Exploring gender differences across cultures: A teaching and learning module in family medicine

Group 4Teachers’ course Kranjska Gora 2004

Group 4

Group 4 members Klaric Zdenko – Bosnia Colin Chilvers – New

Zealand Reka Vernes – Hungary Smiljka Radic – Serbia Alberto de Carvalho –

Portugal Fusun Yaris – Turkey David Manning – UK Andrej Kravos – Slovenia

Nevenka Secer-Dolenc – Slovenia

Darinka Klacar – Slovenia Marko Kocian – Slovenia Yonah Yaphe - Israel

Gender and Culture In all cultures the

differences between men and women are obvious and important.

They are important but not obvious in the practice of medicine in a cross-cultural setting.

This course is designed to meet this learning need in family medicine.

Objectives At the end of this

course the learner will:

Know key gender differences in different ethnic groups

Know how to apply this knowledge in practice.

Value its importance.

Course modules1. Sexual orientation2. Health and disease

prevalence3. Taboos4. Specific cultural health

practices 5. Medicolegal problems6. Venus and Mars7. Expression of

symptoms and emotions

8. Patients’ expectations9. Health beliefs

Module 1: Culture, patient expectations and sexual orientation

Background We are surrounded

by diversity but medical training traditionally focusses on the dominant culture.

This module will train doctors to work with diverse populations

Module 1: Culture, patient expectations and sexual orientation -ObjectivesAt the end of this course

participants will: Know how to deal with

people from different cultures, genders and sexual orientation from their own.

Be able to recognize the different needs in performing examinations on people from different cultures, genders and sexual orientation.

Identify when to have a chaperone.

M1: Methods Workshops, group

work, role play Example: Doctor’s

request for urine sample and patient’s confusion.

Video presentation of cases for discussion

Presentation of the learner’s own cases

M1: Assessment Knowledge: Oral and

written examination Skills: OSCE Attitudes: Pre- and post-

course test Example: 1. I am comfortable

performing an internal examination on a patient of a different gender from a different culture without a chaperone. 12345

2. This course will change (has changed) my practice. 12345

3. I will apply what I will learn (have learned). 12345

Module 2: Culture, gender, health and illness prevalence Background:

Epidemiology is a basic medical science.

It is important that the student understand the importance of the use of epidemiology in medical care of different ethnic communities.

Module 2: Objectives By the end of the module

the learner will be able to: Knowledge: identify major

epidemiological features of ethnic groups within the country.

Skill: interpret relevant health data including simple analysis of statistics of prevalence and incidence of disease in different cultures by gender

Attitude: the student will demonstrate an awareness of cultural influences on the utilization of health care

M2: Methods Knowledge: Public

health data from official sources, health books, published data (NIVEL)

Skills: Problem Based Learning e.g. case study method. A new ethnic group joins your practice. How will you modify your screening procedures?

Attitudes: Case studies in facilitated group discussion

M2: PBL Case In 1991 400,000 Kurdish refugees came

from Northern Iraq to Turkey. 300,000 were young adult females. The rest mainly children and the elderly. 60% of the women were pregnant. You are a public health officer

responsible for women and children. How would you manage this situation?

M2: Assessment Knowledge: MCQ on

ethnicity and disease prevalence in the community.

Skills: OSCE – Encounter with a patient of a different gender and ethnicity who is offered a screening or therapeutic procedure.

Attitudes: Direct observation, questionnaires with Likert scales pre- and post-course.

Module 3: Taboos, health beliefs and gender

Background: Ignorance of taboos and health beliefs may be a source of disagreement and conflict in the consultation.

M3: Objectives At the end of the module the learner will Be aware of differences in acceptance of

taboos and health beliefs according to gender across cultures

Be sensitive to patients’ messages about taboos or health beliefs

Will demonstrate sensitivity about differences in expression of emotions across cultures and genders.

Establish rapport to be able to learn about taboos.

M3: Methods Structure: 4 hour course Introductory lecture on cross cultural differences

(20 minutes) and communication models- patient centred care (20 minutes)

“Thought shower and popcorn session” – report of experiences with taboos in different ethnic groups in the learners’ practices. (20 minutes)

Role play and debriefing: Doctor coping with interview with fatigued woman from a culture where husband will not allow doctor to interview patient alone. (60 minutes) Repeat role play for assessment.

M3: Assessment Feedback sheet to assess what learners

gained from program and changes in attitude and understanding and approach and the influence on daily practice.

Open questions: What was good about today’s exercise? What would I do differently? What would I like more of in this

exercise? What could we use less of?

M3: AssessmentClosed questions: I learned new things today: 12345 I was able to participate actively.12345 The atmosphere was positive I was able to express myself freely. The group leader led the group

effectively. I would participate in a workshop like this

again.

Module 4: Specific health practices - Background Understanding specific cultural

health practices can help the doctor to better understand the reactions of the patient to different health conditions.

This understanding can improve adherence to treatment and outcomes.

M4: ObjectivesAt the end of the course the learner will: Know the background of different cultural

behaviours in relation to health practices. Know how to communicate effectively and

non-judgementally with patients from different cultures to learn about unique health practices.

Show an acceptance of diversity in health practices and avoid conflict with patients.

M4: Methods Knowledge: Home visits, patient

interviews, medical anthropology texts. Invite representative of ethnic group to speak to learners.

Skills: Observation of skilled interviewers, practice interviews with feedback

M4: Assessment Knowledge: Observation of

learners, knowledge tests, feedback from patients

Skills: Observation Asessment: Observation, patient

satisfaction

Conclusion This course helps to bring

medicine up to date with new content and new methods with regard to culture and gender.