Enhancing Cultural Learning for Global and Local Engagement May 2012

1. Enhancing Cultural Learning for Global and Local Engagement May 2012 An educational module developed by inter-professional faculty for the University of Maryland Student Center for Global Education

3. MODULE OVERVIEW • This module is a product of the University of Maryland Baltimore campus-wide Global Health Inter-professional Council (GHIC) as one of several initiatives to encourage multidisciplinary global health activities. • The GHIC is comprised of faculty members from the six UMB professional schools who are committed to collaborative and innovative methods of study to prepare professionals to work across disciplines in developing and implementing effective health care delivery and advocacy. • The primary focus of this educational module is to explore various cultural concepts designed to assist University of Maryland students, staff, and faculty in preparation for engagement in different global and local contexts.

4. MODULE OVERVIEW • Module participants will engage in online learning, including readings, case examples, and reflection exercises. • If the URLs embedded in the module content do not directly link to the reference website, please cut and paste the URL into a separate browser and click to review the recommended resource. • Estimated time to complete this module is three to four (3-4) hours. • You may log-in multiple times to complete this module. • At the end, you will be asked to complete a journaling exercise and a questionnaire on cross-cultural adaptability.

5. LEARNING OBJECTIVES At the conclusion of this module, participants will be able to: • Understand aspects of intercultural communication, cross-cultural skills, and adjustment learning. • Identify and self-assess the influences of beliefs, values, and attitudes on personal assumptions and social expectations and obligations. • Discuss concepts of cultural competency across different professions and understand the profile of the inter-culturally effective person (IEP). • Summarize country-specific background information on Malawi and identify additional key resources. • Describe global citizenship and core expectations for UM students, staff, and faculty. • Re-examine the content of this module and formulate ways to integrate cultural lessons into your individual professional development.

6. MODULE OUTLINE • Introduction: “What’s Up with Culture?” • Overview: Cultural Competency Across Different Professions • Malawi: Global and Local Aspects • Global Citizenship for Professional Development • Conclusion and Final Reflection Questions

8. Enhancing Cultural Learning for Global and Local Engagement I. Introduction: “What’s Up with Culture?”

9. I. What’s Up with Culture? OPEN the following website and refer to it as you continue reading: http://www2.pacific.edu/sis/culture/ • Purpose of this on-line cultural resource training is to: • Introduce the multi-dimensional concept of culture. • Illustrate how culture impacts one’s ability to understand and function in a new and unfamiliar environment. • Intended audience: • Traditional study abroad students. • All university students, staff, and faculty members preparing for any type of cross-cultural engagement and experiential learning activity, both locally and internationally.

10. I. What’s Up with Culture? OPEN the following website and refer to it as you continue reading: http://www2.pacific.edu/sis/culture/ • This is a self-guided, self-paced training and can be used as a vehicle for self-exploration. • It includes many self-assessment and activity exercises from which you can learn a great deal about: • Your communication style; • Your cultural values; and • Your attitudes toward and reactions to different ways of doing things.

11. I. What’s Up with Culture? COMPLETE Module 1: What to Know Before You Go: (1.1 through 1.7)at:http://www2.pacific.edu/sis/culture/ 1.1 If you are going abroad soon… 1.2 Culture: The Hidden Dimension 1.3 Culture: Yours, Ours, and Theirs 1.4 Whose Fault? Why Values Matter 1.5 Packing Up! 1.6 Communication Across Cultures: What are they trying to say? 1.7 Surprises and Shocks STOP! *Please Note: Each section may take up to 20-30 minutes to read and work carefully through the exercises.

12. I. What’s Up with Culture? You have now completed the first seven sections of Module 1: What to Know Before You Go Summary • How successful you will be depends on your ability to: • Transcend the mind-set of the culture(s) in which you have spent most of your life; and • Utilize “culture learning” techniques and figure out how to interact appropriately within a new cultural environment. • Since the ways people think and act in different countries and communities may differ significantly from your home culture, the more you know about what culture is and how it works, the better you will be able to manage and adapt to a new cross-cultural context.

13. I. What’s Up with Culture? Key Reflection Questions • Which self-evaluation/self-assessment activity did you find most useful? Least useful? Why? • How might knowing your preferred communication style (high-context vs. low-context) be helpful to you in intercultural situations? • What are some ways to avoid culture “fatigue” and culture “shock”? Describe 2 or 3 methods to track your adjustment and cultural awareness progress?

15. Enhancing Cultural Learning for Global and Local Engagement II. Overview: cultural competency across different professions

16. II. Cultural Competency “Multiculturalism (…) does not assume that any cultural tradition is ideal or perfect. It looks to the equitable participation of all individuals in society. It assumes that our nation can be both united and diverse, that we can be proud of our heritage and of our individual group identities while at the same time working together on common goals. It is a reciprocal process based on democratic principles and a shared value system.” ~Elizabeth PathySalett, President National Multicultural Society Washington, D.C., 2004 Introduction The concept of “cultural competency” emerged as a response to the changing demographics in the U.S. and the increasing acknowledgement of multiculturalism, diversity, globalization, and disparities across populations.

17. II. Cultural Competency What is Cultural Competence? • The U.S. Department of Health and Human Services defines cultural competence as a “set of behaviors, attitudes and policies that come together in a system, agency or program or among individuals, enabling them to function effectively in diverse cultural interactions and similarities within, among and between groups.” • No single definition. • Evolved from diverse perspectives, interests and needs. • Incorporated in state legislation, Federal statutes and programs, private sector organizations, and academic settings.

18. II. Cultural Competency What is Cultural Competence? • Viewed by other experts as a point on a continuum representing a developmental process that evolves over an extended period. • Groups and associations have integrated specific domains and acquisition of levels of awareness, knowledge, and skills along a cultural competence continuum into the ethics and standards of practice for individuals in their respective professions. Source: National Center for Cultural Competence http://nccc.georgetown.edu/projects/sids/dvd/continuum.pdf

19. II. Cultural Competency Across different professional perspectives Standards in Social Work Practice • Standard 1: Ethics and Values • Standard 2: Self Awareness • Standard 3: Cross-cultural Knowledge • Standard 4: Cross-cultural Skills • Standard 5: Service Delivery • Standard 6: Empowerment and Advocacy • Standard 7: Diverse Workforce • Standard 8: Professional Education • Standard 9: Language and Diversity • Standard 10: Cross-Cultural Leadership Related Resources: http://www.naswdc.org/practice/standards/NASWCulturalStandards.pdf http://www.socialworkers.org/pressroom/features/issue/diversity.asp

20. II. Cultural Competency Across different professional perspectives Discussions in Law Schools and Legal Practice • Beyond Bias: Cultural Competence as a Lawyer Skill (Miller, 2008) http://www.volunteerlawyersnetwork.org/files/4437D0F7d01.pdf • Disappearing Act: The Lack of Values Training in Legal Education - A Case for Cultural Competency (Moran, 2010) http://papers.ssrn.com/sol3/papers.cfm?abstract_id=1635407 • The Role of Law Schools in Shaping Culturally Competent Lawyers (Ward and Miller, 2010) http://www.michbar.org/journal/pdf/pdf4article1619.pdf • The Case for Cultural Competency (Frink-Hamlett, 2011) http://legallyglobal.blogspot.com/2011/04/case-for-cultural-competency-article-in.html

21. II. Cultural Competency Across different professional perspectives Holistic Model of Cultural Competence in Physical Therapy • Examination through reflective practice; • Learn about the diversity dimensions that influence health outcomes, and affect the human experience both positively and negatively; • Recognize the need for patient-centered approach to delivery of culturally competent physical therapy services; • Value effective communication between the patient and the therapist as fundamental for delivery of culturally competent care; • Apply core knowledge about culture, belief systems, and traditions to enhance patient-therapist interaction. Source: APTA Blueprint for Teaching Cultural Competence in Physical Therapy Education, 2008 http://www.apta.org/CulturalCompetence/

22. II. Cultural Competency Across different professional perspectives Physical Therapy Practice Vision 2020 (Professionalism) • Core values: aspiring to and wisely applying principles of altruism, excellence, caring, ethics, respect, communication and accountability; and • By working together with other professionals to achieve optimal health and wellness in individuals and communities. • APTA “Normative Model”, specifically Professional Practice Expectation 7: Cultural Competence: (7.1) Identify, respect, and act with consideration for patients’/clients’ differences, values, preferences, and expressed needs in all professional activities.

23. II. Cultural Competency Across different professional perspectives Pharmacy Education and Practice • With knowledge and understanding about a patient’s cultural background, pharmacists can deliver pharmaceutical care that accommodates the patient’s needs, beliefs, and health practices. • Cultural competence in pharmacy focuses on: • Communication styles; • Familial structure; • Spiritual beliefs; and • Genetic, biochemical, and physiological traits of particular ethnic or sociological groups. Source: American College of Clinical Pharmacy http://www.accp.com/bookstore/pd_01eccpp.aspx

24. II. Cultural Competency Across different professional perspectives Related Resources in Pharmacy • American Association of College Pharmacy (ACCP) Cultural Competence http://www.aacp.org/resources/academicpolicies/studentaffairspolicies/Pages/culturalcompetence.aspx • ACCP White Paper: Cultural Competence in Health Care and Its Implications for Pharmacy, Part 1- Overview of Multicultural Health Care (O’Connell et al, 2007) http://www.accp.com/docs/positions/whitePapers/Pharm2707_ACCP-CulturalComp.pdf • ACCP White Paper: Cultural Competence in Health Care and Its Implications for Pharmacy, Part 2- Emphasis on Pharmacy Systems and Practice (O’Connell et al, 2009) http://www.accp.com/docs/positions/whitePapers/Pharm2902e_ACCP-CultComp2.pdf

25. II. Cultural Competency Across different professional perspectives Dentistry and Dental Hygiene Practice Dental School Accreditation Standard states that “graduates must be competent in managing a diverse patient population and have interpersonal and communication skills to function successfully in a multicultural work environment.” • Bridging the Gap – Does culturally competency make a difference in the provision and efficacy of oral health care? CE course written for dentists, dental hygienists, and dental assistants (Spencer and Trigilidas, 2008) Source: Dimensions of Dental Hygiene http://www.dimensionsofdentalhygiene.com/ddhright.aspx?id=2970

26. II. Cultural Competency Across different professional perspectives Related Resources in Dentistry and Dental Hygiene • Competencies for the Advanced Dental Hygiene Practitioner (Adopted by the ADHA Board of Trustees, 2008) http://www.adha.org/downloads/competencies.pdf • Assessing the Cultural Competency of Dental Students and Residents (Gregorczyk and Bailit, 2008) http://www.jdentaled.org/content/72/10/1122.full.pdf+html • Exploring Dental Students’ Perceptions of Cultural Competence and Social Responsibility (Rubin et al, 2008) http://www.jdentaled.org/content/72/10/1114.full.pdf+html • Cultural Competency: Dentistry and Medicine Learning from One Another (Formicola et al, 2003) http://www.jdentaled.org/content/67/8/869.full.pdf+html

27. II. Cultural Competency Across different professional perspectives Medical Education and Practice Cultural competence is integrated throughout all years of medical school and requires identification and assessment utilizing the TACCT (Tool for Assessing Cultural Competence Training) that includes five domains: Domain I: Cultural Competence—Rationale, Context, and Definition A. Definition and understanding of the importance of cultural competence; how cultural issues affect health and health-care quality and cost; and, the consequences of cultural issues B. Definitions of race, ethnicity, and culture, including the culture of medicine C. Clinicians’ self-assessment, reflection, and self-awareness of own culture, assumptions, stereotypes, biases Source: Association of American Medical Colleges (AAMC) Cultural Competence Education for Medical Students https://www.aamc.org/download/54338/data/culturalcomped.pdf

28. II. Cultural Competency Across different professional perspectives Medical Education and Practice TACCT Content Domains (continued) Domain II: Key Aspects of Cultural Competence A. Epidemiology of population health B. Patient/family-centered vs. physician-centered care: emphasis on patients’/families’ healing traditions and beliefs [for example, ethno-medical healers] C. Institutional cultural issues D. Information on the history of the patient and his/her community of people Domain III: Understanding the Impact of Stereotyping on Medical Decision-Making A. History of stereotyping, incl. limited access to health care & education B. Bias, stereotyping, discrimination, and racism C. Effects of stereotyping on medical decision-making Source: Association of American Medical Colleges (AAMC) Cultural Competence Education for Medical Students https://www.aamc.org/download/54338/data/culturalcomped.pdf

29. II. Cultural Competency Across different professional perspectives Medical Education and Practice TACCT Content Domains (continued) Domain IV: Health Disparities and Factors Influencing Health A. History of health-care design and discrimination B. Epidemiology of specific health and health-care disparities C. Factors underlying health and health-care disparities—access, socioeconomic, environment, institutional, racial/ethnic D. Demographic patterns of health-care disparities, both local and national E. Collaborating with communities to eliminate disparities—through community experiences Source: Association of American Medical Colleges (AAMC) Cultural Competence Education for Medical Students https://www.aamc.org/download/54338/data/culturalcomped.pdf

30. II. Cultural Competency Across different professional perspectives Medical Education and Practice TACCT Content Domains (continued) Domain V: Cross-Cultural Clinical Skills A. Knowledge, respect, and validation of differing values, cultures, and beliefs, including sexual orientation, gender, age, race, ethnicity, and class B. Dealing with hostility/discomfort as a result of cultural discord C. Eliciting a culturally valid social and medical history D. Communication, interaction, and interviewing skills E. Understanding language barriers and working with interpreters F. Negotiating and problem-solving skills G. Diagnosis, management, and patient-adherence skills leading to patient compliance Source: Association of American Medical Colleges (AAMC) Cultural Competence Education for Medical Students https://www.aamc.org/download/54338/data/culturalcomped.pdf

31. II. Cultural Competency Across different professional perspectives Nursing Education and Practice Integration of cultural competence in graduate nursing education deepens the development of the leadership role in eliminating health disparities. This leadership role encompasses: • Socially and empirically derived understanding of complex causes of disparities; • Implementing culturally competent nursing care; • Addressing social justice; • Advocating for patients and policies that advance health care; • Developing competency in collaboration with patients, key persons, agencies, and various stakeholders; • Attitude modification and personal transformation; and • Contributing to culturally competent scholarship. Source: American Association of Colleges of Nursing http://www.aacn.nche.edu/education-resources/cultural-competency

32. II. Cultural Competency Across different professional perspectives Related Resources in Nursing http://www.aacn.nche.edu/education-resources/cultural-competency • Tool Kit of Resources for Cultural Competent Education for Baccalaureate Nurses • Tool Kit of Resources for Establishing a Culturally Competent Master’s- and Doctorally Prepared Nursing Workforce • Culturally competent care: providing patients with health care that is sensitive to the values that emerge out of their particular background (National Standards for Culturally and Linguistically Appropriate Services in Health Care ,U.S. Department of Health and Human Services, 2001).

33. II. Cultural Competency Key Reflection Questions • Do you observe any differences among the professions’ definitions of cultural competence? If so, how do they differ? How are they similar? • How does the concept of cultural competency reflect your professional values and ethics? Do you see any conflicts or potential challenges?

34. II. Cultural Competency Key Reflection Questions • At what point on the cultural competency continuum do you think you currently operate? Why? • Describe specific settings or situations when being a culturally competent professional would help to improve your effectiveness and the quality of care or services you provide to individuals? To families? To communities?

35. II. Cultural Competency Summary • Developing cultural competence over time, throughout the course of your career practice: • Will continually improve the ways you, as an individual, are able to interact with people from different communities and different cultures; and • Has the potential to be a dynamic strategy, both organizationally and professionally, to address current health disparities and reduce social inequities that exist across populations.

37. Enhancing Cultural Learning for Global and Local Engagement III. Malawi: global & local aspects

38. III. Malawi:Global & Local Aspects Introduction • In practical terms, cultural competency suggests that individuals are conscious of the region’s unique cultural, economic, political, and historical attributes. • Sensitivity to regional customs and manners helps convey sincere interest in community members and ensures global and local partnerships are appropriate, respectful, and applicable. • Background knowledge and basic information eases transition into a new community, locally and internationally. Source: Student Handbook for Global Engagement, University of Michigan http://www.globalhealth.umich.edu/pdf/CGH%20standards%20handbook.pdf

39. III. Malawi:Global & Local Aspects Key areas for important background knowledge: • Socio-political and historical background • Cultural background, customs, and geography • Basic Logistics and Fast Facts • Health, Safety, and Security • Host Organization and Primary Local Contacts

40. III. Malawi:Global & Local Aspects Socio-political & historical background • Critical to know the socio-political situation in a country prior to traveling there, for both safety and cultural adaptation. Read both scholarly works and current events in local news sources. • http://www.onlinenewspapers.com/malawi.htm (Online Newspapers) • Important to know historical background in order to understand the present-day situation and interact appropriately with local residents. • http://www.lonelyplanet.com/malawi/history (Lonely Planet Guide)

41. III. Malawi:Global & Local Aspects Socio-political & historical background Several reputable websites provide essential information a traveler should have prior to arrival, including: • https://www.cia.gov/library/publications/the-world-factbook/geos/mi.html(CIA World Fact book) • http://data.worldbank.org/country/malawi(World Bank Data) • http://malawiunmission.com/(United Nations Mission)

42. III. Malawi:Global & Local Aspects Cultural background, customs and geography Additional Online Resources: • http://www.culturecrossing.net/basics_business_student.php?id=124(Culture Crossing) • http://www.africaguide.com/country/malawi/culture.htm (Africa Guide) • http://www.everyculture.com/Ja-Ma/Malawi.html (Every Culture) • http://www.worldatlas.com/webimage/countrys/africa/mw.htm (World Atlas) • http://travel.nationalgeographic.com/travel/countries/malawi-map/(National Geographic)

43. III. Malawi:Global & Local Aspects General Etiquette and Considerations The Basics • Communication Style • Greetings • Personal Space & Touching • Eye Contact • Views of Time • Gender Issues • Gestures • Taboos • Law and Order • Videos and Other Stuff • Business Basics • Dress • Titles & Business Cards • Meetings • Gift Giving • Student Basics • Class Rules • Socializing • Miscellaneous For more details: Culture Crossing, http://www.culturecrossing.net/about_this_guide.php

44. III. Malawi:Global & Local Aspects Communication Style • Malawians do not tend to be direct in their communication style.  When someone is too direct it is usually considered rude. • Most people choose a roundabout way to explain things assuming that the listener will understand what the speaker is trying to communicate. • People usually don’t want to disappoint so they’ll try and tell someone what they think they may want to hear rather than the truth.  Source: Culture Crossing, http://www.culturecrossing.net/basics_business_student.php?id=124

45. III. Malawi:Global & Local Aspects Communication Style (continued) • It is a good idea to ask the same question in a variety of ways in order to make sure you are getting the whole truth. • Public displays of anger are rare and considered bad form. • Being humble and polite is important. People tend to be sensitive to arrogance. Source: Culture Crossing, http://www.culturecrossing.net/basics_business_student.php?id=124

46. III. Malawi:Global & Local Aspects Personal Space & Touching • Personal space differs from place to place based on tribal and religious influences, but people tend to speak to one another at very close distances. Generally, an arm’s length is appropriate. • Personal space tends to be less between members of the same gender and considerably greater between members of opposite genders. Source: Culture Crossing, http://www.culturecrossing.net/basics_business_student.php?id=124

47. III. Malawi:Global & Local Aspects Personal Space & Touching (continued) • It is common for men to touch each other when speaking; sometimes on the arms, hands and legs no matter what the relationship; business, family, stranger, etc. Men and women rarely touch in public. • It is also appropriate for two men to walk hand in hand in public. This does not have any implication on their sexual preferences; it's just a sign of friendship and closeness. This is the same for women. Source: Culture Crossing, http://www.culturecrossing.net/basics_business_student.php?id=124

48. III. Malawi:Global & Local Aspects Dress • Malawians usually dress for the people around them not as a personal expression. • For Men – A suit or nice pants and collared shirt and tie is appropriate in most situations.  Business casual attire may be appropriate in many situations. • For Women - A business suit or a dress with a nice shirt/blouse is appropriate in most situations. Business casual attire may be appropriate in many situations. Source: Culture Crossing, http://www.culturecrossing.net/basics_business_student.php?id=124

49. III. Malawi:Global & Local Aspects Dress (continued) • Jeans and less causal attire is not appropriate for business situations. Clean well-ironed attire is important. • If someone is underdressed or dressed like a slob it could change the way they are treated. • It is difficult for a Malawian to understand why a wealthy person would intentionally dress informally. Source: Culture Crossing, http://www.culturecrossing.net/basics_business_student.php?id=124

50. III. Malawi:Global & Local Aspects Meetings • People are usually formally introduced at the beginning of the meetings and then there is someone chosen to lead the meeting. • Business meetings rarely begin on time, however it is a good idea for a foreigner to be punctual. • It's important to greet the most senior individuals first. • Small talk always precedes any formal conversations.  It's appropriate to inquire about one's health, families, etc., before dealing with business. Source: Culture Crossing, http://www.culturecrossing.net/basics_business_student.php?id=124