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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

• University of Washington Ethnic Medicine Guide
  http://ethnomed.org/ethnomed/
  
• National Alliance for Hispanic Health
  http://www.hispanichealth.org/
  
• AMSA Diversity in Medicine Project:
  http://www.amsa.org/div
  
• Sunita Mutha, MD, FACP, Carol Allen, MA, Melissa Welch, MD, MPH, "Toward Culturally Competent Care: A Toolbox for Teaching Communication Strategies." A Cultural Competency Training Template, Center for the Health Professions, University of California, San Francisco
  http://www.futurehealth.ucsf.edu/cnetwork/resources/curricula/diversity.html
  
• Toward Culturally Competent Care: A Toolbox for Teaching Communication Strategies: Discussing Tough Issues with Patients: Managing Unreasonable Requests, Mistakes, Thomas Gallagher, MD, School of Medicine, University of Washington, Center for the Health Professions, University of California, San Francisco
  http://futurehealth.ucsf.edu/cnetwork/events/gallagherworkshop.html
  
• Best Practices for Busy Clinicians: Applying Continuous Quality Improvement in Practice, Peter Rudd, MD, FACP, Stanford University Medical Center, Center for the Health Professions, University of California, San Francisco http://futurehealth.ucsf.edu/cnetwork/events/ruddworkshop.html
  
• Population and Quality Improvement: Improving Care and Creating Agents of Change, Center for the Health Professions, Alicia Fernandez, MD, et al, Division of General Internal Medicine, San Francisco General Hospital, University of California, San Francisco http://futurehealth.ucsf.edu/pdf_files/PQICoursefinalrev.html (a pdf file)
  
• Teaching Diversity and Cultural Competence in Health Care: A Trainer's Guide, Melissa Welch, MD, Principal and Founder of Perspectives of Differences Diversity Training http://www.mwelchatpodsdt.org/_wsn/page2.html
  
• A Family Physician's Guide to Culturally Competent Care
  8-modules curriculum
  Developed by the Office of Minority Health (contracted to the American Institutes for Research).
  http://cccm.thinkculturalhealth.org/

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

• Cultural Competence and Quality of Care resources at HRSA's Bureau of Primary Health Care
  http://bphc.hrsa.gov/quality/Cultural.htm
  
• Diversity Rx
  http://www.diversityrx.org/
  
• National Center for Cultural Competence
  http://gucchd.georgetown.edu/nccc/
  
• National Standards for Culturally and Linguistically Appropriate Services (CLAS) in Health Care Office of Minority Health Resource Center http://www.omhrc.gov/CLAS
  
• Initiative to Eliminate Racial and Ethnic Disparities in Health U.S. Department of Health and Human Services
  http://raceandhealth.hhs.gov
  
• Office for Civil Rights
  http://www.hhs.gov/ocr/lep/guide.html
  
• EthnoMed
  http://www.ethnomed.org
  
• Resources for Cross Cultural Health Care
  http://www.diversityrx.org
  
• The Provider's Guide to Quality and Culture
  http://erc.msh.org/
  
• National Multicultural Institute Washington, DC
  http://www.nmci.org
  
• Cross Cultural Health Care Program at Pacific Medical Clinics Seattle, WA
  http://www.xculture.org
  
• Reduce disparities in health outcomes for poor, minority, and other underserved people
  http://www.healthdisparities.net/
  
• Minority Health Project to eliminate health disparities, at the University of North Carolina at Chapel Hill
  http://www.minority.unc.edu/
  
• Race, Health Care and the Law University of Dayton School of Law
  http://academic.udayton.edu/health/index.htm
  
• The Center for Cross Cultural Health
  410 Church Street, Suite W227, Minneapolis, MN 55455 http://www.crosshealth.com/
  
• Cross Cultural Health Care Program
  270 South Hanford Street, Suite 100, Seattle, WA 98134 Phone: (206) 860-0329
  http://www.xculture.org/
  
• Department of Health and Human Services Health Resources and Services Administration
  Bureau of Primary Health Care
  4350 East-West Highway, Bethesda, MD 20814
  Office of Minority Health PO Box 37337, Washington DC 20013-7337
  Phone: (800) 444-6472
  www.info@omhrc.gov
  
• Center for American Indian and Alaskan Native Health
  (410) 955-6931
  http://ih.jhsph.edu/cnah/mission.htm

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.

For questions or comments, please contact Webmaster or Ardis Davis

This page last updated October 15, 2005