Teaching Culture and Community in Primary Care: Giving Feedback

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Teaching Culture and Community in Primary
CareGiving Feedback
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Workshop Objectives
By the end of the workshop, participants will be
able to

• Use the plus/delta technique to critically
  observe a learners communication skills
• Provide effective feedback to an individual
  learner about a cross-cultural clinical encounter

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Workshop Outline

• Feedback revisited
• Implications on culture
• Plus/delta revisited
• Small group practice

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Feedback Revisited

• GOAL OF FEEDBACK
• Ensure that the learner improves, while at the
  same time maintains self-respect

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Maintaining self-respect

• Helps learners move up the ladder
• Prevents egocentric, defensive postures
• Model empathic styles

CULTURALLY SENSITIVE
MINIMIZATION
CULTURALLY EGOCENTRIC
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Characteristics of Good Feedback

• Encourage self-assessment
• Covers positives and negatives
• Refers to specific, observed behavior
• Timely and limited in amount
• Occurs in appropriate place
• Ends in an action plan

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Characteristics feedback in context of cultural
learning objective

• Encourage self-assessment
• Facilitates self-reflection
• Promotes self-awareness
• Refer to specific, observed behaviors
• No presumption of attitude
• Provides opportunity for change and growth

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Match teaching styles to needs and objectives

• Assertive When you say that hes ignorant, Im
  offended. This is someone I care about.
• Facilitative Jill, it sounds as though you are
  upset because John made that remark.
• Suggestive You might want to think about the
  power difference here.
• Collaborative Lets think together how we can
  learn from this.

• That guys so ignorant. Im not going to waste
  my time on patient education.
• John, youre such a sexist pig. Get your act
  together!
• Why should I be nice when she swore at me?
• I cant believe that I said that. Im so
  humiliated.

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Case Vignette
Setting Primary Care Office E Rivera is a
seven-year-old male coming in to see you
following an emergency room visit for shortness
of breath attributed to asthma. You have
followed him for several years, and have
repeatedly reviewed the standard of asthma care
with his mother according to the published
practice guidelines. You are concerned that she
is non-compliant with anti-inflammatory
medicines. Recently, one of your attendings
spoke about the impact of folk beliefs on asthma
management in Puerto Rican families, and you want
to explore the idea that Es mother is
non-compliant because of folk beliefs.
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Case Vignette
STUDENT TASKS 1. Explore chief concerns and
present illness, including patient's perspective
of illness and management of his problems. 2.
Negotiate a treatment plan together.
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Practice Case Observe for the following

• The rapport between patient and student
• The content of the students communication
• The students reactions to the information
  presented by the patient.

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Your Charge!

• Create a composite plus/delta sheet in the small
  groups
• Practice giving feedback
• Deliver feedback on feedback

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Video Sequence - LEARN

• Listen.wmv
• Elicit.wmv
• Assess.wmv
• Recommend.wmv
• Negotiate.wmv

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