©2003 community faculty development center teaching of tomorrow faculty development toolbox...
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©2003 Community Faculty Development Center
Teaching of TomorrowTeaching of TomorrowFaculty Development ToolboxFaculty Development Toolbox
Slideshow ResourcesSlideshow Resources
©2003 Community Faculty Development Center
Teaching Culture and Community in Primary Care: Assessing Learner Needs
©2003 Community Faculty Development Center
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?
©2003 Community Faculty Development Center
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
©2003 Community Faculty Development Center
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
©2003 Community Faculty Development Center
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.
©2003 Community Faculty Development Center
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.
©2003 Community Faculty Development Center
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
©2003 Community Faculty Development Center
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
©2003 Community Faculty Development Center
CULTURALLY SENSITIVECULTURALLY SENSITIVE
Assessing EthnosensitivityAssessing Ethnosensitivity
CULTURALLY EGOCENTRICCULTURALLY EGOCENTRIC
MINIMIZATIONMINIMIZATION
©2003 Community Faculty Development Center
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.”
©2003 Community Faculty Development Center
ETHNOSENSITIVEETHNOSENSITIVE
Assessing EthnosensitivityAssessing Ethnosensitivity
ETHNOCENTRICETHNOCENTRICFEARFEAR
©2003 Community Faculty Development Center
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?
©2003 Community Faculty Development Center
ETHNOSENSITIVEETHNOSENSITIVE
Assessing EthnosensitivityAssessing Ethnosensitivity
ETHNOCENTRICETHNOCENTRICFEARFEAR
OVERGENERALIZEOVERGENERALIZE
©2003 Community Faculty Development Center
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.”
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ETHNOSENSITIVEETHNOSENSITIVE
Assessing EthnosensitivityAssessing Ethnosensitivity
FEARFEAR
SUPERIORITYSUPERIORITY
OVERGENERALIZEOVERGENERALIZE
ETHNOCENTRICETHNOCENTRIC
©2003 Community Faculty Development Center
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.”
©2003 Community Faculty Development Center
CULTURALLY EGOCENTRICCULTURALLY EGOCENTRICATTITUDINAL NEEDS
CULTURALLY SENSITIVECULTURALLY SENSITIVE
Assessing EthnosensitivityAssessing Ethnosensitivity
MINIMIZATION
©2003 Community Faculty Development Center
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.
©2003 Community Faculty Development Center
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?
©2003 Community Faculty Development Center
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
©2003 Community Faculty Development Center
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
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Assessing Attitudes: Know Assessing Attitudes: Know Yourself: Yourself:
Reflection on selfReflection on self
Reflection in Reflection in practicepractice
Reflection on Reflection on practicepractice
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Assessing Attitudes: Assessing Attitudes: Assess your learner.Assess your learner.
Facilitative styleFacilitative style
Encourage Encourage reflectionreflection
Active listeningActive listening
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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
©2003 Community Faculty Development Center
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
©2003 Community Faculty Development Center
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