cross-cultural medical education at stanford university clarence h. braddock iii, md, mph ronald d....
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Cross-cultural Medical Education at Stanford University
Clarence H. Braddock III, MD, MPH
Ronald D. Garcia, PhD
NIH(NHLBI) Sponsorship PI: CH Braddock III, MD, MPH RFA Goal: “To enhance the ability of
physicians and other health professionals to address disparities in cardiovascular, pulmonary, hematologic, and sleep disorders in a culturally sensitive manner.”
Five-year grant (2004-2009)
AAMC Sponsorship
PI: Ronald D. Garcia, PhD GOAL: Develop an integrated model
curriculum throughout the preclinical and clinical curriculum.
Challenges Access to time in the required
curriculum Teaching resources Development of cases Evaluation
Leveraging opportunities Complimentary backgrounds
Physician; bioethics, patient-physician communication
Psychologist; leader in cross-cultural medical education, diversity
Complimentary projects NHLBI - focus on preclinical students,
residents, faculty development AAMC - focus on clinical students
Leveraging opportunities Combining resources
Staff support Needs assessment Teaching activities
Critical mass “Cross-cultural Medical Education
Initiative”
Teaching Methods Interactive and experiential Role plays Workshop formats Patient simulations Web-based resources
Outcomes Teaching modules
Interpreters Communication models Patient simulations
Teaching methods
Simulations
Reflective experiences
NHLBI Cultural Competence and Health Disparities Education Collaborative
Who we are - What we’re doing
Clarence H. Braddock III, MD, MPH
Stanford University
NHLBI Health Disparities Program
Goal: “To enhance the ability of physicians and other health professionals to address disparities in cardiovascular, pulmonary, hematologic, and sleep disorders in a culturally sensitive manner.”
Funding: Five-year academic awards to support faculty time for curriculum development
Deliverables Curriculum development &
implementation Medical students Residents Practicing physicians
Evaluation Dissemination to all U.S. medical
schools
NHLBI Cultural Competence and Health Disparities Education Collaborative
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Mission Statement Our Collaborative seeks to develop curricula that
enhance the ability of physicians and other health care professionals to address disparities in the U.S. in a culturally sensitive manner.
Our ultimate goal is to develop, evaluate, and disseminate a comprehensive cultural competence curriculum to medical schools throughout the U.S., thereby providing support and leadership to medical educators nationwide.
Strategies Foster inter-institutional collaboration
Annual collaboration & planning meeting Monthly conference calls Collaborative projects
Forge alliances with other organizations AAMC OMH Professional societies: STFM, SGIM, AMA
Current collaborative projects Curriculum needs assessment:
AAMC’s Tool for Assessing Cultural Competence Training (TACCT)
Dissemination: Web Portal Faculty development: Stanford Faculty
Development Center
Curriculum Dissemination
Web Portal Project
Web Portal: GoalsTo provide: Resources for curriculum needs assessment and
development Platform to disseminate curricular materials Forum for medical educators to share curricular
materials Links to other supporting materials for cultural
competence education.
Faculty Development
Stanford Faculty Development Center
(SFDC)
Stanford Faculty Development Center
Stanford Faculty Development Center
Clinical Teaching Program -1986
Professionalism in Contemporary Practice
Program - 2003
Seminar Facilitators
Seminar Participants(Faculty & Residents)
Learners Institution
DisseminationDissemination Model ModelNationally & internationally since 1986
Previous ProgramsPrevious Programs::
• • Preventive MedicinePreventive Medicine• • Medical Decision MakingMedical Decision Making• • End-of-Life CareEnd-of-Life Care• • Geriatrics in Primary CareGeriatrics in Primary Care
SFDC: Professionalism in Contemporary Practice One-month fellowship to enhance faculty teaching:
Reflective practice, Patient-centered care, EBM, QI, patient safety
Developed pilot module on cultural competence Review data on health disparities; definitions of race,
culture,cultural competence Build skills in cross-cultural communication Gain insight into personal biases Develop effective strategies to teach cultural competence
Shared Decision Making
Shared Decision Making
Evidence-Based
Practice
Evidence-Based
Practice
Working in TeamsWorking in Teams
Quality Improvement
Quality ImprovementPatient
Safety
Patient Safety
Reflective Practice
Reflective Practice
Professionalism in Contemporary Practice
Defining
Professionalism
Defining
Professionalism
Cultural Competence
Cultural Competence
Cultural Competence Module Learning GoalsParticipants will be able to: Define cultural competence Reflect on personal cultural attitudes Describe how communication impacts health
disparities Apply tools to improve cross-cultural communication Reflect on specific ways you can use what you’ve
learned in this module to improve your teaching your clinical practice your institution
Health Belief and Attitudes Survey (HBAS) 15 items scored on 6-point Likert scale. Items are distributed into four domains assessing the
learner’s attitudes towards: Opinion – Importance of assessing patients’ perspectives
and opinions Belief – Importance of determining patients’ beliefs for
history taking and treatment Context – Importance of assessing patients’ psychological
and cultural contexts Quality – Importance of knowing the patients’ perspective
for providing good health care
Dobbie 2002
Design
HBAS“Pre”
HBAS“Retro-Pre” &
“Post”
Cultural Competence Module
HBAS: Results (RetroPre v Post):
Opinion
Retro-Pre
Post
Mean 4.94 5.13
T-test -3.040
P-value 0.002
Belief
Retro-Pre
Post
Mean 4.69 5.06
T-test -5.516
P-value <0.001
HBAS: Results (RetroPre v Post)
Context
Retro-Pre
Post
Mean 5.19 5.53
T-test -3.96
P-value <0.001
Quality
Retro-Pre
Post
Mean 4.64 4.93
T-test -2.6
P-value 0.006
Coming soon…“Enhancing multicultural education & practice”SFDC - In Development
1. Health disparities – overview of evidence & causes2. Definitions of culture, race, ethnicity 3. Reflective practice and self-awareness of beliefs and
biases4. Linguistic barriers– use of interpreters, CLAS standards,
etc.5. Exploring health beliefs & explanatory models of illness6. Educational methods/resources 7. Evaluation & assessment methods & tools