Cross-cultural Medical Education at Stanford University

Clarence H. Braddock III, MD, MPH

Ronald D. Garcia, PhD

NIH(NHLBI) Sponsorship PI: CH Braddock III, MD, MPH RFA Goal: “To enhance the ability of

physicians and other health professionals to address disparities in cardiovascular, pulmonary, hematologic, and sleep disorders in a culturally sensitive manner.”

Five-year grant (2004-2009)

AAMC Sponsorship

PI: Ronald D. Garcia, PhD GOAL: Develop an integrated model

curriculum throughout the preclinical and clinical curriculum.

Challenges Access to time in the required

curriculum Teaching resources Development of cases Evaluation

Leveraging opportunities Complimentary backgrounds

Physician; bioethics, patient-physician communication

Psychologist; leader in cross-cultural medical education, diversity

Complimentary projects NHLBI - focus on preclinical students,

residents, faculty development AAMC - focus on clinical students

Leveraging opportunities Combining resources

Staff support Needs assessment Teaching activities

Critical mass “Cross-cultural Medical Education

Initiative”

Teaching Methods Interactive and experiential Role plays Workshop formats Patient simulations Web-based resources

Outcomes Teaching modules

Interpreters Communication models Patient simulations

Teaching methods

Simulations

Reflective experiences

NHLBI Cultural Competence and Health Disparities Education Collaborative

Who we are - What we’re doing

Clarence H. Braddock III, MD, MPH

Stanford University

NHLBI Health Disparities Program

Goal: “To enhance the ability of physicians and other health professionals to address disparities in cardiovascular, pulmonary, hematologic, and sleep disorders in a culturally sensitive manner.”

Funding: Five-year academic awards to support faculty time for curriculum development

Deliverables Curriculum development &

implementation Medical students Residents Practicing physicians

Evaluation Dissemination to all U.S. medical

schools

NHLBI Cultural Competence and Health Disparities Education Collaborative

*

*

*

Mission Statement Our Collaborative seeks to develop curricula that

enhance the ability of physicians and other health care professionals to address disparities in the U.S. in a culturally sensitive manner.

Our ultimate goal is to develop, evaluate, and disseminate a comprehensive cultural competence curriculum to medical schools throughout the U.S., thereby providing support and leadership to medical educators nationwide.

Strategies Foster inter-institutional collaboration

Annual collaboration & planning meeting Monthly conference calls Collaborative projects

Forge alliances with other organizations AAMC OMH Professional societies: STFM, SGIM, AMA

Current collaborative projects Curriculum needs assessment:

AAMC’s Tool for Assessing Cultural Competence Training (TACCT)

Dissemination: Web Portal Faculty development: Stanford Faculty

Development Center

Curriculum Dissemination

Web Portal Project

Web Portal: GoalsTo provide: Resources for curriculum needs assessment and

development Platform to disseminate curricular materials Forum for medical educators to share curricular

materials Links to other supporting materials for cultural

competence education.

Faculty Development

Stanford Faculty Development Center

(SFDC)

Stanford Faculty Development Center

Stanford Faculty Development Center

Clinical Teaching Program -1986

Professionalism in Contemporary Practice

Program - 2003

Seminar Facilitators

Seminar Participants(Faculty & Residents)

Learners Institution

DisseminationDissemination Model ModelNationally & internationally since 1986

Previous ProgramsPrevious Programs::

• • Preventive MedicinePreventive Medicine• • Medical Decision MakingMedical Decision Making• • End-of-Life CareEnd-of-Life Care• • Geriatrics in Primary CareGeriatrics in Primary Care

SFDC: Professionalism in Contemporary Practice One-month fellowship to enhance faculty teaching:

Reflective practice, Patient-centered care, EBM, QI, patient safety

Developed pilot module on cultural competence Review data on health disparities; definitions of race,

culture,cultural competence Build skills in cross-cultural communication Gain insight into personal biases Develop effective strategies to teach cultural competence

Shared Decision Making

Shared Decision Making

Evidence-Based

Practice

Evidence-Based

Practice

Working in TeamsWorking in Teams

Quality Improvement

Quality ImprovementPatient

Safety

Patient Safety

Reflective Practice

Reflective Practice

Professionalism in Contemporary Practice

Defining

Professionalism

Defining

Professionalism

Cultural Competence

Cultural Competence

Cultural Competence Module Learning GoalsParticipants will be able to: Define cultural competence Reflect on personal cultural attitudes Describe how communication impacts health

disparities Apply tools to improve cross-cultural communication Reflect on specific ways you can use what you’ve

learned in this module to improve your teaching your clinical practice your institution

Health Belief and Attitudes Survey (HBAS) 15 items scored on 6-point Likert scale. Items are distributed into four domains assessing the

learner’s attitudes towards: Opinion – Importance of assessing patients’ perspectives

and opinions Belief – Importance of determining patients’ beliefs for

history taking and treatment Context – Importance of assessing patients’ psychological

and cultural contexts Quality – Importance of knowing the patients’ perspective

for providing good health care

Dobbie 2002

Design

HBAS“Pre”

HBAS“Retro-Pre” &

“Post”

Cultural Competence Module

HBAS: Results (RetroPre v Post):

Opinion

Retro-Pre

Post

Mean 4.94 5.13

T-test -3.040

P-value 0.002

Belief

Retro-Pre

Post

Mean 4.69 5.06

T-test -5.516

P-value <0.001

HBAS: Results (RetroPre v Post)

Context

Retro-Pre

Post

Mean 5.19 5.53

T-test -3.96

P-value <0.001

Quality

Retro-Pre

Post

Mean 4.64 4.93

T-test -2.6

P-value 0.006

Coming soon…“Enhancing multicultural education & practice”SFDC - In Development

1. Health disparities – overview of evidence & causes2. Definitions of culture, race, ethnicity 3. Reflective practice and self-awareness of beliefs and

biases4. Linguistic barriers– use of interpreters, CLAS standards,

etc.5. Exploring health beliefs & explanatory models of illness6. Educational methods/resources 7. Evaluation & assessment methods & tools