Teaching of Tomorrow Faculty Development Toolbox

1. Teaching of TomorrowFaculty Development Toolbox Slideshow Resources

2. Teaching Culture and Community in Primary Care: Assessing Learner Needs

3. Group Exercise • "The faculty and students must demonstrate an understanding of the manner in which people of diverse cultures and belief systems perceive health and illness and respond to various symptoms, diseases, and treatments. Medical students should learn to recognize and appropriately address gender and cultural biases in health care delivery, while considering first the health of the patient." • Why do you think this became a requirement of the LCME in 2000? • What role do community preceptors in meeting it? • What makes this challenging for you as a teacher?

4. Culture and Community:Goals of the Series • Make explicit to learners your expertise at developing relationships with patients. • Improved patient satisfaction . • Improved patient adherence. • Improved patient outcome. • Provide teaching tools for bridging the gap from medical culture to the cultures of the world. • Patient in cultural context • Patient in community • Provider as patient advocate

5. By the end of the workshop, participants will be able to: Articulate broad definitions of culture Identify two reasons for incorporating objectives on culture in primary care teaching programs Apply a framework for performing a cultural needs assessment in teaching Identify teaching methods and styles that most effectively match the teaching of attitudes Learning Objectives

6. Culture is… • the shared values, traditions, norms, customs, arts, folklore and institutions of a group of people. Culture shapes how people see their world and structure their community and family life.

7. Cultural affiliation can... • Determine a person’s values and attitudes about health issues • Determine interpretation and responses to messages • Be repeated and transmitted from one generation to another.

8. Types of Cultural Groups • Ethnicity & Race • Socio-Economic Groups • Physical Disabilities • Sexual Identity • Refugee/Immigrant Status • Age • Religion • Professional Group

9. GNOME: Needs Assessment • Certainty: Learners have culture • Uncertainties: • Experiences of difference and diversity • Predetermined values or stereotypes • Desire to bridge difference • Awareness of institutional oppression or privilege

10. Assessing Ethnosensitivity CULTURALLY SENSITIVE MINIMIZATION CULTURALLY EGOCENTRIC

11. Example: The Non-English Speaker “It must be incredibly difficult to get medical care when you don’t know the language.” “Why would he be nervous if I’ve used an interpreter?” “I can’t believe he’s been here for three years and doesn’t speak English. It’s not my problem.”

12. Assessing Ethnosensitivity ETHNOSENSITIVE FEAR ETHNOCENTRIC

13. Fear • General • “Other students told me: Be careful! It’s not safe over there.” • Specific • “I’ve never dealt with someone with AIDS. Should I wear gloves and a mask?

14. Assessing Ethnosensitivity ETHNOSENSITIVE OVERGENERALIZE FEAR ETHNOCENTRIC

15. Over-generalization • Stereotyping • “She kept using her hands while she talked. She reminded me of my friend’s grandmother. I thought it was Prince Spaghetti Day!” • Culture blindness or denial of difference • “I never thought he could be a drug user. He looks and acts so intelligent.”

16. Assessing Ethnosensitivity ETHNOSENSITIVE SUPERIORITY OVERGENERALIZE FEAR ETHNOCENTRIC

17. Superiority • Negative stereotyping • “He was so rude and macho. I don’t understand why Puerto Rican women put up with that.” • Reversal • “American culture is so boring and crude. I find Vietnamese culture fascinating.”

18. Assessing Ethnosensitivity CULTURALLY SENSITIVE MINIMIZATION ATTITUDINAL NEEDS CULTURALLY EGOCENTRIC

19. What have you observed? You are observing a 3rd year medical student in his clerkship. You note that while he is technically accurate (always asking the cardinal 7, getting appropriate reviews of systems and performing a focused physical exam), you observe poor bonding with some of the patients.

20. Hypothesis: Attitude Need Behavior: Hypotheses: You observe poor bonding only occurs with poor patients. His questions seem to lack empathy. • Bias against person on public assistance? • Overwhelmed by needs? • Feel superior? How will you assess your hypotheses?

21. Teaching culture and community: Assessment and Methods

22. Teaching culture and community: Assessing attitudes • Know yourself. • Assess your learner. • Work for change

23. Assessing Attitudes: Know Yourself: • Reflection on self • Reflection in practice • Reflection on practice

24. Assessing Attitudes: Assess your learner. • Facilitative style • Encourage reflection • Active listening

25. Reflective Practice “No human being ever learned from experience. Human beings learn from reflecting on their experience” P Viles

26. Assessing Attitudes: Working for Change. • Stages of Change • Precontemplation to Contemplation • Reflection • Assessment and Teaching Method • Life-long process

27. Cultural Humility “Cultural humility incorporates a lifelong commitment to self-evaluation and self-critique, to redressing the power imbalances in the patient-physician dynamic, and to developing mutually beneficial and nonpaternalistic clinical and advocacy partnerships with the communities on behalf of individuals and defined populations.” Tervalon, M and Murray-Garcia J