Clinical Administration in an Academic Setting

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The CU School of Medicine Cultural Competency
March 4, 2006
Richard D. Krugman, MD Dean, School of
Medicine University of Colorado
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Cultural Competence

• Medical Schools (1998 data Flores et al., 2000,)
• Only 8 had cultural sensitivity courses
• 70 no instruction on specific ethnic groups
• 65 no instruction about the largest non-white
  ethnic group in their state
• Residency (2003/2004 data Brotherton et al,
  2004)
• 51 offered cultural competence training
• 19 offered non-English instruction

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Cultural Competence Curriculum University of
Colorado School of Medicine

• Director Angela Sauaia, MD, PhD
• angela.sauaia_at_uchsc.edu

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CU School of MedicineCultural Competence
Curriculum

• Woven through entire medical program
• Fully integrated to courses and clerkships
• Reflect required competencies as defined by our
  residency accreditation body in their Outcome
  Project
• Association of American Medical Colleges (AAMC)
  recommendations Tool for Assessing Cultural
  Competence Training (TACCT)
• Funding
• SOM Deans Office
• Colorado Trust for the next five years

new
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Cultural competence training at the CU-SOM
Targeting all three levels of prejudice and racism

• Institutionalized
• Personally mediated
• Internalized

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Cultural Competence Curriculum

• Self-analysis and self-acceptance of our own
  culture, values, prejudices and biases
• Knowledge of the culture, values and biases of
  our community and institutions
• Vigorously fight stereotyping promoting the
  knowledge that each individual is unique
• Patient and community advocacy

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Cultural competence training touchy feely
stuff
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Cultural Competence Curriculum Domains

• Domain I Cultural Competence Rationale,
  Context and Definition
• Domain II Cultural Competence Family and
  Community
• Domain III The Impact of Discrimination and
  Stereotyping in Health Care
• Domain IV Health Disparities
• Domain V Cross-cultural Clinical Skills

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Teaching Methods

• Small groups, Problem Based Learning with case
  studies
• Debates
• Panels (community, advocates, legislators)
• Interactive seminars and workshops
• Standardized patients
• Videos (Color of Fear, KP series, etc)
• Books (e.g., The spirit catches and you fall
  down, Infections and Inequalities, Pedagogy of
  the Oppressed, etc)
• Reports (Institute of Medicine) Unequal
  treatment Physicians for Human Rights The right
  to equal treatment, Healthy People 2010)

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Student evaluation

• Great acceptance, over 70 rated it good and
  excellent
• Feelings of discomfort (expected and desired)
• Blood, sweat and tears

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CU-SOM Cultural Competence Curriculum No student
left behind

• No CU-SOM students will leave our school without
  having heard about
• Tuskegee Experiment
• Racism, prejudice and bias in health care
• IOM Report Unequal Treatment
• National and state health disparities Reports
• The spirit catches you and you fall down by
  Anne Fadiman
• Kleinmans 8 questions
• Infections and Inequalities by Paul Farmer

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Domain I Cultural Competence Rationale, Context
and Definition

• Definitions and impact of culture, race,
  ethnicity, sexual orientation, disability
• History of racism and prejudice in health care
• Diversity in health care professions
• Self-assessment of culture, values, bias,
  prejudices

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Domain II Cultural Competence Family and
Community

• Influence of family, community and institutions
  on health and health care
• Roles of patient, family, community in medical
  situation
• Self-assessment of their own family, community
  and institutions

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Domain III The Impact of Discrimination and
Stereotyping in Health Care

• Impact of bias, stereotyping, racism in health
  and health care
• Potential for provider bias and impact on medical
  decision making
• Self-assessment of own biases, prejudices,
  stereotypes and strategies to manage them
• Legal procedures for reporting discrimination

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Domain IV Health Disparities

• Epidemiology
• Major reports IOM Unequal treatment PHR Human
  Rights The right to equal treatment, Healthy
  People 2010
• Genetics and health disparities
• Socio-economic political determinants
• Health insurance safety nets, uninsured,
  undocumented
• Advocacy
• Critical appraisal of literature
• Community-based participatory research
• Community-immersion experience

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Domain V Cross-cultural Clinical Skills

• Common beliefs, values, traditions
• Adapt communication to literacy, disability,
  culture
• Respectful and culturally sensitive techniques
  for physical exam
• Use of Interpreters
• Cultural and social history
• Building trust
• Collaboration with patient, family, community,
  traditional healers
• Major life events and different cultures
• Collaborative decision-making and treatment plan
• Self-assessment of cultural competence continuum,
  plan for life-long learning, impact on the care
  they provide
• Models for effective cross cultural communication

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What else is important in cultural competence?

• Interpreter services
• Recruitment/retention of minorities in health
  care
• Coordination with traditional healers
• Use of community health workers
• Culturally competent health promotion
• Inclusion of family and community members
• Immersion experiences
• Administrative and organizational changes