Family Medicine Clerkship

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CULTURALLY RESPONSIVE HEALTH CARE

OVERVIEW

The National Center for Cultural Competence defines cultural competency for medical professionals as "a set of congruent behaviors, attitudes, and policies that come together in a system, agency or among professionals and enable them to work effectively in cross-cultural situations."(Cross T et al, 1989. National Center for Cultural Competence)

TOPIC LEARNING GOALS AND OBJECTIVES

(Organized by ACGME Competencies)

Patient Care

GOAL: Students will understand the role of culture in the health and illness of their patients and communities.

OBJECTIVES: Students will be able to:

  • Demonstrate awareness of their own social/cultural heritage and its impact on the experience of health, illness, and the practice of medicine.
  • Describe social/cultural influences on family health.

GOAL: Students will deliver culturally responsive healthcare to patients and families.

OBJECTIVES: Students will be able to:

  • Perform a comprehensive health history, including cultural beliefs and values.
  • Perform a history and physical exam using an interpreter.
  • Incorporate patient's health beliefs into plan of care.

Medical Knowledge

GOAL: Students will gain knowledge about the impact of culture on health and illness.

OBJECTIVES: Students will be able to:

  • Analyze health data and population demographics (including culture, health beliefs, folk illnesses and folk health practices, explanatory models, and common health problems of local community.
  • Incorporate knowledge about culture and its impact on the health of patients and families into patient treatment plans.

GOAL: Students will recognize disparities in health outcomes related to race, ethnicity, and culture.

OBJECTIVES: Students will be able to:

  • Describe differences in access to health care and health outcomes that exist related to cultural and ethnic populations.

Practice-Based Learning and Improvement

GOAL: Students will become aware of the need for culturally responsive health care.

OBJECTIVES: Students will be able to:

  • Explain the impact of the current health care system on access to health care services for various populations.

Interpersonal and Communication Skills

GOAL: Students will communicate effectively with patients and families across cultures and languages.

OBJECTIVES: Students will be able to:

  • Communicate effectively with patients and families from diverse cultural backgrounds.

GOAL: Students will become skilled in communicating effectively with patients and families through an interpreter.

OBJECTIVES: Students will be able to:

  • Demonstrate the ability to communicate effectively with patients and/or families utilizing an interpreter.

Professionalism

GOAL: Students will recognize and address their own limitations and learning needs related to ability to deliver culturally responsive health care.

OBJECTIVES: Students will be able to:

  • Analyze their own behavior to identify culturally relevant practices and/or need for change.

Systems-Based Practice

GOAL: Students will develop awareness of resources that can improve care of patients and families and decrease health outcome disparities.

OBJECTIVES: Students will be able to:

  • Seek out and utilize resources in local practice community that support positive health outcomes for diverse patients and families.

EDUCATIONAL METHODS

Teaching Strategies

  • "Windshield tour" of community

Cultural Competency Models

  • Cross Model
  • Campinha Model
  • Bennett Model
  • Genogram, including cultural factors
  • Collection of logbook data on patient populations

Clinical Experience

  • Clinical rotations in communities with diverse populations
  • Immigrant/refugee clinics--perform a focused history on at least one patient using cultural communication model (LEARN, ETHNIC, BATHE)
  • Perform an interview on a non-English speaking patient through an interpreter.
  • Cultural immersion experiences within practice community (i.e., visit a church, community center, home within a culture different from one's own)

Independent Learning

  • Spanish language immersion schools
  • Develop personal goals for learning culturally responsive care & record in personal journal.

Electives

  • Immigrant/Refugee Medicine, University of Colorado, Denver, Colorado-- contact: David Gaspar, Director, Predoctoral Education.

EDUCATIONAL RESOURCES

Curricula

Published Material

  • Alexander M. Cinemeducation: an innovative approach to teaching multi-cultural diversity in medicine. Ann Behav Sci and Med Educ. 1995; 2(1): 23-28.
    Abstract at PubMed
  • Berlin E, Fowkes W. A teaching framework for cross-cultural health care. West J of Med.1983; 139:934-938.
  • Betancourt JR, Like RC, Gottlieb BR, eds. Caring for diverse populations: breaking down barriers.   Special Issue of Patient Care: The Practical Journal for Primary Care Physicians, 2000; 34(9), May 15, 2000.
  • Borkan JM, Neher JO. A developmental model of ethnosensitivity in family practice training.   Fam Med.1991; 23(3): 212-217.
    Abstract at PubMed
  • Carillo JE, Green AR, Betancourt JR. Cross-cultural primary care: a patient-based approach. Ann Intern Med. 1999; 130:829-834.
    Abstract at PubMed
    Article (pdf file) at Ann Intern Med
  • Culhane-Pera KA, Like RC, Lebensohn-Chialvo P, Loewe R. Multicultural curricula in family practice residencies. Fam Med. 2000; 32(3):167-173.
    Abstract at PubMed
  • Culhane-Pera KA, Reif C, Egli E, Baker NJ, Kassekert R. A curriculum for multicultural education in family medicine. Fam Med. 1997; 29(10): 719-723.
    Abstract at PubMed
  • Gavaga T. Medical care for immigrants and refugees. Am Fam Phys 1998; 57:1065-72.
    Article at Am Fam Phys
  • Hedrick H, ed. Cultural Competence Compendium. Chicago: American Medical Association, 1999.
  • Johnson TM, Hardt EJ, Kleinman A. Cultural factors in the medical interview. In: Lipkin M Jr., Putnam SM, Lazare A. eds. The Medical Interview. Clinical Care, Education and Research. New York: Springer-Verlag; 1995: 153-162.
  • Kleinman A, Eisenberg L, Good B. Culture, illness and care. Clinical lessons from anthropologic and cross-cultural research. Ann Intern Med. 1978;88:251-258.
    Abstract at PubMed
  • Like RC, Steiner RP, Rubel AJ. Recommended core curriculum guidelines on culturally sensitive and competent health care, Fam Med. 1996; 28:291-297.15.
    Abstract at PubMed
  • Loudon RF, Anderson PM, Gill PS, Greenfield SM. Educating medical students for work in culturally diverse societies, JAMA. 1999; 282(9): 875-880.
    Abstract at PubMed
  • Lum CK, Korenman SG. Cultural sensitivity training in US medical schools. Acad Med.1994; 69(3): 239-241.
    Abstract at PubMed
  • McCullough-Zander K, ed. Caring Across Cultures: The Provider's Guide to Cross-Cultural Health. 2 nd ed. The Center for Cross-Cultural Health, Minneapolis, MN, 2000
    http://www.crosshealth.com
  • Nora LM, Daugherty SR, Mattis-Peterson A, Stevenson L, Goodman LJ. Improving cross-cultural skills of medical students through medical school-community partnerships. West J of Med. 1994; 161(2): 144-147.
    Abstract at PubMed
  • Nunez AE. Transforming cultural competence into cross-cultural efficacy in women's health education. Acad Med. 2000; 75:1071l-1080.
    Abstract at PubMed
  • Pinn V. Sex and gender factors in medical studies: Implications for health and clinical practice. JAMA. 289 (4): 397-400
    Abstract
    at PubMed
  • Robins LS, Alexander GL, Wolf FM, Fantone JC, Davis WK. Development and evaluation of an instrument to assess medical students' cultural attitudes. JAMWA. 1998; 53 (3 Suppl.):124-129.
  • Shapiro J, Lenahan P. Family medicine in a culturally diverse world: a solution-oriented approach to common cross-cultural problems in medical encounters. Fam Med.1996; 28(4): 249-255.
    Abstract at PubMed

Web Sites

Multimedia

  • BaFa-BaFa Simulation Training System
    218 Twelfth Street, Del Mar, CA 92014-0901
    Resources for Cross-cultural Health Care

Contact People

  • Robert Like, MD, Robert Wood Johnson Medical School

Other

  • Alvord LA (2000). The Scalpel and the Silver Bear-The First Navajo Woman Surgeon Combines Western Medicine and Traditional Healing.
  • Delgado JL (1997). SALUD! A Latina's Guide to Total Health-Body, Mind and Spirit, the National Hispanic Women's Health Initiative.
  • Fadiman A (1998). The Spirit Catches You and You Fall Down. New York: Farrar, Straus & Giroux. www.spiritcatchesyou.com

ASSESSMENT STRATEGIES

Standardized Patient Cases

  • University of Colorado Family Medicine Clerkship Examination-use of interpreter in clinical setting case, David Gaspar, MD
    david.gaspar@uchsc.edu

 

Lead Author: Ann O'Brien-Gonzales, PhD
Clerkship/Post-Clerkship Workgroup members: Ann O'Brien-Gonzales, PhD (Chair), Alexander Chessman, MD (EC Liaison), Caryl Heaton, DO, Janice Nevin, MD, MPH, Lauren Oshman, MD, Deborah McPherson, MD, Mark. E Quirk, EdD, David Schneider, MD, MSPH, William B. Shore, MD, Richard Usatine, MD

Family Medicine Curriculum Resource (FMCR) Project HRSA Contract 240-00-0107.

Revised March 3, 2003
 

For questions or comments, please contact Webmaster or Ardis Davis

This page last updated November 6, 2004