Teaching Culture and Community in Primary Care: The Community as Teacher

1. Teaching Culture and Community in Primary Care:The Community as Teacher

2. Teaching Culture and Community: The Community as Teacher • After this session, you will be able to: • Address knowledge needs regarding cultural issues in the community setting • Augment the GNOME planning process to include service-learning methodologies • Use the principles of service-learning to plan a community-based learning experience for incorporation into your practice

3. Where have we been?

4. Needs Assessment • Self-assessment • Assess level of ethno-sensitivity • Assess skill level of learner in the context of trans-cultural interviewing CULTURALLY SENSITIVE MINIMIZATION CULTURALLY EGOCENTRIC

5. Objectives • Attitudes and values: • Celebration of diversity • Recognition of cultural biases • Respect for all health beliefs • Avoid assumptions and stereotypes • Skills: • Patient Centered Interviewing • Social Context Review of Systems • LEARN model

6. Methods • Appropriate Use of Teaching Styles Reflection • Modeling • Role Play

7. Evaluation • Characteristics feedback in context of cultural learning objective • Encourage self-assessment • Facilitates self-reflection • Promotes self-awareness • Refer to specific, observed behaviors • No presumption of attitude • Provides opportunity for change and growth

8. What’s missing? • Knowledge Objectives • Population health • Outcome disparities • Exploring history and cultural norms of specific groups • Explore the culture of the community in which you are practicing

9. A Little Knowledge is … • ENLIGHTENING! • Historical context • Geography • Cultural Norms • Facilitate asking pertinent positive and negative questions • Leads to efficiency

10. A Little Knowledge is … • DANGEROUS! • Context needs to be seen as general • To avoid stereotype, still must get patient’s perspective

11. Scenario • A student from your practice in Worcester, MA is seeing a Mexican American with Type II diabetes mellitus. The student comments on the apparent frequency of diabetes in Hispanics and wonders if this is a problem for Mexican-Americans as well as Puerto Ricans (the majority Latino culture). To what resources would you point your learner?

12. Population Health Links - HHS Race and Health Home Page - Census Bureau Home Page - CDC Diabetes Resource - CDC's Diabetes Program - Statistics

13. Scenario, Part 2 Now that the student knows about the increased prevalence of diabetes, she is interested in knowing if there is specific help with dietary counseling available.

14. Latinos and Diabetes - Welcome to DiversityRx-March - Mexican American Diets and Diabetes - Nutritional Materials in Spanish - Latin American Food Pyramid Links

15. Other Reference Materials • Bibliographies for web sites • “Pocket texts” • Its in your handout!

16. But, is knowledge enough??? • General information • May not apply in your community • Acculturation: Process of adapting from one culture to another. • Expertise • Doctors are “experts” • May not be the expert on this. • Solution • Draw on expertise of others • Structure community experiences for deep learning

17. The Community as Teacher: How have you done it? Please think for a minute of an educational experience in which you were sent out into a non-medical community setting? What did you learn? How?

18. The Community as Teacher CONCEPT: SERVICE- LEARNING "A structured learning experience that combines community service with preparation and reflection. Service-learning students not only provide community service, but also learn about the context in which the service is provided” S. Saefer, 2002

19. Service-Learning Community Service Field Education Volunteerism Practicum • Community Beneficiary Provider • Service Activity Learning Service-Learning

20. Service Learning Protocol for Health Professionals Schools • Include more community sites and build long term relationships. • Develop a service learning experience using service-learning objectives • Develop an orientation component • Develop a reflection component • Integrate an evaluation component • Promote the professional ethic of service

21. IS: Partnership: educators and community Learning objective connected to service. Real service, meeting an unmet need. Reflection component. Applicable in future personal and professional life. Equitable IS NOT Not just volunteering. Not just a clinical experience Not a chance to show how much you know. Not a chance to hone your skills. Not just an individual relationship* *(although it can start there) What is Service-Learning?

22. Reflection is the hyphen in Service-Learning WHAT? Concrete Experience SO WHAT?Reflective Observation ACTION! Active Experimentation WHAT NEXT? Abstract Conceptualization

23. Reflective Methods • Before: • Briefing, essay(pre), self evaluation(pre), writing goals/ learning contract, on-line journal • During: • Self-evaluation, community partner or faculty review. • After: • Essay(Post), Self-Evaluation(Post), essay based on on-line journal, review of learning contract.

24. Medical student has just seen a 6 y/o well child whose mother is deaf, and for whom the child is the interpreter. The student doesn’t know ASL, available resources for deaf persons nor much about deaf culture. You don’t know much about it either. What can you do? How could you structure the experience? Please discuss with your neighbor for 2 minutes. How to make it work?

25. Service-Learning in Practice • Surveys and Scavenger Hunts • Community reading day • Visit a home with a home visitor • Writing newspaper articles. • Consulting with HeadStart on lead poisoning • Interviewing the family of a CSHCN

26. Practical Aspects of Service-Learning • Build on existing relationships • Negotiate the objectives • Empower partners to teach • Reflect with your learner

27. What about Culture? • S-L enables growth in the empathic stages: • Models collaboration and power-sharing • Demands reflection and insight • Values all participants • S-L requires time and energy • Need to establish and maintain relationships • Need time and expertise to reflect

28. Summary • Knowledge about culture is available, but requires context. • Service-learning is a teaching method that can provide that context. • Preceptors can incorporate service-learning into their precepting by building on existing relationships.