PROJECT INTERACTPROJECT INTERACT: :

A Predoctoral Training A Predoctoral Training Program for Cultural and Program for Cultural and

Interdisciplinary CompetencyInterdisciplinary CompetencyThe University of Medicine and Dentistry The University of Medicine and Dentistry

of of

New JerseyNew Jersey

School of Osteopathic Medicine School of Osteopathic Medicine

(UMDNJ-SOM) (UMDNJ-SOM)

Department of Family Medicine.Department of Family Medicine.

PresentersPresenters Carman A. Ciervo, D.O., FACOFPCarman A. Ciervo, D.O., FACOFP

Chair, Department of Family MedicineChair, Department of Family Medicine

Frank A. Filipetto, D.O., FACOFPFrank A. Filipetto, D.O., FACOFP

Vice Chair, Department of Family MedicineVice Chair, Department of Family Medicine

Claudia A. Switala, M.Ed.Claudia A. Switala, M.Ed.

Program Development SpecialistProgram Development Specialist

FundingFunding

This project is supported by funds received This project is supported by funds received from the Department of Health and Human from the Department of Health and Human Services (DHHS), Health Resources and Services (DHHS), Health Resources and Services Administration (HRSA), Bureau of Services Administration (HRSA), Bureau of Health Professions (BHPr), under Predoctoral Health Professions (BHPr), under Predoctoral Training Grants.  The information or content Training Grants.  The information or content and conclusions are those of the authors and conclusions are those of the authors and should not be construed as the official and should not be construed as the official position or policy of, nor should any position or policy of, nor should any endorsements be inferred by, the DHHS, endorsements be inferred by, the DHHS, HRSA, or the U.S. Government.HRSA, or the U.S. Government.

Rationale and ProcessRationale and Process

Presented by Presented by

Carman A. Ciervo, D.O., FACOFPCarman A. Ciervo, D.O., FACOFP

Cultural Competency DefinitionCultural Competency Definition

The Association of American Medical The Association of American Medical Colleges:Colleges: ““an awareness of self and one’s own value systems; an awareness of self and one’s own value systems;

an understanding of culture and its role as a factor in an understanding of culture and its role as a factor in health and health care; a sensitivity to cultural issues health and health care; a sensitivity to cultural issues for each patient; and an understanding and ability to for each patient; and an understanding and ability to use specific methods to deal effectively with cultural use specific methods to deal effectively with cultural issues in interacting with individual patients, their issues in interacting with individual patients, their families, members of the healthcare team and the families, members of the healthcare team and the wider community. wider community.

Challenges to Healthcare ProvidersChallenges to Healthcare Providers

In today’s health care environment, In today’s health care environment, physicians must know how to physicians must know how to communicate, negotiate, interact, make communicate, negotiate, interact, make decisions and problem-solve with other decisions and problem-solve with other healthcare professionals to effectively healthcare professionals to effectively deliver health care services. deliver health care services.

Cultural Competence and Cultural Competence and Interdisciplinary SkillsInterdisciplinary Skills

The Association of American Medical The Association of American Medical Colleges put forth recommendations on Colleges put forth recommendations on curriculum that “establish the principle that curriculum that “establish the principle that cultural diversity programs be integrated cultural diversity programs be integrated throughout medical curricula with a focus throughout medical curricula with a focus on interdisciplinary learning.”on interdisciplinary learning.”[1][1]

[1][1] Association of American Medical Colleges Association of American Medical Colleges, Resolution on Cultural Diversity , Resolution on Cultural Diversity

as a LCME Accreditation Standardas a LCME Accreditation Standard..

Project InteractProject Interact

A HRSA funded Predoctoral Training A HRSA funded Predoctoral Training GrantGrant

A Collaborative ModelA Collaborative Model

Standardized Patient Lab as Focal PointStandardized Patient Lab as Focal Point

Project Interact CommitteeProject Interact Committee

• UMDNJ School of Osteopathic UMDNJ School of Osteopathic MedicineMedicine

• Family MedicineFamily Medicine• Internal MedicineInternal Medicine• PediatricsPediatrics• OB/GynOB/Gyn• PsychiatryPsychiatry• Center for AgingCenter for Aging

• Predoctoral StudentsPredoctoral Students

Project Interact CommitteeProject Interact Committee

• School Health Related Professions School Health Related Professions

• School of Nursing School of Nursing

• School of Public HealthSchool of Public Health

• School of Dental MedicineSchool of Dental Medicine

• New Jersey Area Health Education New Jersey Area Health Education CenterCenter

A Collaborative ModelA Collaborative Model

Through three ComponentsThrough three Components CurriculumCurriculum

Standardized Patient LabStandardized Patient Lab

Community Service RotationCommunity Service Rotation

Incorporating Cultural and Incorporating Cultural and Interdisciplinary Competencies Interdisciplinary Competencies into the Predoctoral Curriculuminto the Predoctoral Curriculum

Presented byPresented by

Frank A. Filipetto, D.O., FACOFPFrank A. Filipetto, D.O., FACOFP

Family Medicine FacultyFamily Medicine Faculty Identified all FM Curriculum throughout the Identified all FM Curriculum throughout the

four years.four years. Discussed where competencies could be Discussed where competencies could be

learned.learned. Developed curriculum modules.Developed curriculum modules. Developed Standardized Patient Cases Developed Standardized Patient Cases

with cultural considerations and with cultural considerations and interdisciplinary needsinterdisciplinary needs

Establishing CompetenciesEstablishing Competencies

Intensive faculty developmentIntensive faculty development Identified cultural and interdisciplinary Identified cultural and interdisciplinary

competenciescompetencies Incorporated competencies into all Family Incorporated competencies into all Family

Medicine coursesMedicine courses Creation of standardized patient casesCreation of standardized patient cases

First YearFirst Year

Health disparities, health beliefs and Health disparities, health beliefs and barriers to healthcarebarriers to healthcare

Cultural awarenessCultural awareness Interdisciplinary principles and conceptsInterdisciplinary principles and concepts Cultural heritage and lifestyle assessmentCultural heritage and lifestyle assessment

Second YearSecond Year

Performing cultural and lifestyle Performing cultural and lifestyle assessmentsassessments

Communicating through an interpreterCommunicating through an interpreter Implement interdisciplinary concepts via Implement interdisciplinary concepts via

core projectscore projects Identify subcultures and its impact on Identify subcultures and its impact on

healthcarehealthcare

Third YearThird Year

Two weeks after rotation exposing Two weeks after rotation exposing students to health disparities and students to health disparities and interdisciplinary careinterdisciplinary care

Telling bad newsTelling bad news Resolving conflictResolving conflict

Fourth YearFourth Year

Troublesome bequests – cultural Troublesome bequests – cultural explanations and interdisciplinary solutions explanations and interdisciplinary solutions to ethical dilemmasto ethical dilemmas

Physician assisted suicidePhysician assisted suicide

Truth tellingTruth telling

HIV confidentialityHIV confidentiality

Student Outcomes

Presented by

Claudia A. Switala, M.Ed.

Demographic DataDemographic Dataon on

Project Interact ParticipantsProject Interact Participants Academic Year 2001 -2002Academic Year 2001 -2002

n=322n=322

SexSex Females 163Females 163 MalesMales 159159

ClassClass MS I MS I 8989 MS II MS II 8181 MS IIIMS III 7171 MS IVMS IV 8181

Demographic DataDemographic Dataon on

Project Interact ParticipantsProject Interact Participants Academic Year 2001 -2002Academic Year 2001 -2002

n=322n=322 Ethnic Racial DemographicsEthnic Racial Demographics

73 73 Underrepresented minorities Underrepresented minorities (African American, Hispanic, Native (African American, Hispanic, Native

American, Vietnamese)American, Vietnamese) 74 74 Other Minorities (Chinese, Japanese, Other Minorities (Chinese, Japanese,

Philipino, Indian)Philipino, Indian) 175175 CaucasiansCaucasians

Assessment of First Year StudentsAssessment of First Year Studentsn=89n=89

Cultural Self Awareness ToolCultural Self Awareness Tool 78% Willing to identify own culture78% Willing to identify own culture 54% Willing to identify and share health 54% Willing to identify and share health

beliefs and practicesbeliefs and practices 7% Willing to identify stereotypes that 7% Willing to identify stereotypes that

they have of other culturesthey have of other cultures 52% Willing to identify “typical 52% Willing to identify “typical

stereotypes” you have heard stereotypes” you have heard about about other culturesother cultures

48% Willing to identify biases and 48% Willing to identify biases and prejudices.prejudices.

Assessment of First Year StudentsAssessment of First Year Studentsn=89n=89

S P Case I : Conducting Cultural S P Case I : Conducting Cultural Heritage Assessment / Completion of Heritage Assessment / Completion of GenogramGenogram

91% 91% Identified Cultural Identified Cultural considerationsconsiderations

84% 84% Identified Interdisciplinary Identified Interdisciplinary needsneeds

88% 88% Identified Psychosocial issuesIdentified Psychosocial issues76% 76% Identified Economic issues Identified Economic issues

Assessment of First Year StudentsAssessment of First Year Studentsn=89n=89

S P Case II: Overweight AdultS P Case II: Overweight Adult

92% 92% Identify cultural aspects Identify cultural aspects impacting on case (impacting on case (Family, Family, Religion and Diet)Religion and Diet)

87% Identify interdisciplinary support 87% Identify interdisciplinary support system for patient. (system for patient. (Church, Church, Nutritionist and Family)Nutritionist and Family)

Assessment of Second Year StudentsAssessment of Second Year Studentsn=81n=81

S P Case I: Migrant Worker with Back Pain and S P Case I: Migrant Worker with Back Pain and Language BarrierLanguage Barrier

80% 80% Provided appropriate instruction to Provided appropriate instruction to interpreterinterpreter

78% 78% Placed interpreter in appropriate Placed interpreter in appropriate position in relation to patientposition in relation to patient

82% 82% Focused on patient, not interpreterFocused on patient, not interpreter 81% 81% Conducted a cultural and lifestyle Conducted a cultural and lifestyle

assessmentassessment 72%72% Identified impact of cultural issue’s on Identified impact of cultural issue’s on

patient’s health (family support, family not in patient’s health (family support, family not in this country)this country)

68%68% Identified interdisciplinary resources for patientIdentified interdisciplinary resources for patient

Assessment of Second Year StudentsAssessment of Second Year Studentsn=81n=81

S P Case II – Physical ExamS P Case II – Physical Exam 71% 71% Treated the patient respectfully with Treated the patient respectfully with

regards to privacyregards to privacy 52% 52% Asked permission of patient to begin Asked permission of patient to begin

the examthe exam 55%55% Prepares patient for what they are Prepares patient for what they are

about to do during the examabout to do during the exam 73%73% Does not use medical jargonDoes not use medical jargon

Assessment of Third Year StudentsAssessment of Third Year Students Two week Community Service Rotation Two week Community Service Rotation

n=71n=71

Comments taken from their logs.Comments taken from their logs. 91% 91% Rated experience as meaningful, Rated experience as meaningful,

positive, worthwhile. positive, worthwhile. 78% 78% Indicated appreciation for work of Indicated appreciation for work of

interdisciplinary team membersinterdisciplinary team members 47% 47% Were more appreciative of their own livesWere more appreciative of their own lives 69% 69% Indicated they had a better understanding of Indicated they had a better understanding of

the complex psychosocial and economic the complex psychosocial and economic issues impacting on healthissues impacting on health

Assessment of Third Year StudentsAssessment of Third Year Studentsn=71n=71

42% 42% Appreciated the dedication and hard Appreciated the dedication and hard work of physicians in medically work of physicians in medically

underserved communities.underserved communities. 52%52% Recognized that patients in Recognized that patients in

underserved communities respect underserved communities respect and and appreciate the physician.appreciate the physician.

22%22% Would want to continue to volunteer Would want to continue to volunteer time at their rotation sitetime at their rotation site

29% 29% Said they would work in a medically Said they would work in a medically underserved community after underserved community after

graduationgraduation

Assessment of Third Year StudentsAssessment of Third Year Studentsn=71n=71

S P Case I: Telling Bad NewsS P Case I: Telling Bad News 78% 78% Asked what patient knew about illnessAsked what patient knew about illness 81%81% Asked if patient wanted someone with Asked if patient wanted someone with

them.them. 84%84% Assessed willingness of patient to hear Assessed willingness of patient to hear

bad newsbad news 82%82% Demonstrated verbal or non verbal Demonstrated verbal or non verbal

empathy to patient.empathy to patient.

Assessment of Third Year StudentsAssessment of Third Year Studentsn=71n=71

S P Case II: Interdisciplinary Team S P Case II: Interdisciplinary Team MeetingMeeting 82% 82% Communicated effectively with team Communicated effectively with team

membersmembers 85%85% Demonstrated respect for team Demonstrated respect for team

membersmembers 78%78% Demonstrated knowledge of team Demonstrated knowledge of team

members roles.members roles. 79%79% Interacted as an equal with team Interacted as an equal with team

membersmembers

Assessment of Fourth Year StudentsAssessment of Fourth Year Studentsn=81n=81

S P Case I: Ethical Request to assist S P Case I: Ethical Request to assist with suicide (End Stage lung cancer)with suicide (End Stage lung cancer) 81% 81% discussed physician responsibilities discussed physician responsibilities

with patientwith patient 84%84% identified psychosocial issues of case identified psychosocial issues of case

and negotiated with patientand negotiated with patient 86%86% determined and discussed determined and discussed

interdisciplinary interventions with interdisciplinary interventions with patientpatient

Assessment of Fourth Year StudentsAssessment of Fourth Year Studentsn=81n=81

SP Case II: Truth Telling Case SP Case II: Truth Telling Case (Terminal Diagnosis of lung cancer and (Terminal Diagnosis of lung cancer and physician is meeting with daughter)physician is meeting with daughter) 95%95% Listened to family member’s concernsListened to family member’s concerns 78%78% Discussed physician’s responsibilities Discussed physician’s responsibilities

with family members.with family members. 79%79% Explored cultural aspect of truth telling Explored cultural aspect of truth telling

(why you don’t want mother to (why you don’t want mother to hear the hear the diagnosis)diagnosis)

Assessment of Fourth Year StudentsAssessment of Fourth Year Studentsn=81n=81

S P Case III: HIV / AIDSS P Case III: HIV / AIDS 82%82% Discussed and negotiated with patient Discussed and negotiated with patient

regarding informing spouseregarding informing spouse 78%78% Knowledgeable about N J’s resources Knowledgeable about N J’s resources

and requirements regarding and requirements regarding HIV/AIDSHIV/AIDS

86%86% Determined with patient the Determined with patient the appropriate interdisciplinary appropriate interdisciplinary

interventionsinterventions

Institutional OutcomesInstitutional Outcomes

Changed the curriculum of SOM to include Changed the curriculum of SOM to include cultural and interdisciplinary trainingcultural and interdisciplinary training

Changed the culture of Family Medicine Changed the culture of Family Medicine and SOMand SOM

Placed Family Medicine in leadership role Placed Family Medicine in leadership role with regards to cultural and with regards to cultural and interdisciplinary training in the State of interdisciplinary training in the State of New JerseyNew Jersey

Governor of New Jersey signed Cultural Governor of New Jersey signed Cultural Competency bill on our campusCompetency bill on our campus