aamc asph cultural competence education

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Cultural Competence Educationfor Students in Medicine and Public HealthReport of an Expert Panel

Joint Expert Panel Convened by theAssociation of American Medical Colleges and the

Association of Schools of Public Health

July 2012


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Cultural Competence Educationfor Students in Medicine and Public HealthReport of an Expert Panel

Joint Expert Panel Convened by the

Association of American Medical Colleges and theAssociation of Schools of Public Health

July 2012


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Cultural Competence Education for Students in Medicine and Public Health

The work of the expert panel was supported in part by the CaliforniaEndowment through grant #20042940.

Suggested Citation: Expert Panel on Cultural Competence Education for Studentsin Medicine and Public Health (2012). Cultural competence education for students inmedicine and public health: Report of an expert panel. Washington, D.C.: Associationof American Medical Colleges and Association of Schools of Public Health.

For additional information, contact

s !LEXIS 2UFlN \ [email protected], Medical Education, Association of American Medical Colleges

s %LIZABETH - 7EIST \ [email protected], Special Projects, Association of Schools of Public Health

Free PDF versions of this report are available for download or linkage fromwww.aamc.org/culturalcompetenceinmedicineandpublichealth or www.asph.org/competency

2012 Association of American Medical Colleges and Association of Schools of Public Health. Washington, D.C.

4HIS DOCUMENT MAY BE REPRODUCED DISTRIBUTED PUBLICLY DISPLAYED AND MODIlED PROVIDED THAT ATTRIBUTION IS CLEARLY STATED ON ANY RESULTING WORK AND THAT IT ISUSED FOR NONCOMMERCIAL SCIENTIlC OR EDUCATIONALINCLUDING PROFESSIONAL DEVELOPMENTPURPOSES )F THE WORK HAS BEEN MODIlED IN ANY WAY ALL LOGOS MUSTbe removed.
mailto:[email protected]:[email protected]://www.aamc.org/culturalcompetenceinmedicineandpublichealthhttp://www.aamc.org/culturalcompetenceinmedicineandpublichealthmailto:[email protected]:[email protected]


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)NTRODUCTION ..................................................................................... 1

Report of an Expert Panel................................................................. 2

Competency Statements................................................................... 7

Collaborative Learning Experiences ................................................... 9

Road Map for the Future .................................................................11

Conclusion..................................................................................... 16

Appendix A: Mapping to ACGME Core Competence Domains..........17

Appendix B: Entrustable Professional Activity .................................. 19

Appendix C: Selected MedEdPORTAL Abstracts............................. 21

References ..................................................................................... 24

Expert Panel................................................................................... 26

Table of Contents

2012 Association of American Medical Colleges and Association of Schools of Public Health


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1 2012 Association of American Medical Colleges and Association of Schools of Public Health

The Association of American Medical Colleges (AAMC) and the Association of Schoolsof Public Health (ASPH) charged an expert panel of educators with identifying a setof competencies appropriate for learners in disciplines of both medicine and publichealth to prepare culturally competent practitioners. The competencies are designedto enable faculty in medical schools and graduate schools/programs of public healthTO STANDARDIZE CURRICULA BENCHMARK STUDENT PERFORMANCE AND PREPARE GRADUATES FORculturally competent practice. The panel additionally provided recommendations forembedding cultural competence education within and across curricula of medicineand public health, highlights of exemplary case studies, and a road map for the future

Though recommendations in this report will be of primary use to faculty andadministrators developing and administering curricula in schools of medicine andschools/programs in public health, faculty in other health professions schools and

THOSE IN HEALTH SCIENCE DEPARTMENTS MAY lND THE COMPETENCIES AND EDUCATIONALstrategies to be similarly applicable to their programs of study.

)N ORDER TO MAXIMIZE APPLICABILITY BETWEEN THE HEALTH PROFESSIONS THE COMPETENCIESARE ORGANIZED BY THE GENERAL DOMAIN AREAS OF KNOWLEDGE SKILLS AND ATTITUDES !S ANexample of discipline alignment with accreditation requirements, a crosswalk of thecompetencies offered here with the general domains adopted by the AccreditationCouncil for Graduate Medical Education is offered in the appendix. Though contentproposed in this report can be found in both the accreditation language andeducational literature of medicine and public health, the competencies articulated aremeant to offer emphasis to the nexus shared by the two disciplines.

The AAMC/ASPH partnership to develop the joint report offered here, CulturalCompetence Education for Students in Medicine and Public Health: Report of an Expert0ANELv REPRESENTS THE SECOND SUCH ISSUANCE OF JOINT EDUCATIONAL RECOMMENDATIONS )NSPRING THE !!-# AND !30( BOTH AS FOUNDING MEMBERS OF THE )NTERPROFESSIONAL%DUCATION #OLLABORATIVE )0%# WITH FOUR OTHER EDUCATIONAL ASSOCIATIONS PUBLISHED h#ORE#OMPETENCIES FOR )NTERPROFESSIONAL #OLLABORATIVE 0RACTICEv

Acknowledgements: The panel wishes to acknowledge Dr. Maureen Lichtveld forHER ROLE IN CATALYZING THE FORMATION OF THIS PANEL AND PROVIDING INVALUABLE GUIDANCE TOthe co-chairs in development of the report. The panel is also grateful for the supportof the following individuals during the course of this initiative: Dr. Carol Aschenbrener,CHIEF MEDICAL EDUCATION OFlCER !SSOCIATION OF !MERICAN -EDICAL #OLLEGES !!-#$R $AVID !COSTA &!!&0 CHAIR OF THE !!-# 'ROUP ON $IVERSITY AND )NCLUSION ANDASSOCIATE DEAN OF MULTICULTURAL AFFAIRS AT 5NIVERSITY OF 7ASHINGTON 3CHOOL OF -EDICINEDr. Harrison Spencer, president and CEO, Association of Schools of Public Health!30( AND $R -ARLA 'OLD CHAIR OF THE !30( $IVERSITY #OMMITTEE AND DEAN OF THEDrexel University School of Public Health.

In memoriam: The AAMC and ASPH appreciate the contributions of Dr. Jessie Satia,associate professor, departments of nutrition and epidemiology, special assistant tothe dean for diversity, at the UNC Gillings School of Global Public Health.

)NTRODUCTION


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Most health professionals intuitively make the connection between medicine andpublic health, yet these disciplines still largely operate as silos -AESHIRO ET AL )NTERPROFESSIONAL %DUCATION #OLLABORATIVE (OWEVER EXAMPLES OF SUCCESSFUL JOINTeducational efforts do exist and include M.D./M.P.H. programs, work in communityhealth centers and neighborhood clinics, and collaboration in community-basedparticipatory research.

4HE !!-# AND !30( HAVE MADE DELIBERATE SYNERGISTICALLY BENElCIAL INVESTMENTS TOdeliver graduates capable of functioning across the respective disciplines of medicineand public health. For example, in the aftermath of the September 11th terroristATTACKS BOTH ORGANIZATIONS ACTED ON THE URGENCY TO EQUIP STUDENTS IN MEDICINEand public health with basic skills and knowledge related to disaster preparedness(Association of American Medical Colleges, 2003). Regional medicine-public health

EDUCATION CENTERS ENCOURAGED CROSSFERTILIZATION BY PROVIDING OPPORTUNITIES FORmedical schools and residency programs to collaborate with public health partners,including schools and graduate programs in public health (Maeshiro et al., 2010).

Interdependence Between Medicine and Public Health

Beyond intuitive connectivity, key drivers in developing this joint panel were theINCREASING REALIZATION OF THE INTERDEPENDENCE OF BOTH DISCIPLINES AND THE RECOGNITIONthat cultural competence is a critical, influencing factor common to all forces ofchange in health care and public health. The panels recommendations for improvingcultural competence education can be leveraged in a three-pronged fashion:

s !S A PREREQUISITE FOR TRANSDISCIPLINARY HOLISTIC PRACTICE

s 4O ACCELERATE TEAMDRIVEN COMMUNITYBASED HEALTH CARE PROGRAMS SERVICES ANDpolicies.

s !S A STIMULUS TO ADVANCE HEALTH DISPARITIES RESEARCH AND INCREASE DISEASEprevention outreach.

!S ONE OF MANY APPROACHES EACH ORGANIZATION IS TAKING TOWARD THE ULTIMATE AIM OFeliminating health and health care disparities, the set of core competencies developedby this unique collaborative partnership and published in this report embraces thecommonalities of both disciplines and is therefore appropriate for medical and publichealth students.

Initiative Description and Goals

#ULTURAL COMPETENCE IS DElNED IN THE BROADER CONTEXT OF DIVERSITY AND INCLUSION ASthe active, intentional, and ongoing engagement with diversity to increase onesawareness, content knowledge, cognitive sophistication, and empathic understandingof the complex ways individuals interact within systems and institutions (Milem,2005).

Report of an Expert Panel


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The target audiences, therefore, for the competencies outlined in this report includestudents in schools of medicine prior to their graduation with a Doctor of Medicine(M.D.) degree and students in graduate schools of public health or graduate programs

of public health prior to their graduation with the Master of Public Health (M.P.H.)degree or related masters degree.

The panels recommendations aim to ensure that students acquire culturalCOMPETENCIES IN THEIR CHOSEN lELDS TO PREPARE THEM FOR SUCCESSFUL PRACTICE INCLUDINGthe development and delivery of appropriate health care and population healthprograms, services, and policies for an increasingly diverse U.S. population. Thispopulation includes those currently medically underserved and those whom the publicHEALTH SYSTEM HAS MORE DIFlCULTY REACHING WITH PROGRAMS SERVICES AND POLICIES

The panel anticipates that its recommendations will be of primary use to facultyand administrators who decide on curricula in schools of medicine and in schoolsof and programs in public health. Faculty in other health professions schools

and those in health science departments may wish to review the competenciesand recommendations in this report in light of their own objectives for culturalcompetence in the education of their students.

The joint panels recommendations have a goal of fostering innovations in thedevelopment of educational experiences that integrate culturally competentknowledge, skills, and attitudes. The panel views cultural competence as a signaturetopic in the education of medical and public health students leading to a greaterappreciation of its application in practice and how it can be ultimately integrated atthe individual and community levels.

Background

Learning to communicate with patients, families, communities, and fellowprofessionals in a culturally competent manner helps to reduce disparities andpromote enhanced health and wellness. (Gebbie et al., 2003) Ample evidenceexists documenting the role of cultural competence in addressing health disparities"ETANCOURT ET AL "RACH &RASER 'OODE ET AL 4HE ABILITY TOpractice in a culturally competent manner within the frame of reference of onespatient(s) and/or the community of interest improves the delivery of appropriate careand enhances the likelihood that programs, services, and policies will be relevant toDIVERSE POPULATIONS 4HE BENElT IS TWOFOLD AN IMPROVEMENT IN HEALTH OUTCOMES AND Acorresponding reduction in health disparities.

An evolving multiracial, multicultural, and multilingual society makes strengtheningthe cultural competence of the health workforce even more imperative. Global

and national entities have stated that by embracing their own cultural diversityand differences across practice settings and showing respect for the patients andPOPULATION THEY ARE ATTENDING HEALTH CARE TEAMS ACHIEVE MULTIPLE BENElTS FOR BOTHthemselves and the communities they serve.


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Such outcomes include:

s "REAKING DOWN OF PROFESSIONAL BARRIERS

s "UILDING OF TRUSTs %NHANCING APPRECIATION AMONG PRACTITIONERS OF EACH OTHER AS VALUABLE COLLEAGUESs )NCREASING EFFECTIVE COORDINATION AND DELIVERY OF PATIENTPOPULATIONCENTERED CARE

PROGRAMS SERVICES AND POLICIES &RENK ET AL )0%# s !CCELERATING INNOVATION AND PROMOTING EXCELLENCE BY ENGAGING DIVERSITY

(Nivet, 2011).

Although recognition is increasing that culturally competent, team-based care mayREPRESENT A MORE EFlCIENT APPROACH TO PROVIDING EFFECTIVE HEALTH SERVICES AND TOachieving improved health outcomes and sustained well-being, the health workforceLACKS THE KNOWLEDGE AND SKILLS TO REALIZE THIS TRANSFORMATION FULLY 4HE !!-# ANDASPH have collaborated for two decades on these and other issues of commonconcern to both associations (Gemmell, 2003). Through the joint panel, the AAMC

and ASPH have embraced the challenge of exploring cultural competency in thecurricula of schools of medicine and schools of public health and will seek to buildupon the recommendations outlined in this report.

Methods

)N -AY AN MEMBER PANEL ALONG WITH INVITED STAFF AND OBSERVERS MET TOdiscuss issues in cultural competence education and to draft related competencies formedical and public health students using existing curricula, related competencies, andkey recommendations from national reports and other literature in its assessment.Following this in-person meeting, a core writing team comprising the project co-chairs, a single panel member representing both the medicine and public healthperspectives, and one staff member each from the AAMC and ASPH communicated

via e-mail and telephone to develop consensus, to align the competencies withBlooms taxonomy of educational outcomes as revised by Krathwohl (2002), and toassign the competency statements into major areas of KSAs (knowledge, skills, andattitudes).

A representative from the panel displayed the draft competency statements in aposter session during the AAMC- and CDC-sponsored 2010 Patients and Populations:Public Health in Medical Education conference in Cleveland, Ohio (Lichtveld, 2010).The conference was supported by the AAMC-CDC cooperative agreement andhelped to highlight its Regional Medicine-Public Health Education Centers (RMPHEC)initiative, an effort to integrate public/population health and prevention educationinto medical school and residency curricula through partnerships with local andstate public health agencies and other public health partners. Conference attendees

provided comments and feedback, and the core writing team reviewed and carefullyconsidered the input.

The core writing team presented a revised draft to the full panel for review andapproval, as well as solicited feedback from the constituent chairs of the AAMCs'ROUP ON $IVERSITY AND )NCLUSION AND !30(S $IVERSITY #OMMITTEE )NTENDED FORrelease on both the AAMC and the ASPH Web sites, the report will be available formutual and derivative use by both association communities.
https://www.aamc.org/download/252862/data/phinmeded2010posterabstracts.pdf%20https://www.aamc.org/download/252862/data/phinmeded2010posterabstracts.pdf%20


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Building Blocks of Cultural Competence Education

Schools of medicine and public health have each undertaken efforts to include

cultural competence in their respective curricula. For example, to address culturalCOMPETENCE SPECIlCALLY IN THE MEDICAL CURRICULUM THE !!-# CONVENED EXPERTS IN2006 to develop a detailed list of content elements essential to teaching culturalcompetence in the medical school curriculum. These key content areas wereincorporated into a curricular evaluation tool, the Tool for Assessment of CulturalCompetence Training or TACCT, which medical schools can use to assess thecultural competence content in their curriculum (Association of American Medical#OLLEGES ,IE 4HE 5NIVERSITY OF 7ASHINGTON DEVELOPED A SET OF COREprinciples for cultural competence for medical education outlining learner objectivesand outcomes focused on awareness, knowledge, skills, and advocacy (Acosta,2010). Maeshiro et al. (2010) also described population health competencies forgraduating medical students.

)N SOME INSTANCES TECHNIQUES AND APPROACHES FROM PUBLIC HEALTH ARE HELPING TOinform medical education with ecological models that place patients within largerenvironments, thus enabling future medical providers to work on resolving issuesbeyond the traditional model of individual care. A recent report, for example,ARGUED THAT THE hPERSPECTIVES AND lNDINGS THAT mOW FROM THE BEHAVIORAL ANDsocial sciences serve to prepare medical school graduates for comprehensive,patient-centered practice and provide the conceptual framework needed to addresscomplex societal problems that have direct bearing on health and health caredisparities (Association of American Medical Colleges, 2011).

Similarly, ASPH, with support from the Kellogg Foundation, publishedrecommendations for infusing cultural competence into the curricula of accreditedpublic health schools (Association of Schools of Public Health/W. K. Kellogg Task

Force, 2008). This effort was intended to address the role of the public healthpractice community in eliminating racial and ethnic health disparities. The desiredoverarching outcome was that public health practitioners involved in advocacy,policy, disease prevention, and health promotion would know the differences in thehealth beliefs, practices, behaviors, attitudes, and outcomes of diverse populations.
https://www.mededportal.org/publication/3185https://www.mededportal.org/publication/3185https://www.mededportal.org/publication/3185https://www.mededportal.org/publication/3185


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Core Competencies for Improving Health and Health Care

Demonstrable evidence of the value of and need for interprofessional education

is documented in a joint expert panel report issued by six national educationassociations of schools of the health professions. Core Competencies forInterprofessional Collaborative Practice )NTERPROFESSIONAL %DUCATION #OLLABORATIVE2011) delineates four domains of core competencies for preparing future healthprofessionals to provide integrated, high-quality care to patients within the nationscurrent, evolving health care system:

1. Teams and Teamwork

6ALUES%THICS FOR )NTERPROFESSIONAL 0RACTICE

3. Roles/Responsibilities

)NTERPROFESSIONAL #OMMUNICATION

These four domains, populated by competencies and subcompetencies, describeessential behaviors across the domains and illustrate the common frame of referenceregarding cultural competence required by both medicine and public health studentsAT THE PRELICENSUREPRECERTIlCATION POINTS IN THEIR EDUCATIONAL CONTINUUM

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The Learning Continuum pre-licensure through practice trajectory

2EPRINTED WITH PERMISSION FROM )NTERPROFESSIONAL %DUCATION #OLLABORATIVE %XPERT 0ANEL #ORE COMPETENCIES

FOR INTERPROFESSIONAL COLLABORATIVE PRACTICE 2EPORT OF AN EXPERT PANEL 7ASHINGTON $# )NTERPROFESSIONAL %DUCATION

Collaborative.
http://www.aamc.org/interprofessionalcorecompetencieshttp://www.aamc.org/interprofessionalcorecompetencieshttp://www.aamc.org/interprofessionalcorecompetencieshttp://www.aamc.org/interprofessionalcorecompetencies


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The proposed competency sets reflect the nexus of medicine and public healthcultural competence education and are intended to help embed cultural competenceknowledge, skills, and attitudes in medical and public health education and practice.4HE COMPETENCIES BUILD ON OTHER EXISTING DISCIPLINEDERIVED EFFORTSAS MENTIONEDbefore, the Tool for Assessing Cultural Competence Training (TACCT) as well as themasters degree in public health core competencies outlined in the Diversity andCulture domain developed by ASPH (Association of Schools of Public Health, 2006).Deliberately designed to apply to the education and practice of medicine and publichealth in an interdependent, holistic fashion, this effort is distinguished from previousones.

While competencies articulated by accrediting bodies in medicine and public healthMAY VERY WELL ADDRESS CONTENT PRESENTED HERE EITHER IN A GENERAL OR SPECIlC MANNER

this exercise was undertaken to examine principles of cultural competence as theoverlay of identifying areas of knowledge, skill, and attitude common between thetwo professions.

The anticipated performance outcome for both student populations is a whole-person, patient-centered approach embedded in a community-wide and population-wide setting. The competency set proposed here is not intended to be implementedIN ITS ENTIRETY RATHER SCHOOLS OF MEDICINE AND PUBLIC HEALTH HAVE AMPLE mEXIBILITY TOTAILOR CURRICULA ANCHORED BY SPECIlC COMPETENCIES WHILE ASSURING OPPORTUNITIES TObenchmark student performance. The competencies are deliberately broad, allowingfor the integration and tailoring not only within the scope of practice, but also withineducational strategies and modalities relevant to the progressive stages of learning inmedicine and public health.

4HE COMPETENCIES ARE CATEGORIZED IN THREE DOMAIN AREAS KNOWLEDGE SKILLS ANDattitudes. Some competency statements are bridging in nature, naturally linkingmore than one of the three domains and are thus designated with an asterisk. Whilesome of the included competencies are general and apply broadly (e.g., role andfunction of a local health department) bridging competencies are explicated here forTHE PURPOSE OF EMPHASIZING THE INTERCONNECTEDNESS OF THE THREE DOMAINS

)T BEARS REPEATING THAT THE TARGET AUDIENCES FOR THE COMPETENCIES OUTLINED BELOW AREstudents in schools of medicine prior to their graduation with a Doctor of Medicine(M.D.) degree and students in graduate schools of public health or graduate programsof public health prior to their graduation with the Master of Public Health (M.P.H.)degree or related masters level degree.

Since the M.P.H. is considered a prerequisite for the Doctor of Public Health(Dr.P.H.) degree, students seeking their Dr.P.H. degree are encouraged to obtainthe competencies listed below as a foundation for advanced work at the doctorallevel. (Thus competency requirements for the Dr.P.H. subsume competenciesrequired for the M.P.H. degree or its masters level correlate.) These competenciesalso are applicable as a basis for acquiring cultural competence among seekers ofother doctoral degrees, such as the Doctor of Philosophy (Ph.D.) and the Doctor ofScience (Sc.D.).

Competency Statements


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Cultural Competencies Common to Medical and Public Health Students* competencies bridge more than one domainKnowledge, Skills, and/or Attitudes

Knowledge (Cognitive competencies)

At the completion of the program of study,students will be able to:

s $ElNE CULTURAL DIVERSITY INCLUDING LANGUAGE SEXUAL IDENTITY AGErace, ethnicity, disability, socioeconomics, and education

s $IFFERENTIATe health, health care, health care systems, and healthdisparities

s )DENTIFY CULTURAL FACTORS THAT CONTRIBUTE TO OVERALL HEALTH AND

wellness*

s $ESCRIBE THE INmUENCE OF CULTURE FAMILIAL HISTORY RESILIENCY AND

genetics on health outcomes

s %XAMINE FACTORS THAT CONTRIBUTE TO HEALTH DISPARITIES PARTICULARLY

social, economic, environmental, health systems, and access

s )DENTIFY HEALTH DISPARITIES THAT EXIST AT THE LOCAL STATE REGIONAL

national, and global levels

s 2ECOGNIZE THAT CULTURAL COMPETENCE ALONE DOES NOT ADDRESS HEALTH

care disparities

s $ESCRIBE THE ELEMENTS OF EFFECTIVE COMMUNICATION WITH PATIENTS

families, communities, peers, and colleagues*

s $ESCRIBE STRATEGIES TO COMMUNICATE WITH LIMITED %NGLISH PROlCIENT

patients and communities

s $ESCRIBE THE ROLE OF COMMUNITY ENGAGEMENT IN HEALTH CARE AND

wellness

s !SSESS THE IMPACT OF ACCULTURATION ASSIMILATION AND IMMIGRATION

on health care and wellness

s !RTICULATE THE ROLE OF REmECTION AND SELFASSESSMENT OF CULTURAL

humility in ongoing professional growth

s $ESCRIBE BOTH VALUE AND LIMITATION OF EVIDENCEBASED LITERATURE ON

understanding the health of individuals and communities

s !RTICULATE ROLES AND FUNCTIONS OF LOCAL HEALTH DEPARTMENTS AND

community partners, to include capabilities and limitations*

Attitudes (Values/beliefs competencies)

At the completion of the program of study, students will be able to:

s Demonstrate willingness to apply the principles of cultural competence

s !PPRECIATE HOW CULTURAL COMPETENCE CONTRIBUTES TO THE PRACTICE OF MEDICINE AND PUBLIC HEALTHs !PPRECIATE THAT BECOMING CULTURALLY COMPETENT INVOLVES LIFELONG LEARNING

s $EMONSTRATE WILLINGNESS TO ASSESS THE IMPACT OF ONES OWN CULTURE ASSUMPTIONS STEREOTYPES AND BIASES ON THE ABILITY TO PROVIDE CULTURALLY

competent care and service

s $EMONSTRATE WILLINGNESS TO EXPLORE CULTURAL ELEMENTS AND ASPECTS THAT INmUENCE DECISION MAKING BY PATIENTS SELF AND COLLEAGUES

s $EMONSTRATE WILLINGNESS TO COLLABORATE TO OVERCOME LINGUISTIC AND LITERACY CHALLENGES IN THE CLINICAL AND COMMUNITY ENCOUNTER

s !PPRECIATE THE INmUENCE OF INSTITUTIONAL CULTURE ON LEARNING CONTENT STYLE AND OPPORTUNITIES OF PROFESSIONAL TRAINING PROGRAMS

Skills (Practice competencies)

At the completion of the program of study,students will be able to:

s )DENTIFY ONES OWN ASSETS AND LEARNING NEEDS RELATED TO CULTURAL

competence

s )NCORPORATE CULTURE AS A KEY COMPONENT OF PATIENT FAMILY AND

community history

s )NTEGRATE CULTURAL PERSPECTIVES OF PATIENT FAMILY AND COMMUNITY IN

developing treatment/interventions*

s !PPLY COMMUNITY CONSTITUENT PATIENTCENTERED PRINCIPLES TO EARN

trust and credibility

s #ONDUCT CULTURALLY APPROPRIATE RISK AND ASSET ASSESSMENT

management, and communication with patients andpopulations

s #ONTRIBUTE EXPERTISE TO CULTURALLY COMPETENT INTERVENTIONS

s #OMMUNICATE IN A CULTURALLY COMPETENT MANNER WITH PATIENTS

families, and communities

s %MPLOY SELFREmECTION TO EVALUATE THE IMPACT OF ONES PRACTICE

s 7ORK IN A TRANSDISCIPLINARY SETTINGTEAM

s $EMONSTRATE SHARED DECISION MAKING

s !NALYZE ILLNESS CONDITIONS AND HEALTH OUTCOMES OF CONCERN AT THE

patient and community levels

s %NGAGE COMMUNITY PARTNERS IN ACTIONS THAT PROMOTE A HEALTHY

environment and healthy behaviors

s #OMMUNICATE WITH COLLEAGUES PATIENTS FAMILIES AND COMMUNITIES

about health disparities and health care disparities

s %STABLISH EQUITABLE PARTNERSHIPS WITH LOCAL HEALTH DEPARTMENTS

FAITH AND COMMUNITYBASED ORGANIZATIONS AND LEADERS TO DEVELOP

culturally appropriate outreach and interventions*


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Successful shared learning opportunities already serve as a rich foundation forcultural competence education in medicine and public health. For example,students participating in multidisciplinary team-based service learning projectsMAY EXPERIENCE lRSTHAND HOW ONE ANOTHERS INTERDEPENDENCE AND EXPERTISE LEADto a more successful health outcome. Such learning projects often serve high-riskpopulations challenged by multiple health conditions and a persistent or historicallydisproportionate burden of health disparities.

For both medicine and public health students, a multitude of additional sharedlearning opportunities exist, including the following:

s 3TUDY OF A HEALTH CONDITION OR DISEASE ENTITY THAT AFFECTS BOTH lELDS EG OBESITY

s #OMMUNITYBASED INTERVENTIONS FOCUSED ON MEASURING IMPROVEMENT IN HEALTHoutcomes.

s 0ROJECTS ILLUMINATING THE CENTRAL ROLE OF CULTURAL COMPETENCE IN PROMOTINGhealthy behaviors and, ultimately, sustained well-being.

s 4EAMBASED ACTIVITIES TO ENHANCE QUALITY AND PATIENT SAFETY

s 0ROBLEMBASED LEARNING EXPERIENCES SHOWCASING MEDICINEnPUBLIC HEALTHcollaboration in which both groups contribute important subject-matter contentand disciplinary methods (e.g., adverse health effects related to environmentalexposures, cancer screening and early detection).

s #ROSSLISTING COURSES BETWEEN HEALTH PROFESSIONS SCHOOLS IN THE SAME SYSTEM

s /PEN EDUCATIONAL RESOURCES PUBLICATION SERVICES AND OTHER MECHANISMS FORsharing teaching and assessment tools (e.g., MedEdPORTAL).

Collaborative Learning Experiences
https://www.mededportal.org/https://www.mededportal.org/https://www.mededportal.org/


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Selected MedEdPORTAL Cultural Competence Resources*

s -EDICINE 2ESOURCES

%LLIOTT $ 3T 'EORGE # 3IGNORELLI $ 4RIAL * 3TEREOTYPES AND "IAS AT THE 0SYCHIATRIC "EDSIDE#ULTURAL#OMPETENCE IN THE 4HIRD 9EAR 2EQUIRED #LERKSHIPS -ED%D0/24!, )$

%LLIOTT $ 3CHAFF 0 7OEHRLE 4 7ALSH ! 4RIAL * .ARRATIVE 2EmECTION IN &AMILY -EDICINE #LERKSHIP#ULTURAL#OMPETENCE IN THE 4HIRD 9EAR 2EQUIRED #LERKSHIPS -ED%D0/24!, )$

s 0UBLIC (EALTH %DUCATION 2ESOURCES

-ARION ' #RANDALL 3 (ILDEBRANDT # 7ALKER + 'AMBERINI " 3PANGLER * 4OBACCO 4IES -ED%D0/24!,)$

-ARION ' (ILDEBRANDT # #RANDALL 3 +IRK * %STHER (INES #ULTURALLY #OMPETENT #OLLABORATION TO -ANAGE$IABETES -ED%D0/24!, )$

* See Appendix C: Selected MedEdPORTAL Resource Abstracts for expanded abstract narratives.

MedEdPORTALwww.mededportal.org

s !N OPEN EDUCATION RESOURCE AND PUBLICATION SERVICE PROVIDED BY THE !SSOCIATION OF !MERICAN -EDICAL #OLLEGES INpartnership with the American Dental Education Association.

s &EATURES APPROXIMATELY PEERREVIEWED EDUCATIONAL RESOURCES THAT SPAN THE CONTINUUM OF MEDICAL AND DENTALeducation.

s )NCLUDES A GROWING INTERNATIONAL REACH OF MORE THAN HEALTH EDUCATION INSTITUTIONS FROM MORE THAN countries.

s 5P TO -ED%D0/24!, PUBLICATIONS ACCESSED EACH WEEK BY USERS ACROSS THE GLOBE

MedEdPORTAL maintains a rigorous peer-review process based on standards used in the scholarly publishingCOMMUNITY %ACH SUBMISSION IS SCRUTINIZED BY EDITORIAL STAFF AND INDEPENDENT REVIEWERS USING A STANDARDIZED REVIEWinstrument grounded in the tenets of scholarship. Published authors receive a formal citation for their acceptedpublication.

MedEdPORTAL publications are considered by many to be scholarly works that may support faculty advancementdecisions.
http://www.mededportal.org/http://www.mededportal.org/


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4HIS JOINT PANEL HAS UNDERTAKEN AN UNPRECEDENTED lRST STEP IN WORKING TOGETHER

across disciplines to identify essential competencies for culturally appropriate medicaland public health education. Subsequent activities the panel suggests for preparingculturally competent medical and public health practitioners and for reducing healthdisparities while promoting enhanced health and wellness include:

s 0ROMOTING FACULTY SKILL IN COMPETENCYBASED EDUCATION #"%

s )NTEGRATING APPLICATION OF THE COMPETENCIES

s #ULTIVATING AN AGENDA FOR RESEARCH AND SCHOLARSHIP

s %MPLOYING CASE STUDIES DISSEMINATING EXISTING CASE STUDIES AND CREATING NOVEL ONES

s )DENTIFYING STRATEGIES FOR TRANSLATING CURRICULUM TO PRACTICE SETTINGS

Each of these recommendations is addressed briefly below.

Promote Faculty Skill in Competency-based Education

Although this report is focused on building students cultural competence,transdisciplinary faculty development must be addressed as a core implementationstrategy. A systematic approach to advancing the cultural competence of facultymembers themselves must be integral to any curricular transformation to achievesustained success in cultural competence education. Some early opportunities includethe collaborative development of case studies, courses, seminars, and brown-baglunch sessions which explore interprofessional competencies and issues in culturalcompetence, and working with faculty peer mentors.

Faculty development in creating, adapting, implementing, and evaluating CBE is stronglyrecommended. Most faculty members have been trained in traditional lecture formatsand, consequently, many resort to the same tried-and-true presentation styles in theircurrent teaching. Competency-based education, however, is best achieved throughmore interactive, student-centered, pedagogical principles (Calhoun et al., 2011).

Special attention to building faculty expertise in enabling student acquisition ofattitudinal competencies is warranted. Attitudes represent special abilities that developOVER TIME FACULTY MAY NEED TO IMPLEMENT A MORE SEQUENCED SYSTEM OF BENCHMARKS TOassess students attitudes at the beginning, middle, and end of a particular educationalprogram.

Faculty support in evaluating student acquisition of competencies is also

recommended. Building a consensus on objective evaluation methods of attitudinalchange is particularly challenging. Special resources should be provided to helpfaculty develop and use rubrics for evaluating student attitudes. The Health BeliefsAttitudes Survey (HBAS), for example, has been used successfully in introductoryclinical medicine courses to determine positive changes in students attitudes on issuesrelating to cultural competency (Crosson et al., 2004).

Road Map for the Future


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Therefore, curriculum planning needs to include not only a means of integratingcompetencies into facultys instruction, but also a broader array of student-centeredevaluation techniques to ensure that students leave the discrete learning experience,as well as graduate from a program, having demonstrated competence in the

desired areas. See the ASPH Learning Taxonomy Levels for Developing Competencies ,EARNING /UTCOMES 2EFERENCE 'UIDE (also known as the Reference Guide) forinformation about aligning competencies with instruction and evaluation (Associationof Schools of Public Health, 2011b).

Integrate Competencies

!S DRAFTED THE CULTURAL COMPETENCE EDUCATION SET WAS SPECIlCALLY CONSTRUCTED SO THATundergraduate medical and graduate public health programs have the ability to adoptall or part of the proposed model. Experience and integration into the learning settingwill bring further understanding about effective incorporation strategies. Developingdemonstration projects could further assist schools with faculty deliberation abouthow to incorporate the competencies into teaching and learning, as well as testing

competency-based curricula at their local level. At the institutional level, strong andclear administrative support for both CBE and cultural competence is critical for thesustained application of these recommendations.

Cultivate Research and Scholarship Agenda

Schools that opt to integrate the competencies into curricula may begin by mappingthe model against their existing course requirements to expose content gaps andINDICATE AREAS OF NEEDED REDRESS IN THE ACADEMIC PROGRAM )N SOME CASES ADDINGcontent, methods, and learning experiences will help to round out the educationalPROGRAM IN OTHER INSTANCES ADDING CONTENT WILL lLL GAPS CAUSED BY A LACK OF EVIDENCEbased research in a particular area.

Employ Case Studies

Case studies, particularly those drawn from real life, offer students excellentopportunities to translate learning into frontline culturally competent practice. Ameans for sharing existing case studies and a mechanism for creating new studiesfrom real-world experiences would greatly aid faculty in educating students tobecome culturally competent providers and practitioners better equipped to meet theneeds of their patients and populations.

Resources such as the Milestones in Public Health course (Association of Schools ofPublic Health, 2011) and MedEdPORTAL.org are rich sources for case study materials.The medicine and public health case study examples that follow were developedby panel members to serve as illustrations of integrating cultural competence as an

overlay to an educational resource.
http://www.asph.org/UserFiles/CompetencyReferenceGuide.pdfhttp://www.asph.org/UserFiles/CompetencyReferenceGuide.pdfhttp://www.asph.org/UserFiles/CompetencyReferenceGuide.pdfhttp://www.asph.org/UserFiles/CompetencyReferenceGuide.pdf


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Public Health

Quintero v. Encarnacion

Adapted from Material Prepared by Thomas A. LaVeist, Ph.D. and Cheri Wilson, M.A., M.H.S., C.P.H.Q.

Case Background for M.P.H. Student

)N 2ITA 1UINTERO A -EXICAN NATIVE WAS FOUND WANDERING THE STREETS OF A +ANSAS TOWN 3HE WAS DRESSED ODDLY SEEMED

not to have bathed recently, and was not able to communicate except for a few Spanish words. She was taken into protectivecustody, and doctors determined that she was mentally ill and in need of treatment. She was involuntarily committed andREMAINED HOSPITALIZED UNTIL $URING HER COMMITMENT SHE WAS TREATED AGAINST HER WILL WITH PSYCHOTROPIC DRUGS !LTHOUGH3PANISH INTERPRETERS OCCASIONALLY ATTEMPTED TO EXPLAIN THE TREATMENT PLAN TO HER 1UINTERO WAS UNABLE TO UNDERSTAND BECAUSE OF

her limited grasp of Spanish.

!FTER A TIME A PATIENT ADVOCACY GROUP TOOK INTEREST IN HER CASE THROUGH THEIR EFFORTS IT WAS LEARNED THAT SHE WAS INDEED ACITIZEN OF -EXICO BUT NOT A NATIVE 3PANISH SPEAKER )NSTEAD SHE WAS FOUND TO BE A MEMBER OF THE 4ARAHUMARA )NDIAN TRIBE OF

Mexico. Her appearance, dress, and behaviors, which had been described as odd and indicative of mental illness, were actuallytraditional aspects of her culture. She had only a limited grasp of Spanish because she was a native speaker of Ramuri, a triballanguage. After a Ramuri interpreter was located, she was released and allowed to return to Mexico. With the assistance of thePATIENT ADVOCACY GROUP SHE lLED A LEGAL ACTION AGAINST THE DOCTORS AND THE STATE OF +ANSAS

4HE DOCTORS ARGUED THAT THEY HAD FULlLLED THEIR OBLIGATION TO OBTAIN INFORMED CONSENT ALBEIT IN %NGLISH AND 3PANISH BEFOREtreating her. However, the 10th Circuit Court of Appeals held that if the patients capacity to understand is limited by alanguage barrier, and the physician proceeds without addressing this barrier the physician may be liable for failing to obtainINFORMED CONSENT FROM THE PATIENTv 3OURCE 1UINTERO V %NCARNACION ,EXIS TH #IR

Questions

(OW COULD THE COURT AND THE HEALTH CARE TEAM HAVE DETERMINED -S 1UINTEROS LANGUAGE NEEDS

4HINK BACK TO THE LAST TIME YOU WORKED WITH A POPULATION THAT HAD COMMUNICATION BARRIERS SUCH AS LIMITED %NGLISH PROlCIENCY

(LEP), deafness or hardness of hearing, or visual impairments, or worked with individuals with tracheostomies, low levels ofhealth literacy, etc.

a. Explain how you would overcome communication barriers with these populations.

B )F A PATIENT WAS TREATED AND RECEIVED MEDICAL OR SURGICAL PROCEDURES LAB OR RADIOLOGIC tests, medication, etc., how can you be certain that the patient understood andPROVIDED INFORMED CONSENT

3. How could the health care team have been more culturally competent to prevent this patient from being involuntarily

COMMITTED FOR YEARS

(OW COULD THE HEALTH CARE ORGANIZATION HAVE BEEN BETTER PREPARED TO ADDRESS DIVERSE PATIENT POPULATION NEEDS

2ATHER THAN MAKING ASSUMPTIONS ABOUT -S 1UINTEROS MENTAL STATUS WITH WHOM COULD THE HEALTH CARE TEAM HAVE CONSULTEDTO LEARN MORE ABOUT HER CUSTOMS BEHAVIORS AND HEALTH BELIEFS

ILLUSTRATIVE CASE STUDY EXAMPLE

Illustrative Case Study Examples


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Disseminate Existing and Developing Case Studies

Public Health Case Studies Resource Center

ASPH has developed a free, user-friendly Public Health Case Studies Resource Center (www.asph.org/casestudies/) whereboth public health academics and professionals can post and access case studies contributed by schools and programs ofPUBLIC HEALTH )T OFFERS A CASE STUDY ON CULTURAL COMPETENCY TITLED Providing Culturally Appropriate Services in a ChangingCommunity.

iCollaborative

The AAMC has launched iCollaborative (www.aamc.org/icollaborative A CENTRALIZED ONLINE RESOURCE SERVICE DESIGNEDto foster an online community for curriculum enhancement and faculty development exchange. Posted content in theiCollaborative is dynamically cross-indexed with relevant resources in the AAMCs journalAcademic Medicine andMedEdPORTAL.

Medicine

Teaching Case for Using Epidemiologic and Practice Data for Breast Cancer Screening

Prepared by Desiree Lie, M.D., M.S.Ed.Case Problem for Clerkship Student or Resident

You care for a multiethnic population with varying levels of risk for breast cancer. Data suggest that African American womenpresent with more aggressive cancers and at a later stage. The practice guidelines from the American Cancer Society, the!MERICAN #OLLEGE OF /BSTETRICS AND 'YNECOLOGY AND OTHER NATIONAL ORGANIZATIONS DO NOT OFFER GUIDANCE ON ETHNICITY OR RACE AS ARISK FACTOR (OW WOULD YOU MODIFY YOUR RISK ASSESSMENT STRATEGY TO OPTIMIZE SCREENING FOR YOUR OWN PRACTICE

Potential Solutions

One strategy for practice-level quality improvement is to examine local or regional data on breast cancer incidence and mortalityby race, geography, and other factors not accounted for by national practice guidelines (data are available from the U.S. Centersfor Disease Control and Prevention, or CDC). Another strategy is to maintain vigilance for new literature identifying disparities

in breast cancer outcomes, particularly studies identifying underlying factors accounting for the disparities. Such factors mightinclude variations in patient attitudes, biases, fears, or limited health literacy that lead to delayed use of preventive services,including surgery after diagnosis, and to low adherence to recommended treatments such as chemotherapy.

Application Exercise

,OCATE DATA ON BREAST CANCER OUTCOMES FOR YOUR PRACTICE AND COMMUNITY )DENTIFY WHAT YOU CONSIDER THE HIGHEST RISK FACTORS

for late diagnosis and treatment of breast cancer. Examine practice guidelines for breast cancer screening from a nationalORGANIZATION SUCH AS THE U.S. Preventive Services Task Force, or USPSTF). Consider improving your practice outcomes (detectionand treatment of breast cancer) using the following questions:

(OW MIGHT YOU MODIFY THE PRACTICE GUIDELINES FOR YOUR OWN PRACTICE

(OW MIGHT YOU COMMUNICATE A MESSAGE ABOUT THE IMPORTANCE OF SCREENING TO HIGHRISK PATIENTS WITHIN YOUR COMMUNITY

ILLUSTRATIVE CASE STUDY EXAMPLE
http://www.asph.org/casestudies/http://www.asph.org/casestudies/http://www.asph.org/casestudies/http://www.aamc.org/icollaborative/http://www.aamc.org/icollaborativehttp://www.aamc.org/icollaborativehttp://www.cdc.gov/http://www.cdc.gov/http://www.uspreventiveservicestaskforce.org/http://www.uspreventiveservicestaskforce.org/http://www.cdc.gov/http://www.cdc.gov/http://www.aamc.org/icollaborativehttp://www.aamc.org/icollaborativehttp://www.aamc.org/icollaborative/http://www.asph.org/casestudies/http://www.asph.org/casestudies/http://www.asph.org/casestudies/


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Create New Case Studies

Using the set of cultural competencies as a road map, transdisciplinary teams of medical and public health faculty can

work together to create new case studies that explicitly address curricular gaps, such as outlined in the sample below.

)N A TEAM MEETING AT THE END OF A BUSY DAY A COLLEAGUE WORKING IN A MEDICAL OR PUBLIC HEALTH CLINIC SERVING A LARGENUMBER OF PATIENTS FROM IMMIGRANT BACKGROUNDS EXPRESSES FRUSTRATION ABOUT PATIENTS WITH LIMITED %NGLISH PROlCIENCY(LEP) who require more time to evaluate, seem less engaged, and appear less willing or able to follow through with theRECOMMENDED INTERVENTIONS SAYING h)TS OBNOXIOUS THAT THEYRE IN !MERICA BUT DONT EVEN BOTHER TO LEARN %NGLISHv

Questions for the Learner:

s 7HAT ARE THE PROFESSIONAL AND EMOTIONAL CHALLENGES THAT PROVIDERS FACE WHEN WORKING ACROSS LANGUAGE ANDCULTURAL BARRIERS

s 7HAT ARE THE FACTORS THAT CONTRIBUTE TO YOUR COLLEAGUEgS PERSPECTIVE #ONSIDER CULTURAL FACTORS BIAS VALUESresource constraints, burnout, etc.).

s 7HAT ARE THE CHALLENGES THAT IMMIGRANT PATIENTS AND POPULATIONS FACE WHEN TRYING TO ACCESS QUALITY MEDICAL ANDPUBLIC HEALTH SERVICES

s (OW WOULD YOU ADDRESS YOUR COLLEAGUEgS COMMENT

s 7HAT CAN BE DONE TO HELP IMPROVE YOUR COLLEAGUEgS ABILITY TO WORK WITH PATIENTS WITH ,%0

s 7HAT COMMITMENTS CAN YOU MAKE TO ENABLE YOU AND YOUR COLLEAGUES TO GIVE QUALITY CARE TO CULTURALLY DIVERSEPATIENTS

Identify Strategies for Translating Curriculum to Practice Settings

$EMONSTRATED STRATEGIES THAT OPTIMIZE EXPERIENTIAL LEARNING AND LONGITUDINAL EXPOSUREserve to reinforce critical principles of patient-centered culturally appropriate healthcare. Medical and public health students have opportunities to experience cultureIN A MULTIDIMENSIONAL FASHIONTHROUGH THEIR OWN CULTURE THROUGH THE CULTURE OFMEDICINE AND THE CULTURES OF OTHER PROFESSIONALS WITH WHOM PROVIDERS INTERACT ANDthrough patients perspectives of the socio-cultural experience of the health system.These experiences occur in a variety of settings, such as in small groups, in problem-based learning teams, in ambulatory settings, and in interprofessional team-basedlongitudinal clinics. Such opportunities better equip emerging health professionals toexamine the social and behavioral factors that influence health.

Service learning, practica, internships, capstone experiences, and other learning

OPPORTUNITIES FAMILIARIZE STUDENTS IN PUBLIC HEALTH AND MEDICINE EARLY ON WITH THESOCIOCULTURAL CONTEXT OF HEALTH AND FACTORS INmUENCING HEALTH DISPARITIES )N THESEsettings, students not only gain a better appreciation of community needs and assets,but also build relationships with the stakeholders they serve. Cultural competenciesmastered through such experiences help to infuse theory with practice and,consequently, enrich student learning with real-world, population- and systems-levelencounters.


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The Expert Panel on Cultural Competence Education for Studentsin Medicine and Public Health convened on the notion thatcultural competence education serves as an effective crossoverTOPIC AREA FOR THE MUTUAL BENElT OF STUDENTS IN BOTH DISCIPLINESMeaningful integration of cultural competence curricula will beTHE REAL BAROMETER OF THE PANELS SUCCESS )T IS THE INTENTION OFthe joint panel that the competencies set forth in this reportfunction as touchstones for faculty and administrative effortsTO STANDARDIZE CURRICULA BENCHMARK STUDENT PERFORMANCE ANDbetter prepare graduates for culturally competent practice.Anticipating that individual programs have unique areas of focus,the panel encourages faculty and administrators in such programsto adapt this competency model to their particular mission,

educational goals, and instructional objectives. The panel offersits recommendations to embed cultural competence educationwithin and across medicine and public health curricula, highlightsof exemplary case studies, and the road map for the future toassist schools of medicine and public health in preparing a cadreof culturally competent practitioners for the health workforce.Ultimately, culturally competent team-based practice must involveprofessionals, as well as those they serve, to improve health andwell-being and to reduce health disparities.

Conclusion


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!00%.$)8 ! -APPING TO

ACGME Core Competence DomainsPrepared by Robert Englander, M.D., MPHSenior Director, Competency-Based Learning and Assessment, AAMC

With the paradigm shift in medical education focusing on competency-based outcomes (Carraccio, C., et al, 2002) thepredominant framework within the U.S. is the Accreditation Council for Graduate Medical Education (ACGME) core domainsof competence (ACGME, 2011), widely used by undergraduate medical education (UME) programs, required of graduatemedical education (GME) residency programs, and adopted by the American Board of Medical Specialties for its maintenanceof licensure program.

The medicine and public health cultural competencies have been mapped below to the ACGMEs six domains of competence.

Medical Knowledges )DENTIFY CULTURAL FACTORS THAT CONTRIBUTE TO OVERALL HEALTH AND WELLNESS

s $ESCRIBE THE INmUENCE OF CULTURE FAMILIAL HISTORY RESILIENCY AND GENETICS ON HEALTH OUTCOMES

s $ESCRIBE THE VALUES AND LIMITATIONS OF EVIDENCEBASED LITERATURE ON UNDERSTANDING THE HEALTH OF INDIVIDUALS ANDcommunities.

Patient Care

s )NCORPORATE CULTURE AS A KEY COMPONENT OF PATIENT FAMILY AND COMMUNITY HISTORY

s )NTEGRATE A PATIENTSFAMILYSCOMMUNITYS CULTURAL PERSPECTIVES IN DEVELOPING TREATMENTINTERVENTIONS

s $EMONSTRATE SHARED DECISION MAKING

s #ONTRIBUTE EXPERTISE TO CULTURALLY COMPETENT INTERVENTIONS

Interpersonal and Communication Skills

s $ESCRIBE THE ELEMENTS OF EFFECTIVE COMMUNICATION WITH PATIENTS FAMILIES COMMUNITIES PEERS AND COLLEAGUES

s $ESCRIBE STRATEGIES TO COMMUNICATE WITH LIMITED %NGLISH PROlCIENT PATIENTS AND COMMUNITIES SUCH AS WORKING WITH TRAINEDmedical interpreters or translated materials.

s !PPLY COMMUNITY CONSTITUENTPATIENTCENTERED PRINCIPLES TO EARN TRUST AND CREDIBILITY

s #OMMUNICATE IN A CULTURALLY COMPETENT MANNER WITH PATIENTS FAMILIES AND COMMUNITIES

s #OMMUNICATE WITH COLLEAGUES PATIENTS FAMILIES AND COMMUNITIES ABOUT HEALTH DISPARITIES AND HEALTH CARE DISPARITIES

s $EMONSTRATE WILLINGNESS TO COLLABORATE TO OVERCOME LINGUISTIC AND LITERACY CHALLENGES IN THE CLINICAL AND COMMUNITYencounter.

s $EMONSTRATE WILLINGNESS TO APPLY THE PRINCIPLES OF CULTURAL COMPETENCE


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Professionalism

s !RTICULATE CULTURAL HUMILITY CULTURAL DIVERSITY AND CULTURAL COMPETENCE AND THEIR ROLES IN ONGOING PROFESSIONAL DEVELOPMENT

s !PPRECIATE HOW CULTURAL COMPETENCE CONTRIBUTES TO THE PRACTICE OF MEDICINE AND PUBLIC HEALTH

s $EMONSTRATE WILLINGNESS TO EXPLORE CULTURAL ELEMENTS AND ASPECTS THAT INmUENCE DECISION MAKING BY PATIENTS SELF ANDcolleagues.

s !PPRECIATE THE INmUENCE OF INSTITUTIONAL CULTURE ON LEARNING CONTENT STYLE AND OPPORTUNITIES OF PROFESSIONAL TRAININGprograms.

Practice-Based Learning and Improvement

s !RTICULATE CULTURAL HUMILITY AND ITS ROLE IN REmECTION AND SELFASSESSMENT

s !SSESS THE IMPACT OF ACCULTURATION ASSIMILATION AND IMMIGRATION ON HEALTH CARE AND WELLNESS

s )DENTIFY ONES OWN ASSETS AND LEARNING NEEDS RELATED TO CULTURAL COMPETENCE

s %MPLOY SELFREmECTION TO EVALUATE THE IMPACT OF ONES PRACTICE

s !PPRECIATE THAT BECOMING CULTURALLY COMPETENT INVOLVES LIFELONG LEARNING

s $EMONSTRATE WILLINGNESS TO ASSESS THE IMPACT OF ONES OWN CULTURE ASSUMPTIONS STEREOTYPES AND BIASES ON THE ABILITY TOprovide culturally competent care and service.

SystemsBased Practice

s $IFFERENTIATE HEALTH HEALTH CARE HEALTH CARE SYSTEMS AND HEALTH DISPARITIES

s %XAMINE FACTORS THAT CONTRIBUTE TO HEALTH DISPARITIES PARTICULARLY SOCIAL ECONOMIC ENVIRONMENTAL HEALTH SYSTEMS ANDaccess to quality health care.

s $ESCRIBE THE ROLE OF COMMUNITY ENGAGEMENT IN HEALTH CARE AND WELLNESS

s )DENTIFY HEALTH DISPARITIES THAT EXIST AT THE LOCAL STATE REGIONAL NATIONAL AND GLOBAL LEVELS

s !RTICULATE THE ROLES AND FUNCTIONS OF LOCAL HEALTH DEPARTMENTS COMMUNITY PARTNERS AND ORGANIZATIONS TO INCLUDEcapabilities and limitations.

s #ONDUCT CULTURALLY APPROPRIATE RISK AND ASSET ASSESSMENT MANAGEMENT AND COMMUNICATION WITH PATIENTS AND POPULATIONS

s 7ORK IN A TRANSDISCIPLINARY SETTINGTEAM

s !NALYZE ILLNESS CONDITIONS AND HEALTH OUTCOMES OF CONCERN AT THE PATIENT AND COMMUNITY LEVELS

s %NGAGE COMMUNITY PARTNERS IN ACTIONS THAT PROMOTE A HEALTHY ENVIRONMENT AND HEALTHY BEHAVIORS

s %STABLISH EQUITABLE PARTNERSHIPS WITH LOCAL HEALTH DEPARTMENTS FAITH AND COMMUNITYBASED ORGANIZATIONS AND LEADERS TOdevelop culturally appropriate outreach and interventions.

s 2ECOGNIZE THAT CULTURAL COMPETENCE ALONE DOES NOT ADDRESS HEALTH CARE DISPARITIES


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!00%.$)8 "

Entrustable Professional ActivityThe entrustable professional activity (EPA) descriptions that follow represent examples of linking the cultural competenciesOUTLINED IN THE KNOWLEDGE SKILLS AND ATTITUDES DOMAINS IN THIS REPORT TO THE SIX COMPETENCY DOMAINS IDENTIlED BY THEAccreditation Council for Graduate Medical Education. These examples are intended to demonstrate, in an integrated fashion,how selected competencies in this report satisfy EPAs, to provide culturally competent care to families and community. (ten#ATE TEN #ATE AND 3CHEELE

Prepared by Robert Englander, M.D., M.P.H., Senior Director Competency-Based Learning and Assessment,Medical Education, AAMC

Entrustable Professional Activity

Provide care that is culturally competent to individual patients and families by:s $EMONSTRATING THE NECESSARY KNOWLEDGE REQUISITE TO CULTURALLY COMPETENT CARE EG IDENTIFYING CULTURAL FACTORS THAT

CONTRIBUTE TO OVERALL HEALTH AND WELLNESS DESCRIBING THE ROLE OF COMMUNITY ENGAGEMENT IN HEALTH CARE AND WELLNESSDESCRIBING THE INmUENCE OF CULTURE FAMILIAL HISTORY RESILIENCY AND GENETICS ON HEALTH OUTCOMES DESCRIBING FACTORS THATcontribute to health disparities, particularly social, economic, environmental, health systems, and access to quality healthcare).

s )NCORPORATING CULTURE AS A KEY COMPONENT OF PATIENT AND FAMILY HISTORY EG COMMUNICATING IN A CULTURALLY COMPETENTMANNER WITH PATIENTS AND FAMILIES CONDUCTING CULTURALLY APPROPRIATE RISK AND ASSET ASSESSMENT MANAGEMENT ANDCOMMUNICATION WITH PATIENTS ANALYZING ILLNESS CONDITIONS AND HEALTH OUTCOMES OF CONCERN TO THE PATIENT DEMONSTRATINGSTRATEGIES TO COMMUNICATE WITH LIMITED %NGLISH PROlCIENT PATIENTS SUCH AS WORKING WITH TRAINED MEDICAL INTERPRETERS ORTRANSLATED MATERIALS DEMONSTRATING WILLINGNESS TO COLLABORATE TO OVERCOME LINGUISTIC AND LITERACY CHALLENGES IN THE CLINICAL

ENCOUNTER AND PRACTICING CULTURAL HUMILITY TO UNDERSTAND HOW ONES OWN BACKGROUND AFFECTS THE RELATIONSHIP WITH THEpatient and family).

s )NCORPORATING CULTURE AS A KEY COMPONENT OF THE EVALUATION AND TREATMENT PLAN EG INTEGRATING A PATIENTSFAMILYSCOMMUNITYS CULTURAL PERSPECTIVES IN DEVELOPING TREATMENTINTERVENTIONS DEMONSTRATING SHARED DECISION MAKINGcommunicating about health disparities and health care disparities and applying patient-centered principles to earn trustAND CREDIBILITY $EMONSTRATING WILLINGNESS TO EXPLORE CULTURAL ELEMENTS AND ASPECTS THAT INmUENCE DECISION MAKING BYpatients, self, and colleagues).


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Prepared by Maureen Y. Lichtveld, M.D., M.P.H. (Special Advisor),Professor and Chair, Freeport McMoRan Chair of Environmental Policy,Department of Global Environmental Health Sciences, Tulane UniversitySchool of Public Health and Tropical Medicine

Entrustable Professional Activity

Address community-based health disparities in a culturallycompetent manner by:

s $EMONSTRATING THE NECESSARY KNOWLEDGE REQUISITE TO CULTURALLY COMPETENT PUBLIC HEALTH ACTIONS EG IDENTIFYING CULTURALFACTORS THAT CONTRIBUTE TO OVERALL HEALTH AND WELLNESS DESCRIBING THE ROLE OF COMMUNITY ENGAGEMENT IN HEALTH CARE ANDWELLNESS DESCRIBING THE INmUENCE OF CULTURE FAMILIAL HISTORY RESILIENCY AND GENETICS ON HEALTH OUTCOMES DESCRIBING FACTORSthat contribute to health disparities, particularly social, economic, environmental, health systems, and access to qualityhealth care).

s )NCORPORATING CULTURE AS A KEY COMPONENT OF POPULATION AND COMMUNITY HEALTH EG ASSESSING THE IMPACT OF ACCULTURATIONASSIMILATION AND IMMIGRATION ON HEALTH CARE AND WELLNESS CONDUCTING CULTURALLY APPROPRIATE RISK AND ASSET ASSESSMENTMANAGEMENT AND COMMUNICATION USING A SYSTEMSDRIVEN APPROACH AND ANALYZING ILLNESS CONDITIONS AND HEALTH OUTCOMESof concern at the community level).

s )NCORPORATING CULTURE AS A KEY COMPONENT OF ADDRESSING HEALTH DISPARITIES EG WORKING IN A TRANSDISCIPLINARY SETTINGTEAM TO IDENTIFY HEALTH DISPARITIES AT THE LOCAL STATE REGIONAL NATIONAL AND GLOBAL LEVELS ENGAGING COMMUNITY PARTNERS INactions that promote a healthy environment and healthy behaviors by establishing equitable and sustainable partnershipsWITH LOCAL HEALTH DEPARTMENTS FAITH AND COMMUNITYBASED ORGANIZATIONS AND LEADERS TO DEVELOP CULTURALLY APPROPRIATEOUTREACH AND INTERVENTIONS WHICH MAXIMIZE COMMUNITY ASSETS


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!00%.$)8 # 3ELECTED MedEdPORTAL Abstracts

1. Stereotypes and Bias at the Psychiatric MedEdPORTALPEERREVIEWED

Bedside Cultural Competence in the ThirdYear Required Clerkships

Resource typeCURRICULUM

DescriptionDIDACTIC AND STUDENT REmECTION AND FEEDBACK LEARNING EXPERIENCE

Cultural competence education begins with a focus on building cultural self-awareness and acquiring cultural knowledgeAS THE lRST STAGES IN A DEVELOPMENTAL PROCESS THAT LEADS TO CULTURAL COMPETENCE 4HE EXPLANATORY MODEL OF ILLNESS AND THEphilosophy of patient-centered care should guide this progression. Cultivating effective cross-cultural communication skillsrequires an understanding of culture that includes both the physicians and the patients perspectives. Building on a foundationof cultural awareness, knowledge, and skills that students have acquired during Years 1 and 2, this clinical curriculum provides

AN OPPORTUNITY FOR STUDENTS TO CONTINUE TO RElNE THEIR CULTURAL COMPETENCY CLINICAL SKILLS AS THEY PRACTICE THEIR MEDICALinterpretation skills at the bedside.

Citation: %LLIOTT $ 3T 'EORGE # 3IGNORELLI $ 4RIAL * 3TEREOTYPES AND BIAS AT THE PSYCHIATRIC BEDSIDECULTURALcompetence in the third year required clerkships. MedEdPORTAL. Available at: www.mededportal.org/publication/1150

2. Narrative Reflection in Family Medicine MedEdPORTALPEERREVIEWED

Clerkship Cultural Competence in theThird Year Required Clerkships

Resource typeCURRICULUM

DescriptionNARRATIVE REmECTION EXERCISE AND JOINT CAPSTONE PROJECT

This resource incorporates cultivating effective cross-cultural communication skills, which requires an understanding of culturethat includes both the physicians and the patients perspectives. Building on a foundation of cultural awareness, knowledge,and skills that students have acquired during the pre-clinical curriculum, this exercise provides an opportunity for students toCONTINUE TO RElNE THEIR NARRATIVE REmECTION SKILLS AS THEY INTERACT WITH PATIENTS IN THE CLINICAL SETTING $URING THE FAMILY MEDICINEclerkship, students participate in learning activities that allow them to explore the rich opportunities of thoughtful reflectionand narrative practice. During the clerkship orientation, students participate in a formative narrative reflection exercise. Duringeach of the subsequent weeks of the rotation, students complete an electronic journal entry that is focused on the patient-physician interaction based on their clinical encounters. During the last week of the clerkship, students demonstrate theirABILITY TO REmECT ON PATIENT CARE THROUGH A lNAL PROJECT THAT IS SHARED WITH FACULTY AND FELLOW CLASSMATES IN A FACULTYLED WRAPup discussion.

Citation: %LLIOTT $ 3CHAFF 0 7OEHRLE 4 7ALSH ! 4RIAL * .ARRATIVE REmECTION IN FAMILY MEDICINE CLERKSHIP

cultural competence in the third year required clerkships. MedEdPORTAL. Available at: www.mededportal.org/publication/1153
http://www.mededportal.org/publication/1150http://www.mededportal.org/publication/1150http://www.mededportal.org/publication/1150http://www.mededportal.org/publication/1150http://www.mededportal.org/publication/1150http://www.mededportal.org/publication/1150http://www.mededportal.org/publication/1150http://www.mededportal.org/publication/1150https://www.mededportal.org/publication/1150http://www.mededportal.org/publication/1153http://www.mededportal.org/publication/1153http://www.mededportal.org/publication/1153http://www.mededportal.org/publication/1153http://www.mededportal.org/publication/1153http://www.mededportal.org/publication/1153http://www.mededportal.org/publication/1153http://www.mededportal.org/publication/1153https://www.mededportal.org/publication/1153https://www.mededportal.org/publication/1153http://www.mededportal.org/publication/1153http://www.mededportal.org/publication/1153http://www.mededportal.org/publication/1153https://www.mededportal.org/publication/1150http://www.mededportal.org/publication/1150http://www.mededportal.org/publication/1150http://www.mededportal.org/publication/1150


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3. Interpreter Cases for Cultural Competency MedEdPORTALPEERREVIEWED

Instruction

Resource typeCASEDescriptionINSTRUCTIONAL CASES SERIES

4HIS COLLECTION OF lVE CASES IS BASED ON REAL CLINICAL SCENARIOS THAT REmECT THE CHALLENGES OF CLINICAL ENCOUNTERS USINGINTERPRETERS 4HE CASES ARE OF DIFFERENT LEVELS OF DIFlCULTY AND CAN BE ADMINISTERED TO MEDICAL STUDENTS AND RESIDENTS AS PRACTICE(teaching) cases. They use interactions that involve both history-taking and counseling. One case (smoking cessation) includesbehavior and self-reflection checklists that allow summative assessment of student skills in the use of interpreters.

Content includes:

1. Generic communication checklists

#HECKLISTS SPECIlC TO THE CLINICAL SITUATION AND TASK EG HISTORYTAKING

3TANDARDIZED PATIENT CHECKLISTS FOR STUDENT PERFORMANCE

)NTERPRETER CHECKLIST FOR STUDENT PERFORMANCE

5. Student self-assessment/reflection checklist

The checklists may be used as a way to improve performance and to trigger discussion about the challenges of encountersinvolving interpreters.

Citation: ,IE $ )NTERPRETER CASES FOR CULTURAL COMPETENCY INSTRUCTION -ED%D0/24!, Available at: www.mededportal.org/publication/205

4. Interpretation at the OB/GYN Bedside MedEdPORTALPEERREVIEWED

Cultural Competence in the Third YearClerkships

Resource typeCASE PRESENTATION EVALUATION TOOL

Description#ULTIVATING EFFECTIVE CROSSCULTURAL COMMUNICATION SKILLS REQUIRES AN UNDERSTANDING OF CULTURE THAT INCLUDESboth the physicians and the patients perspectives. Building on a foundation of cultural awareness, knowledge, and skills thatstudents have acquired during the pre-clinical curriculum, this exercise provides an opportunity for students to continue toRElNE THEIR CLINICAL SKILLS AS THEY PRACTICE MEDICAL INTERPRETATION AT THE BEDSIDE 4HIS CLINICAL EXPERIENCE IN MEDICAL INTERPRETATIONis designed for implementation during the third year required OB/GYN clerkship. After a brief didactic review on the use ofMEDICAL INTERPRETERS STUDENTS ARE ASSIGNED TO CARE FOR A WOMAN WITH LIMITED %NGLISH PROlCIENCY ,%0 THROUGH THE COURSEof her labor. Following the clinical encounter, students are assigned to write a reflection (from two points of view) to assistthem with reflecting on their skills in providing care to LEP patients. Faculty-led small-group discussions use these essays todiscuss the students clinical encounters. Finally, evaluation of student mastery of interpretation skills is made by an objectiveSTRUCTURED CLINICAL EXAM /3#% DURING THE lNAL WEEK OF THE CLERKSHIP

Citation: 4RIAL * %LLIOTT $ ,AUZON 6 ,IE $ #HVIRA % )NTERPRETATION AT THE /"'9. BEDSIDECULTURALcompetence in the third year clerkships. MedEdPORTAL. Available at: www.mededportal.org/publication/1148
http://www.mededportal.org/publication/205http://www.mededportal.org/publication/205http://www.mededportal.org/publication/205http://www.mededportal.org/publication/205http://www.mededportal.org/publication/205http://www.mededportal.org/publication/205http://www.mededportal.org/publication/205https://www.mededportal.org/publication/205http://www.mededportal.org/publication/1148http://www.mededportal.org/publication/1148http://www.mededportal.org/publication/1148http://www.mededportal.org/publication/1148http://www.mededportal.org/publication/1148http://www.mededportal.org/publication/1148http://www.mededportal.org/publication/1148http://www.mededportal.org/publication/1148https://www.mededportal.org/publication/1148https://www.mededportal.org/publication/1148http://www.mededportal.org/publication/1148http://www.mededportal.org/publication/1148http://www.mededportal.org/publication/1148https://www.mededportal.org/publication/205http://www.mededportal.org/publication/205http://www.mededportal.org/publication/205


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5. Tobacco Ties MedEdPORTALPEERREVIEWED

Resource typeVIDEO

Descriptionh4OBACCO 4IESv IS A NINEMINUTE VIDEO OF A PATIENTCENTERED TOBACCO CESSATION INTERVIEW

The Tobacco Ties video and facilitator guide are designed to be used formatively to instruct clinicians and health professionslearners about how to use culturally sensitive, patient-centered communication skills effectively to counsel patients to stopusing tobacco.

.OTE 4HIS RESOURCE CONSISTS OF SEPARATE PIECES OF CONTENT 9OU MAY NEED TO VISIT THE 7EB SITE DOWNLOAD RESOURCE lLES ANDrequest additional information from MedEdPORTAL staff to access the full publication.

Citation: -ARION ' #RANDALL 3 (ILDEBRANDT # 7ALKER + 'AMBERINI " 3PANGLER * 4OBACCO TIESMedEdPORTAL. Available at: www.mededportal.org/publication/3138

6. Esther Hines: Culturally CompetentMedEdPORTALPEERREVIEWED

Collaboration to Manage Diabetes

Resource typeVIDEO

Descriptionh%STHER (INESv IS AN MINUTE VIDEO WITH FACILITATOR GUIDE DESIGNED TO BE USED FORMATIVELY TO INSTRUCT PROVIDERSand health professions learners how to apply culturally responsive, patient-centered communication skills effectively to counselpatients on blood sugar control and weight loss.

4HIS RESOURCE CONSISTS OF SEPARATE PIECES OF CONTENT 9OU MAY NEED TO VISIT THE 7EB SITE DOWNLOAD RESOURCE lLES AND REQUESTadditional information from MedEdPORTAL staff to access the full publication.

Citation: -ARION ' (ILDEBRANDT # #RANDALL 3 +IRK * %STHER (INES #ULTURALLY COMPETENT COLLABORATION TOmanage diabetes. MedEdPORTAL. Available at: www.mededportal.org/publication/8368
http://www.mededportal.org/publication/3138https://www.mededportal.org/publication/3138http://www.mededportal.org/publication/8368http://www.mededportal.org/publication/8368http://www.mededportal.org/publication/8368http://www.mededportal.org/publication/8368http://www.mededportal.org/publication/8368http://www.mededportal.org/publication/8368http://www.mededportal.org/publication/8368https://www.mededportal.org/publication/8368https://www.mededportal.org/publication/8368http://www.mededportal.org/publication/8368http://www.mededportal.org/publication/8368https://www.mededportal.org/publication/3138http://www.mededportal.org/publication/3138


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Accreditation Coucil for Graduate Medical Education. (2011). Common Program

Requirements. Retrieved from ACGME: www.acgme.org/acWebsite/dutyHours /dg_dutyhoursCommonPR07012007.pdf

Acosta, D. (2010). Core guiding principles for cultural competence for medicaleducation, version 2.0. Seattle: University of Washington School of Medicine.

Association of American Medical Colleges. (2006). Tool for assessing culturalcompetence training. Retrieved from AAMC: www.aamc.org/initiatives/tacct /

Association of American Medical Colleges. (2011). Core Behavioral and Social ScienceFoundations for Future Physicians: Report of an expert panel. Washington, D.C.:AAMC.

Association of American Medical Colleges. . (2003). Training future physicians about

weapons of mass destruction: Report of the expert panel on bioterrorism educationfor medical students. Washington, D.C.: AAMC.

Association of Schools of Public Health. (2006). Masters degree in public health corecompetency model, version 2.3. Retrieved from ASPH: www.asph.org/publication/MPH_Core_Competency_Model/index.html

Association of Schools of Public Health. (2011).An instructors guide to case-studyinstruction in the Milestones in Public Health course. Washington, D.C.: ASPH.

Association of Schools of Public Health. (2011). Learning taxonomy levels fordeveloping competencies and learning outcomes reference guide (ReferenceGuide). Washington, D.C.: ASPH.

Association of Schools of Public Health/W. K. Kellogg Task Force . (2008). Schoolsof public health goals towards eliminating racial and ethnic health disparities.Washington, D.C: ASPH.

#ALHOUN * ' 7ROBEL # ! &INNEGAN * 2 #URRENT STATE IN 53 PUBLIChealth competency-based graduate education. Public Health Reviews, 33(1), pp.n

Carraccio, C. e. (2002). Shifting paradigms: From Flexner to competencies. AcademicMedicine, 77(5), pp. 361-367.

#ROSSON * # 7EILING $ "RAZEAU # "OYD , 3OTO'REENE - %VALUATINGthe effect of cultural competency training on medical student attitudes. Family

Medicine, 36 PP n

&RASER # "RACH ) #AN CULTURAL COMPETENCY REDUCE RACIAL AND ETHNIC HEALTHDISPARITIES ! REVIEW AND CONCEPTUAL MODEL Medical Care Research and Review,57 PP n

&RENK * #HEN , "HUTTA : ! #OHEN * #RISP . %VANS 4 :URAYK ( Health professionals for a new century: Transforming education to strengthenhealth systems in an interdependent world. The Lancet, 376 PP n

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'EBBIE + 2OSENSTOCK , (ERNANDEZ , - %DS Who will keepthe public healthy? Educating public health professionals for the 21st century.Washington, D.C.: National Academies Press.

Gemmell, M. K. (2003). History of the association of schools of public health.Washington, D.C.: Association of Schools of Public Health.

'OODE 4 $ $UNNE - # "RONHEIM 3 - The evidence base for culturaland linguistic competency in health care. New York: The Commonwealth Fund.

)0%# !MERICAN !SSOCIATION OF #OLLEGES OF .URSING !MERICAN !SSOCIATION OF #OLLEGESof Osteopathic Medicine, American Association of Colleges of Pharmacy, AmericanDental Education Association, Association of American Medical Colleges. (2011).Core Competencies for Interprofessional Collaborative Practice. Washington, D.C.:)NTERPROFESSIONAL %DUCATION #OLLABORATIVE

*2 "ETANCOURT ! '& $ElNING CULTURAL COMPETENCE ! PRACTICAL FRAMEWORKfor addressing racial/ethnic disparities in health and health care. Public Health

Reports, 118(4), pp. 293-302.

Krathwohl, D. R. (2002). A revision of Blooms taxonomy: An overview. Theory intoPractice, 41 PP n

Lichtveld, M. Y. (2010). Cultural competence education for students in medicine andpublic health. Poster abstract: Patients and Populations: Public Health in MedicalEducation Conference . Cleveland, OH: Association of American Medical Collegesand the Centers for Disease Control.

,IE $ "OKER * #RANDALL 3 $E'ANNES # %LLIOTT $ (ENDERSON 0 3ENG ,(2009).A Revised Curriculum Tool for Assessing Cultural Competency Training(TACCT) in Health Professions Education. Retrieved from MedEdPORTAL: www.

mededportal.org/publication/3185-AESHIRO 2 *OHNSON ) +OO $ 0ARBOOSINGH * #ARNEY * + 'ESUNDHEIT .

Cohen, L. (2010). Medical education for a healthier population: Reflections on theFlexner report from a public health perspective.Academic Medicine, 85(2), pp.n

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Nivet, M. A. (2011). Commentary: Diversity 3.0: A necessary systems upgrade .Academic Medicine, 86 PP n

1UINTERO V %NCARNACION .O 5.)4%$ 34!4%3 #/524 /& !00%!,3 THCircut November 29, 2000).

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Linda A. Alexander, Ed.D. (Co-chair), Associate Dean for Academic and Student Affairs (2005-2010). Currently Associate

Professor of Health Behavior, Department of Health Behavior, University of Kentucky College of Public Health.

Donna D. Elliott, M.D., Ed.D. (Co-chair), Professor, Pediatrics, Associate Dean, Student Affairs, Keck School of Medicine,University of Southern California.

Sylvia Bereknyei, Dr.P.H. candidate, 2ESEARCH !SSISTANT 'ENERAL )NTERNAL -EDICINE 0ROGRAM -ANAGER #OORDINATING #ENTERat Stanford, Stanford University School of Medicine.

Joe Dan Coulter, Ph.D., 0ROFESSOR $EPARTMENT OF #OMMUNITY AND "EHAVIORAL (EALTH #OLLEGE OF 0UBLIC (EALTH $EPARTMENTOF !NATOMY AND #ELL "IOLOGY #ARVER #OLLEGE OF -EDICINE 4HE 5NIVERSITY OF )OWA

Thomas A. LaVeist, Ph.D., Professor, Health Policy, Director, Hopkins Center for Health Disparities Solutions, Johns HopkinsBloomberg School of Public Health.

Maureen Y. Lichtveld, M.D., M.P.H. (Special Advisor), Professor and Chair, Freeport McMoRan Chair of EnvironmentalPolicy, Department of Global Environmental Health Sciences, Tulane University School of Public Health and Tropical Medicine.

Desiree A. Lie, M.D., M.S.Ed., #LINICAL 0ROFESSOR $EPARTMENT OF &AMILY -EDICINE 5NIVERSITY OF #ALIFORNIA )RVINE

Tricia Penniecook, M.D., M.P.H., Dean, Loma Linda University School of Public Health.

Jessie Satia, Ph.D., M.P.H., !SSOCIATE 0ROFESSOR $EPARTMENTS OF .UTRITION %PIDEMIOLOGY 3PECIAL !SSISTANT TO THE $EAN FORDiversity, UNC Gillings School of Global Public Health. (Deceased).

Hendry Ton, M.D., M.S., Assistant Clinical Professor, Psychiatry, Director of Education, Center for Reducing Health DisparitiesUniversity of California, Davis.

Janet L. Trial, Ed.D., C.N.M., M.S.N., #LINICAL )NSTRUCTOR $IRECTOR 0ROFESSIONALISM IN THE 0RACTICE OF -EDICINE +ECK 3CHOOL OF

Medicine, University of Southern California.

Observers

Ignatius Bau, J.D., Director, Health Systems, The California Endowment.

Roy Weiner, M.D., !SSOCIATE $EAN #LINICAL 2ESEARCH %DUCATION 4ULANE 5NIVERSITY (EALTH 3CIENCES

Ann Steinecke, Ph.D., Senior Program Specialist, Diversity Policy and Programs, Association of American Medical Colleges.

AAMC/ASPH Staff

Alexis L. Ruffin, M.S., $IRECTOR #URRICULUM )NNOVATION )NITIATIVES !SSOCIATION OF !MERICAN -EDICAL #OLLEGES

Elizabeth M. Weist, M.A., M.P.H., C.P.H., Director, Special Projects, Association of Schools of Public Health.

Expert Panel1

1 Titles and affiliations at empanelment

aamc asph cultural competence education

Documents