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

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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.

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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

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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.

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Rationale and Process

• Presented by
• Carman A. Ciervo, D.O., FACOFP

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Cultural Competency Definition

• The Association of American Medical
  Colleges
• an awareness of self and ones 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.

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Challenges to Healthcare Providers

• In todays 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.

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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.

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Project Interact

• A HRSA funded Predoctoral Training Grant
• A Collaborative Model
• Standardized Patient Lab as Focal Point

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Project Interact Committee

• UMDNJ School of Osteopathic Medicine
• Family Medicine
• Internal Medicine
• Pediatrics
• OB/Gyn
• Psychiatry
• Center for Aging
• Predoctoral Students

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Project Interact Committee

• School Health Related Professions
• School of Nursing
• School of Public Health
• School of Dental Medicine
• New Jersey Area Health Education Center

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A Collaborative Model

• Through three Components
• Curriculum
• Standardized Patient Lab
• Community Service Rotation

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Incorporating Cultural and Interdisciplinary
Competencies into the Predoctoral Curriculum

• Presented by
• Frank A. Filipetto, D.O., FACOFP

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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

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Establishing Competencies

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

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First Year

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

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Second Year

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

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Third Year

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

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Fourth Year

• Troublesome bequests cultural explanations and
  interdisciplinary solutions to ethical dilemmas
• Physician assisted suicide
• Truth telling
• HIV confidentiality

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Student Outcomes Presented by Claudia A.
Switala, M.Ed.
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Demographic Dataon Project Interact
Participants Academic Year 2001 -2002n322

• Class
• MS I 89
• MS II 81
• MS III 71
• MS IV 81

• Sex
• Females 163
• Males 159

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Demographic Dataon Project Interact
Participants Academic Year 2001 -2002n322

• Ethnic Racial Demographics
• 73 Underrepresented minorities
• (African American, Hispanic, Native
  American, Vietnamese)
• 74 Other Minorities (Chinese, Japanese,
  Philipino, Indian)
• 175 Caucasians

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Assessment of First Year Studentsn89

• 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.

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Assessment of First Year Studentsn89

• 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

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Assessment of First Year Studentsn89

• 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)

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Assessment of Second Year Studentsn81

• 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 issues on
  patients health (family support, family not
  in this country)
• 68 Identified interdisciplinary resources for
  patient

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Assessment of Second Year Studentsn81

• 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

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Assessment of Third Year Students Two week
Community Service Rotationn71

• 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

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Assessment of Third Year Studentsn71

• 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

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Assessment of Third Year Studentsn71

• 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.

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Assessment of Third Year Studentsn71

• 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

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Assessment of Fourth Year Studentsn81

• 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

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Assessment of Fourth Year Studentsn81

• SP Case II Truth Telling Case (Terminal
  Diagnosis of lung cancer and physician is meeting
  with daughter)
• 95 Listened to family members concerns
• 78 Discussed physicians responsibilities with
  family members.
• 79 Explored cultural aspect of truth telling
  (why you dont want mother to hear the
  diagnosis)

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Assessment of Fourth Year Studentsn81

• S P Case III HIV / AIDS
• 82 Discussed and negotiated with patient
  regarding informing spouse
• 78 Knowledgeable about N Js resources and
  requirements regarding HIV/AIDS
• 86 Determined with patient the appropriate
  interdisciplinary interventions

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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