PROJECT INTERACT : A Predoctoral Training Program for Cultural and Interdisciplinary Competency

1. PROJECT INTERACT: A Predoctoral Training Program for Cultural and Interdisciplinary Competency The University of Medicine and Dentistry of New Jersey School of Osteopathic Medicine (UMDNJ-SOM) Department of Family Medicine.

2. Presenters • Carman A. Ciervo, D.O., FACOFP Chair, Department of Family Medicine • Frank A. Filipetto, D.O., FACOFP Vice Chair, Department of Family Medicine • Claudia A. Switala, M.Ed. Program Development Specialist

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

4. Rationale and Process Presented by Carman A. Ciervo, D.O., FACOFP

5. Cultural Competency Definition • The Association of American Medical Colleges: • “an awareness of self and one’s own value systems; an understanding of culture and its role as a factor in health and health care; a sensitivity to cultural issues for each patient; and an understanding and ability to use specific methods to deal effectively with cultural issues in interacting with individual patients, their families, members of the healthcare team and the wider community.

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

7. Cultural Competence and Interdisciplinary Skills • The Association of American Medical Colleges put forth recommendations on curriculum that “establish the principle that cultural diversity programs be integrated throughout medical curricula with a focus on interdisciplinary learning.”[1] [1]Association of American Medical Colleges, Resolution on Cultural Diversity as a LCME Accreditation Standard.

8. Project Interact • A HRSA funded Predoctoral Training Grant • A Collaborative Model • Standardized Patient Lab as Focal Point

9. Project Interact Committee • UMDNJ School of Osteopathic Medicine • Family Medicine • Internal Medicine • Pediatrics • OB/Gyn • Psychiatry • Center for Aging • Predoctoral Students

10. Project Interact Committee • School Health Related Professions • School of Nursing • School of Public Health • School of Dental Medicine • New Jersey Area Health Education Center

11. A Collaborative Model • Through three Components • Curriculum • Standardized Patient Lab • Community Service Rotation

12. Incorporating Cultural and Interdisciplinary Competencies into the Predoctoral Curriculum Presented by Frank A. Filipetto, D.O., FACOFP

13. Family Medicine Faculty • Identified all FM Curriculum throughout the four years. • Discussed where competencies could be learned. • Developed curriculum modules. • Developed Standardized Patient Cases with cultural considerations and interdisciplinary needs

14. Establishing Competencies • Intensive faculty development • Identified cultural and interdisciplinary competencies • Incorporated competencies into all Family Medicine courses • Creation of standardized patient cases

15. First Year • Health disparities, health beliefs and barriers to healthcare • Cultural awareness • Interdisciplinary principles and concepts • Cultural heritage and lifestyle assessment

16. Second Year • Performing cultural and lifestyle assessments • Communicating through an interpreter • Implement interdisciplinary concepts via core projects • Identify subcultures and its impact on healthcare

17. Third Year • Two weeks after rotation exposing students to health disparities and interdisciplinary care • Telling bad news • Resolving conflict

18. Fourth Year • Troublesome bequests – cultural explanations and interdisciplinary solutions to ethical dilemmas Physician assisted suicide Truth telling HIV confidentiality

19. Student Outcomes Presented by Claudia A. Switala, M.Ed.

20. Sex Females 163 Males 159 Class MS I 89 MS II 81 MS III 71 MS IV 81 Demographic Dataon Project Interact ParticipantsAcademic Year 2001 -2002n=322

21. Demographic Dataon Project Interact ParticipantsAcademic Year 2001 -2002n=322 • Ethnic Racial Demographics • 73 Underrepresented minorities (African American, Hispanic, Native American, Vietnamese) • 74 Other Minorities (Chinese, Japanese, Philipino, Indian) • 175 Caucasians

22. Assessment of First Year Studentsn=89 • Cultural Self Awareness Tool • 78% Willing to identify own culture • 54% Willing to identify and share health beliefs and practices • 7% Willing to identify stereotypes that they have of other cultures • 52% Willing to identify “typical stereotypes” you have heard about other cultures • 48% Willing to identify biases and prejudices.

23. Assessment of First Year Studentsn=89 • S P Case I : Conducting Cultural Heritage Assessment / Completion of Genogram • 91% Identified Cultural considerations • 84% Identified Interdisciplinary needs • 88% Identified Psychosocial issues • 76% Identified Economic issues

24. Assessment of First Year Studentsn=89 • S P Case II: Overweight Adult • 92% Identify cultural aspects impacting on case (Family, Religion and Diet) • 87% Identify interdisciplinary support system for patient. (Church, Nutritionist and Family)

25. Assessment of Second Year Studentsn=81 • S P Case I: Migrant Worker with Back Pain and Language Barrier • 80% Provided appropriate instruction to interpreter • 78% Placed interpreter in appropriate position in relation to patient • 82% Focused on patient, not interpreter • 81% Conducted a cultural and lifestyle assessment • 72% Identified impact of cultural issue’s on patient’s health (family support, family not in this country) • 68% Identified interdisciplinary resources for patient

26. Assessment of Second Year Studentsn=81 • S P Case II – Physical Exam • 71% Treated the patient respectfully with regards to privacy • 52% Asked permission of patient to begin the exam • 55% Prepares patient for what they are about to do during the exam • 73% Does not use medical jargon

27. Assessment of Third Year Students Two week Community Service Rotationn=71 • Comments taken from their logs. • 91% Rated experience as meaningful, positive, worthwhile. • 78% Indicated appreciation for work of interdisciplinary team members • 47% Were more appreciative of their own lives • 69% Indicated they had a better understanding of the complex psychosocial and economic issues impacting on health

28. Assessment of Third Year Studentsn=71 • 42% Appreciated the dedication and hard work of physicians in medically underserved communities. • 52% Recognized that patients in underserved communities respect and appreciate the physician. • 22% Would want to continue to volunteer time at their rotation site • 29% Said they would work in a medically underserved community after graduation

29. Assessment of Third Year Studentsn=71 • S P Case I: Telling Bad News • 78% Asked what patient knew about illness • 81% Asked if patient wanted someone with them. • 84% Assessed willingness of patient to hear bad news • 82% Demonstrated verbal or non verbal empathy to patient.

30. Assessment of Third Year Studentsn=71 • S P Case II: Interdisciplinary Team Meeting • 82% Communicated effectively with team members • 85% Demonstrated respect for team members • 78% Demonstrated knowledge of team members roles. • 79% Interacted as an equal with team members

31. Assessment of Fourth Year Studentsn=81 • S P Case I: Ethical Request to assist with suicide (End Stage lung cancer) • 81% discussed physician responsibilities with patient • 84% identified psychosocial issues of case and negotiated with patient • 86% determined and discussed interdisciplinary interventions with patient

32. Assessment of Fourth Year Studentsn=81 • SP Case II: Truth Telling Case (Terminal Diagnosis of lung cancer and physician is meeting with daughter) • 95% Listened to family member’s concerns • 78% Discussed physician’s responsibilities with family members. • 79% Explored cultural aspect of truth telling (why you don’t want mother to hear the diagnosis)

33. Assessment of Fourth Year Studentsn=81 • S P Case III: HIV / AIDS • 82% Discussed and negotiated with patient regarding informing spouse • 78% Knowledgeable about N J’s resources and requirements regarding HIV/AIDS • 86% Determined with patient the appropriate interdisciplinary interventions

34. Institutional Outcomes • Changed the curriculum of SOM to include cultural and interdisciplinary training • Changed the culture of Family Medicine and SOM • Placed Family Medicine in leadership role with regards to cultural and interdisciplinary training in the State of New Jersey • Governor of New Jersey signed Cultural Competency bill on our campus