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LIME 2009. Culturally Safe Clinicians. Training and Education. Undergraduate, graduate coursework Prevocational and vocational training Vertical integration of curriculum and clinical experience CME Responsibility across sector, health workforce. Systems Issues.
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LIME 2009 Culturally Safe Clinicians
Training and Education • Undergraduate, graduate coursework • Prevocational and vocational training • Vertical integration of curriculum and clinical experience • CME • Responsibility across sector, health workforce
Systems Issues • Creating culturally safe environments • Systems reform inclusive of attitudinal and behavioural change • Zero tolerance for racist, discriminatory behaviours • Accountability – incentives, consequences • Facilitate advocacy – students, clinicians, community
What does a culturally safe clinician look like? Critical self-awareness Understands the impact of ownculture & that of the health systemon patient outcomes Committed to indigenous healthand reducing inequities
Ensuring culturally safe clinicians • Undergraduate: • Encourage critical self-reflection and lifelong learning • Engage learners as ‘disciples’ • Evidence-based assessment to identify unsafe students • Postgraduate: • Integrate competencies, teaching and assessment into specialty training programmes • CME to monitor cultural safety, not just participation in cultural competence activities
One example: University of Hawaii John A. Burns School of Medicine • In 1999, Native Hawaiian Center of Excellence • Federally funded, HRSA • Director realized few faculty aware of Native Hawaiian Health Disparities • Many faculty were clinical, volunteer faculty • Faculty trained in era of “treat all patients the same” • Failure of that mindset • Health disparities not improved Photo courtesy of: NHCOE and Herb Kane (the artist)
Faculty Development in Cultural Competency • Series of conferences to teach faculty about Native Hawaiian health and health disparities • Traditional medicine and concepts of health and well being • Improving teaching skills • Addressing the needs of Native Hawaiian Doctors • Can cultural competency in providers improve the poor health statistics for Native Hawaiians? • Can physicians trained in western medicine and western ways of thinking bridge the gap that exists with traditional Native Hawaiian approaches to health and healing?
Cultural Immersion • 5 Day experience on the island of Kahoolawe, damaged by bombs, goats, cattle • Healing the land, healing the people • Participants: physicians, faculty, medical students, nurses, traditional healers, family members • Intense cultural immersion experience • Incorporate traditional Hawaiian values and protocol • CME courses
Post Immersion Physician Focus Groups Native Hawaiian Physicians Faculty/community, male/female, various ages and specialties represented. All underwent “cultural competency” curriculum Kaho‘olawe. (Questions:centered on whether previous experiences with cultural competency training had an effect, and on the use of cultural immersion as a teaching strategy) Primary Theme 1: Cultural sensitivity/humility training leading to personal transformation Increased cultural awareness, pride Understood connectedness to land, spirituality Acquired sense of generational responsibility Photo courtesy of ‘Ahahui o na Kauka
Secondary Theme 1: Improved medical practice • Improved patient communication • Awareness of conflict of cultures (Western vs. Traditional) • Increased knowledge of/openness to traditional healing Secondary Theme 2: Cultural sensitivity/humility related student training • Allow time for self discovery and reflection • Discuss culture of medicine, potential conflicts • Consider diversity of backgrounds, stages of readiness • Sustainability of lessons; need follow-up activities • Cultural Immersion experiences should include: • spiritual/emotional preparation • training in protocol and history • exposure to traditional healing
Additional steps • Native Hawaiian research fellowship (new grant) • Yearly departmental conferences that include cultural competency training in some way • Cultural competency curricula being introduced at residency level in various specialties • Standardized cultural patients being used in FP residency • Surgery residency is piloting cases • More regular immersion experiences for clincians, faculty being proposed
Looking to the Future AAMC: USMLE II standardized patient clinical skills stations-must pass!!! Specialty boards online courses in cultural competency coming soon to a specialty board near you….. standardized patient clinical skills stations!! Photo courtesy of ‘Ahahui o na Kauka