Title: Hispanic Cultural Competence for Medical Education
1Hispanic Cultural Competence for Medical
Education Curriculum
2Hispanic Cultural Competence Medical Education
Curriculum Introduction
- Hispanics are the largest ethnic group in the
United States (40 million or 14.5 of the total
U.S. population) - In order to promote the health of Hispanics, the
largest group of the workforce of the near
future, it has been recognized that it is
important to develop cultural competence staff
training in various sectors of the health system.
3Hispanic Cultural Competence Medical Education
Curriculum Introduction
- Through this project, the NHMA will complete the
following - Collect Cultural Competence definitions
- Collect Cultural Competence books and journal
articles - Develop a virtual library of information focused
on cultural competence and Hispanic health - Conduct a literature search of medical articles
regarding Hispanic health - Collect examples of medical education curriculum
- Plan and coordinate a Hispanic Health for the
Office of Minority Health, U.S. Department of
Health and Human Services - Convene a one day meeting of cultural competence
experts to produce recommendations for guidelines
for cultural competence medical education
curriculum
4Hispanic Cultural Competence Medical Education
Curriculum Methodology
- NHMA Conference Plenary Session Guidance
- The relationship between mind and body (biology
of belief) - The physiology of the healing
- The relationship between nutrition and health,
with a focus on the typical Hispanic diet - The current health seeking behavior of Hispanics
with focus on traditional healing and
conventional medicine - The importance of family dynamics and health
promotion and treatment information among
Hispanics - Traditional healing practices
- Hispanic history in the Southwest with a focus on
developing and understanding of the unique
transfer of information from the health provider
to different generations in the Mexican American
family.
5Hispanic Cultural Competence Medical Education
Curriculum Methodology
- Cultural Competence Definition
- Cultural Competence is a set of attitudes,
skills, behaviors, and policies that enable
organizations and staff to work effectively in
cross cultural situations. - It reflects the ability to acquire and use
knowledge of the health related beliefs,
attitudes, practices, and communication patterns
of patients and their families to improve
services, strengthen programs, increase community
participation, and close the gaps in health
status among diverse population groups. - Cultural competency also focuses attention on
population-specific issues, including
health-related beliefs and cultural values (the
socioeconomic perspective), disease prevalence
(the epidemiological perspective), and treatment
efficacy (the outcome perspective). HRSA
Cultural Competency A Journey.www.bphc.hrsa.gov.2
000
6Hispanic Cultural Competence Medical Education
Curriculum Methodology
- Dr. Likes Framework
- The society of Teachers of Family Medicine Core
Curriculum Guidelines, Recommended Core
Curriculum Guidelines on Cultural Sensitive and
Competent Health Care Robert C. Like, M.D.,
M.S. - A focus on Attitude Change Information on
perceptions (views, customs, traditions, values
and behavior) that can generate awareness and
self-awareness on the part of practitioner and
patient - A focus on Knowledge Knowledge on the attitudes,
values, beliefs, and behaviors of certain
cultural groups - A focus on Skills Tools and skills
7Hispanic Cultural Competence Medical Education
Curriculum Methodology
- Literature Review
- A broad but cursory search of the literature on
Latino Health was conducted to identify the
type of information that is relevant to
developing Hispanic cultural competence for
medical education curriculum.
8Hispanic Cultural Competence Medical Education
Curriculum Methodology
- Limitations of Data
- Many of the search terms used tended to produce
the same content results. - None of the searches appeared to produce
sufficient information on subgroup knowledge
(Dominicans, Puerto Ricans, Mexicans, South
Americans, regional, and local) - Few curriculum models were found, and few of
these focused on Hispanic culture. - Little information was found on self-awareness of
physicians, experiences with self-awareness
activities or attitude change per se, in medical
students or physicians
9Hispanic Cultural Competence Medical Education
Curriculum Methodology
- Limitations of Data (Continued)
- The eventual goal and future goal is to review a
critical mass of these studies and codify the
findings. - Future searches should explore the databases
California, New York, Puerto Rico - Future searches should explore the databases
belonging to the 10 Regions of the USDHHS for
Hispanic Health information - Focus groups in New York will be used to gather
additional knowledge to cultural health patterns
amongst Puerto Ricans, Mexicans, and Dominicans.
10Hispanic Cultural Competence Medical Education
Curriculum Core Competencies for Hispanic
Cultural Competence
- Demographics of Hispanics in the U.S.
- Hispanic are 40 million, 14.5 of the
population. - Heterogeneous Sub-groups
- Mexican-American, Puerto-Rican, Dominican,
Cuban-American, Central and South Americans - Social Economic Status (SES)
- Poor, young, less educated
- Occupations
- Few managers
11Hispanic Cultural Competence Medical Education
Curriculum Core Competencies for Hispanic
Cultural Competence
- Health Policy Issues
- Access to Health Care
- Cultural Competence
- Hispanic Health Professions Development
- Managed Care Issues
- Data Collection
- Research
- Racial and Ethnic Disparities in Health
- Hispanic Childrens Health
- Hispanic Womens Health
- Hispanic Elderly Health
- Immigrants Health
12Hispanic Cultural Competence Medical Education
Curriculum Core Competencies for Hispanic
Cultural Competence
- Health Policy Issues (Continued)
- Priority Issues Summary
- LEP and Title VI of the Civil Rights Act
- Quality of Health Care
- CLAS Standards
13Hispanic Cultural Competence Medical Education
Curriculum Core Competencies for Hispanic
Cultural Competence
- Crossing the Quality Chasm
- The report, Crossing the Quality Chasm from the
Institute of Medicine, in 2001, proposes six
areas for improvement to address key dimensions
in which todays health care system functions at
far lower levels than it can and should. - Health care should be
- Safe,
- Effective,
- PatientCentered,
- Timely,
- Efficient, and
- Equitable
14Hispanic Cultural Competence Medical Education
Curriculum Core Competencies for Hispanic
Cultural Competence
- Crossing the Quality Chasm (Continued)
- Care based on continuous healing relationships
- Customization based on patient needs and values
- The patient is the source of control
- Shared knowledge and free flow of information
- The need for transparency
15Hispanic Cultural Competence Medical Education
Curriculum Core Competencies for Hispanic
Cultural Competence
- Crossing the Quality Chasm (Continued)
- Hispanics are less involved in their health care
than they would like - Hispanics find it harder to understand
instructions from their doctors - Hispanics find it less easy to understand
instructions on prescription bottles - Hispanics had more communication problems with
their doctors - Hispanics have the highest rate of self-rating of
health as fair or poor - Hispanics have less satisfaction with their
quality of health care
16Hispanic Cultural Competence Medical Education
Curriculum Core Competencies for Hispanic
Cultural Competence
- Culture and Health
- Aztec History
- The Aztecs believed that
- Just as the balance of the opposing forces in
the cosmos must be maintained. - Imbalances in the human body led to disease
- Disease could also be caused by uncleanliness
- Herbs used to treat several illness
- Body and Spirit was one inseparable entity.
- Santeria
- Curanderismo
17Hispanic Cultural Competence Medical Education
Curriculum Core Competencies for Hispanic
Cultural Competence
- Understanding Health Status
- The Hispanic Paradox
- For the past twenty years, there has been
widespread evidence of a Hispanic paradox
regarding health in the United States, in which
most Hispanic groups are characterized by low
socioeconomic status, but better than expected
health and mortality outcomes. - A closer look reveals variation by age, gender,
Hispanic subgroup, acculturation, country of
birth and cause of death. - Possible under-reporting of Hispanic deaths,
salmon bias and healthy migrant effects, and
risk profile may contribute to, but do not
explain, the paradox the Reasons for this paradox
are likely to be multi factorial and social in
origin.
18Hispanic Cultural Competence Medical Education
Curriculum Core Competencies for Hispanic
Cultural Competence
- Understanding Health Status
- Acculturation and Assimilation
- The detrimental and beneficial effects
- The family as a positive social support
- Connections to health outcomes not satisfactorily
documented
19Hispanic Cultural Competence Medical Education
Curriculum Core Competencies for Hispanic
Cultural Competence
- Cultural Competence and Hispanics - Categorized
- Stress
- Attitudes
- Knowledge Psychoneuroimmunology
- Skills
20Hispanic Cultural Competence Medical Education
Curriculum Core Competencies for Hispanic
Cultural Competence
- Cultural Competence and Hispanics - Categorized
- Nutrition
- Attitudes
- Knowledge Advances in Nutritional Science
- Skills
21Hispanic Cultural Competence Medical Education
Curriculum Core Competencies for Hispanic
Cultural Competence
- Cultural Competence and Hispanics - Categorized
- Diabetes
- 2-3 times more common in Hispanics than in whites
- 700,000 Hispanics and Mexican-Americans have
diabetes and dont know it - Diet
- High use of saturated fat
- Stats higher in Mexican-Americans
- Obesity
- Especially in children
- Higher rates of complications
- Amputations, eye and kidney disease
22Hispanic Cultural Competence Medical Education
Curriculum Core Competencies for Hispanic
Cultural Competence
- Cultural Competence and Hispanics - Categorized
- Diabetes
- Attitudes
- Fear of insulin
- Fear of becoming blind
- Fatalism
- Skills
- To discuss diabetes with family
- To understand
- Referrals to resources
23Hispanic Cultural Competence Medical Education
Curriculum Core Competencies for Hispanic
Cultural Competence
- Physician Patient Interaction and Communication
- A fundamental skill that must be learned by
medical students, residents, and physicians is
how to communicate with patients effectively. - Communication Issues with Hispanics
- Lack of Trust
- Familiarity with subject
- Personal Bias
24Hispanic Cultural Competence Medical Education
Curriculum Core Competencies for Hispanic
Cultural Competence
- Physician Patient Interaction and Communication
- Providers must be aware and be able to
communicate with persons speaking other
languages. - Providers must be aware of basic communication
precepts such as how to recognize patterns in
non-verbal and verbal communication -
- Non-verbal communication
-
- Verbal Communication
25Hispanic Cultural Competence Medical Education
Curriculum Core Competencies for Hispanic
Cultural Competence
- Physician Patient Interaction and Communication
(Continued) - Non-verbal communication
- Silence,
- Distance Hispanic Prefer close proximity
- Eye contact
- Emotional expressiveness
- Body language
- Touch
- Invisible person syndrome
- Treating adults like children
- The feeling of linguistic isolation
- Technical Talk
26Hispanic Cultural Competence Medical Education
Curriculum Core Competencies for Hispanic
Cultural Competence
- Physician Patient Interaction and Communication
(Continued) - Verbal Communication
- Tone of voice
- Addressing a person
- Formality
- Importance of verbal communication
- Direct questions and appropriateness of
requesting certain types of information
27Hispanic Cultural Competence Medical Education
Curriculum Core Competencies for Hispanic
Cultural Competence
- Physician Patient Interaction and Communication
(Continued) - Spanish Language
- There are some 32 million Americans who speak a
language other than English at home. - Spanish is the main other language in the U.S.
- A majority of Hispanics in the U.S. are bilingual
and likely to retain their Spanish language
skills as their communities are replenished with
new Spanish speaking immigrants and the
increasing growth of Spanish media. - Only 24 of Hispanics were born outside the U.S.
and Puerto Rico, 77 report Spanish as their
primary language and the language they speak at
home.
28Hispanic Cultural Competence Medical Education
Curriculum Core Competencies for Hispanic
Cultural Competence
- Physician Patient Interaction and Communication
(Continued) - Spanish Language
- Approaches to language used in the U.S. in
various business services include - Bilingual Staff
- Interpreters
- Language Skills Training
- Internal Language Banks
- Phone-based Interpreter Services
- Written Translators
- The Robert Wood Johnson Foundation has recently
established a national effort, Hablamos Juntos,
to develop and evaluate language technology for
use in the health care system in emerging Spanish
markets across the country.
29Hispanic Cultural Competence Medical Education
Curriculum Core Competencies for Hispanic
Cultural Competence
- Physician Patient Interaction and Communication
(Continued) - Use of Medical Interpreters
-
- Due to the prevalence of Spanish language by
Hispanics, it is critical to provide training for
physicians and medical students about the proper
use of interpreters. - We know that language can be a major barrier in
the physician-patient interaction when there is
no understanding between the two.
30Hispanic Cultural Competence Medical Education
Curriculum Core Competencies for Hispanic
Cultural Competence
- Physician Patient Interaction and Communication
(Continued) - Use of Medical Interpreters
- These barriers can lead to
- Misdiagnoses,
- medical errors,
- lack of informed consent,
- under use as well as over use of testing and
referrals, - poor compliance,
- patient dissatisfaction,
- patient mistrust,
- patient increased stress,
- malpractice claims and
- poor health outcomes.
31Hispanic Cultural Competence Medical Education
Curriculum Core Competencies for Hispanic
Cultural Competence
- Physician Patient Interaction and Communication
(Continued) - Use of Medical Interpreters
- The use of medical interpreters is a major
challenge that needs to be promoted in order to
deliver quality of health care to an increasing
number of LEP patients in the U.S. Certification
of medical interpreters as a unique occupation
and the subsequent reimbursement policy
development by the public and private sector is
seen as a promising mechanism to move forward.
32Hispanic Cultural Competence Medical Education
Curriculum Core Competencies for Hispanic
Cultural Competence
- Physician Patient Interaction and Communication
(Continued) - Communication Skills for Cultural Competence
Curriculum - A curriculum about cultural competence should
address communication issues for
Physician-Patient Communication focused on the
ethnic patients and their communication patterns.
33Hispanic Cultural Competence Medical Education
Curriculum Core Competencies for Hispanic
Cultural Competence
- Physician Patient Interaction and Communication
(Continued) - Building a Cultural Base
- A practical way to understand some from another
culture is to be aware and learn to recognize the
ways in which their culture and yours differ. - Americans have a tendency to be more informal but
reserved in their initial contacts and
relationships in general. - Traditional Hispanics, on the other hand, tend to
be more formal on first encounters and to address
people by their last names. - In relationships, Hispanics tend to share more
about their personal lives, and more of the talk
about their family, children, and husbands,
whereas Anglo Saxons tend to be reserved
regarding their personal lives. -
34Hispanic Cultural Competence Medical Education
Curriculum Core Competencies for Hispanic
Cultural Competence
- Physician Patient Interaction and Communication
(Continued) - Building a Cultural Base
- To effectively communicate with Hispanics, you
need to get to know who they are, how they live,
their likes and dislikes and what they enjoy in
life. -
35Hispanic Cultural Competence Medical Education
Curriculum Core Competencies for Hispanic
Cultural Competence
- Conclusion
- Given the increasing growth of the Hispanic
population in the United States, it is imperative
that the health professions continue to develop
curricula that address attitudes, knowledge and
skills about cross-cultural education. - Cultural Competence Curriculum should include a
component that is ethnic specific, in this case,
on Hispanics. - Hispanics are regional and sub-group dominant
with their own cultural peculiarities. - Hispanics have demographic trends, historical
traditions, traditional medicine knowledge,
fundamental values and beliefs, policy issues,
language and communication needs, - And a growing body of medical literature.