review of a standardized patient medical student training ... · review of a standardized patient...
TRANSCRIPT
Review of a Standardized Patient Medical Student Training Exercise
Presenting and Promoting Cultural Competency—
Working with the Adult Amish Patient
Peter R. Lewis, MD, FAAFP Professor; Department of Family & Community Medicine
Penn State College of Medicine [email protected]
Eighth National Conference on Quality Health Care for
Culturally Diverse Populations Oakland, CA
March 12, 2013
Diversity Rx--Lecture-Discussion Objectives:
1. Recognize and appreciate that there is significant diversity within the Amish population
2. Better anticipate and respond to the healthcare needs of members of the Amish community
3. Utilize a Standardized Patient (SP) role play exercise with healthcare learners to improve their care of members of the Amish community
4. Recognize opportunities to apply the general precepts in this SP training exercise to the care of other cultural, ethnic, and religious groups that are underserved
By the conclusion of today’s lecture-discussion participants will be
able to:
Background—Cultural Competency/Humility—PSCOM/MSHMC
Definition of Diversity
Inclusive of all Cultures
Respect for Individuality
Appreciate our Uniqueness
Value Human-Kinds and -Minds
~Penn State College of Medicine
Milton S. Hershey Medical Center
Dean’s Council on Diversity, 2005
http://www.pbs.org/wgbh/americanexperience/films/amish/
Media Images/Stories of the Amish
Media Images/Stories of the Amish
“The Amish so don’t like to be the focus of the media, yet in
our culture we are just intensely fascinated by the Amish.”
Crystal Downing,
Professor of English and Film Studies at Messiah College
http://www.pennlive.com/midstate/index.ssf/2010/03/controver
sial_amish_grace_movi.html
Background— Historical Notes on the Amish
The Amish faith is a Christian religion that originated with Swish Anabaptists in the 1600s; an outgrowth of the Protestant Reformation
Amish migration to North America began in the 1700s
Majority of the Amish population affiliated with one of four orders - Old Order, New Order, Andy Weaver, and Swartzentruber
Amish emphasize adult baptism, separation/freedom from the State, conscientious objection to war, and obedience to God, their Order and District
The "Ordnung" is code which guides Amish daily living including use of technologies such as electricity and the automobile which may differ between districts and Orders
Background— Amish Population in the United States
http://www.rcms2010.org/maps2010.php
-more than a quarter of a million people
in nearly 2,000 church districts.
-463 geographical settlements in 30
states and the Canadian province of
Ontario
Background—Healthcare Needs in the Amish Community
Background— Pennsylvania Maps
Background—Pediatric Care in Hershey & the Amish
“The House That Love Built.”®
over 50 Amish and Mennonite carpenters from Perry County, PA, donated their carpentry skills to help frame the new addition
Background— The Amish in South-Central PA
PSCOM 2nd Yr Medical Student Teaching Session on Cultural Competency
1. Cultural Competency & the Clinical Encounter PowerPoint presentation--pdf version
2. American Family Physician article—“Cross Cultural Medicine”
3. JAMA A Piece of My Mind Essay—“Lessons in Friendship”—authored by a physician of Jewish background working within a predominantly Arab-American community
4. The Medical Interview—Ch. Excerpts—“Cultural Competence in the Medical Interview”
2 hr small group session
*1st hr review and discussion incorporating above resources
*2nd hr role play exercise with SP portraying an adult pt. who is Amish presenting for care at an outpatient practice setting with a primary concern of a tender foot with associated discharge following a puncture injury
FCM II Communications Observation Form 1. What did you observe on the part of your student colleague that fostered rapport and
established trust during the SP communications/interview role play?
2. What did you observe in terms of agenda-setting at the beginning of the SP role play?
3. What did you observe in terms of open-ended questions?
4. What did you observe in terms of affirmations?
5. What did you observe in terms of reflections?
6. What did you observe in terms of Summarization?
7. What did you observe in terms of allowing the patient to tell their story?
8. What did you observe in terms of eliciting the patient’s perspective?
9. What did you observe in terms of learning more about the patient as a person?
Major teaching points to be illustrated in the role play and applied to the care of Amish patients as well as members of other diverse cultural groups
1. we help to provide medical care and related services to one of the largest Amish communities in the country; primarily in Lancaster and neighboring counties
2. the vast majority of Amish individuals presenting for care are without health insurance; this may lead to delay in treatment and need for negotiation in terms of testing, treatment, and payment
3. many members of the Amish community, as a rule, will likely avoid modern technologies and conveniences such as a car or telephone which relates to their faith-belief system and may impact on their access to medical care
SP Amish Role Play—Intro/Agenda Setting
Major teaching points to be illustrated in the role play and applied to the care of Amish patients as well as members of other diverse cultural groups 4. the Amish, as a rule, will avoid many types of
preventive care including vaccinations (tetanus is relevant in this example)
5. the Amish may commonly employ herbal remedies for treatment
6. the faith community, church district, is important to the Amish life and belief system which impact on their choices for medical care and services
Important topics highlighted in the SP Amish role play include
doctor-patient communication
agenda setting
cultural competency
eliciting the patient’s perspective and worldview
complementary healthcare practices
occupational medicine
access to and payment for healthcare services, eliciting patient preferences
patient education and comprehension
negotiating a treatment plan
SP Amish Role Play— PMHx including Vaccinations
SP Amish Role Play— Social Hx including Religious/Faith Hx
SP Amish Role Play— Self-Reflection & Feedback
Acknowledgements and Thanks to Student and SP Role Play Actors
Yousif, Bruce, Trish, Roger, & Ana
Amish Grace @ Nickel Mines (Lancaster County, PA)
Adds a father who lost a daughter at the Nickel Mines school massacre:
"As far as the community, I think it made us all realize — Amish, Mennonite, English — we're a lot more alike than we thought we were."
Amish SP Role Play—Resources/References
PA German Audio Links (Woman reading Nursery Rhymes)-- www.pgs.org/dialect_audio.asp
Ohio State University--"Working with the Amish"-- http://ohioline.osu.edu/hyg-fact/5000/5236.html
New York Times Magazine Article on Dr. Holmes Morton and his Clinic For Special Children in Lancaster County-- www.nytimes.com/2005/11/06/magazine/06amish.html?ex=1288933200&en=cd1c319f62d95b18&ei=5088&partner=rssnyt&emc=rss
Clinic for Special Children-- http://www.clinicforspecialchildren.org
American Experience-- http://www.pbs.org/wgbh/americanexperience/films/amish/
BBC2 –Amish A Secret Life-- http://www.youtube.com/watch?v=KaBnmSyNxHE
Amish Studies Elizabethtown College-- http://www2.etown.edu/amishstudies/
Amish Grace-- http://amishgrace.mennonite.net/
Raymond D. Hobbs; An Amish House Call. Annals of Internal Medicine. 2000 Nov;133(10):834-836.http://annals.org/article.aspx?articleid=714010
Patients Are A Virtue—Practicing Medicine in the Pennsylvania Amish Country– Henry S. Wentz, M.D.