I can’t believe he’s been here for three years and doesn’t speak English. It’s not my problem.”


ETHNOSENSITIVEETHNOSENSITIVE


ETHNOCENTRICETHNOCENTRICFEARFEAR


FearFear

GeneralGeneral– ““Other students Other students

told me: Be careful! told me: Be careful! It’s not safe over It’s not safe over there.”there.”

SpecificSpecific– ““I’ve never dealt I’ve never dealt

with someone with with someone with AIDS. Should I wear AIDS. Should I wear gloves and a mask?gloves and a mask?




ETHNOCENTRICETHNOCENTRICFEARFEAR

OVERGENERALIZEOVERGENERALIZE


Over-generalizationOver-generalization

StereotypingStereotyping– ““She kept using her hands while she She kept using her hands while she

talked. She reminded me of my friend’s talked. She reminded me of my friend’s grandmother. I thought it was Prince grandmother. I thought it was Prince Spaghetti Day!”Spaghetti Day!”

Culture blindness or denial of Culture blindness or denial of differencedifference– ““I never thought he could be a drug I never thought he could be a drug

user. He looks and acts so intelligent.”user. He looks and acts so intelligent.”




FEARFEAR

SUPERIORITYSUPERIORITY

OVERGENERALIZEOVERGENERALIZE

ETHNOCENTRICETHNOCENTRIC


SuperioritySuperiority

Negative Negative stereotypingstereotyping– ““He was so rude and He was so rude and

macho. I don’t macho. I don’t understand why Puerto understand why Puerto Rican women put up Rican women put up with that.”with that.”

ReversalReversal– ““American culture is so American culture is so

boring and crude. I find boring and crude. I find Vietnamese culture Vietnamese culture fascinating.”fascinating.”


CULTURALLY EGOCENTRICCULTURALLY EGOCENTRICATTITUDINAL NEEDS

CULTURALLY SENSITIVECULTURALLY SENSITIVE


MINIMIZATION


What have you observed?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.


Hypothesis: Attitude NeedHypothesis: 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?


Teaching culture and community:Teaching culture and community:Assessment and MethodsAssessment and Methods

Objective Needs Assessment

Method

Knowledge Question Lecture

Skills Observe Model

Attitudes Reflect Reflect


Teaching culture and community: Teaching culture and community: Assessing attitudesAssessing attitudes

Know yourself. Know yourself.

Assess your learner. Assess your learner.

Work for changeWork for change


Assessing Attitudes: Know Assessing Attitudes: Know Yourself: Yourself:

Reflection on selfReflection on self

Reflection in Reflection in practicepractice

Reflection on Reflection on practicepractice


Assessing Attitudes: Assessing Attitudes: Assess your learner.Assess your learner.

Facilitative styleFacilitative style

Encourage Encourage reflectionreflection

Active listeningActive listening


Reflective PracticeReflective Practice

““No human being No human being ever learned from ever learned from experience. experience. Human beings Human beings learn from learn from reflecting on their reflecting on their experience”experience”

P VilesP Viles


Assessing Attitudes: Assessing Attitudes: Working for Change.Working for Change.

Stages of ChangeStages of Change– Precontemplation to Precontemplation to

ContemplationContemplation

ReflectionReflection– Assessment Assessment andand

Teaching MethodTeaching Method

Life-long processLife-long process


Cultural HumilityCultural 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

Documents

Teaching of Tomorrow Faculty Development Toolbox