teaching culture and community in primary care: the community as teacher

©2003 Community Faculty Development Center

Teaching Culture and Community in Teaching Culture and Community in Primary Care:Primary Care:

The Community as TeacherThe Community as Teacher


Teaching Culture and Community: Teaching Culture and Community: The Community as TeacherThe Community as Teacher

After this session, you will be able to:

• Address knowledge needs regarding cultural issues in the community setting

• Augment the GNOME planning process to include service-learning methodologies

• Use the principles of service-learning to plan a community-based learning experience for incorporation into your practice


Where have we been?Where have we been?


Needs AssessmentNeeds Assessment

• Self-assessment• Assess level of ethno-

sensitivity• Assess skill level of

learner in the context of trans-cultural interviewing

CULTURALLY EGOCENTRICCULTURALLY EGOCENTRIC

CULTURALLY SENSITIVECULTURALLY SENSITIVE

MINIMIZATION


• Attitudes and values:– Celebration of diversity

– Recognition of cultural biases

– Respect for all health beliefs

– Avoid assumptions and stereotypes

• Skills: – Patient Centered Interviewing

– Social Context Review of Systems

– LEARN model

ObjectivesObjectives


MethodsMethods

• Appropriate Use of Teaching Styles Reflection

• Modeling• Role Play


EvaluationEvaluation

• Characteristics feedback in context of cultural learning objective

• Encourage self-assessment– Facilitates self-reflection

– Promotes self-awareness

• Refer to specific, observed behaviors– No presumption of attitude

– Provides opportunity for change and growth


• Knowledge Objectives– Population health

– Outcome disparities

– Exploring history and cultural norms of specific groups

– Explore the culture of the community in which you are practicing

What’s missing?What’s missing?


A Little Knowledge is …A Little Knowledge is …

• ENLIGHTENING!– Historical context

– Geography

– Cultural Norms

• Facilitate asking pertinent positive and negative questions

• Leads to efficiency


A Little Knowledge is A Little Knowledge is ……

• DANGEROUS!– Context needs to be

seen as general

– To avoid stereotype, still must get patient’s perspective


ScenarioScenario

• A student from your practice in Worcester, MA is seeing a Mexican American with Type II diabetes mellitus. The student comments on the apparent frequency of diabetes in Hispanics and wonders if this is a problem for Mexican-Americans as well as Puerto Ricans (the majority Latino culture). To what resources would you point your learner?


Population HealthPopulation Health

- HHS Race and Health Home Page

- Census Bureau Home Page

- CDC Diabetes Resource

- CDC's Diabetes Program - Statistics

Links


Scenario, Part 2Scenario, Part 2

Now that the student knows about the increased prevalence of diabetes, she is interested in knowing if there is specific help with dietary counseling available.


Latinos and DiabetesLatinos and Diabetes

- Welcome to DiversityRx-March- Mexican American Diets and Diabetes- Nutritional Materials in Spanish- Latin American Food Pyramid

Links


Other Reference MaterialsOther Reference Materials

• Bibliographies for web sites• “Pocket texts”• Its in your handout!


But, is knowledge enough???But, is knowledge enough???

• General information– May not apply in your community

– Acculturation: Process of adapting from one culture to another.

• Expertise– Doctors are “experts”

– May not be the expert on this.

• Solution– Draw on expertise of others

– Structure community experiences for deep learning


The Community as Teacher: The Community as Teacher: How have you done it?How have you done it?

Please think for a minute of an educational experience in which you were sent out into a non-medical community setting?

What did you learn? How?


CONCEPT: SERVICE- LEARNING

"A structured learning experience that combines community service with preparation and reflection. Service-learning students not only provide community service, but also learn about the context in which the service is provided”

S. Saefer, 2002

The Community as TeacherThe Community as Teacher


Service-LearningService-Learning

Volunteerism Practicum

Community Service Field Education

Service-Learning

Community Beneficiary Provider

Service Activity Learning


• Include more community sites and build long term relationships.

• Develop a service learning experience using service-learning objectives

• Develop an orientation component• Develop a reflection component • Integrate an evaluation component• Promote the professional ethic of service

Service Learning Protocol for Service Learning Protocol for Health Professionals SchoolsHealth Professionals Schools


• IS:Partnership: educators and

communityLearning objective connected

to service.Real service, meeting an

unmet need.Reflection component.Applicable in future personal

and professional life.Equitable

• IS NOTNot just volunteering.Not just a clinical experience

Not a chance to show how

much you know.Not a chance to hone your

skills.Not just an individual

relationship* *(although it can start there)

What is Service-Learning?What is Service-Learning?


WHAT NEXT?Abstract

Conceptualization

SO WHAT? Reflective Observation

WHAT?Concrete

Experience

ACTION!Active

Experimentation

Reflection is the hyphen in Reflection is the hyphen in Service-LearningService-Learning


Reflective MethodsReflective Methods

• Before:– Briefing, essay(pre), self evaluation(pre), writing goals/

learning contract, on-line journal

• During:– Self-evaluation, community partner or faculty review.

• After:– Essay(Post), Self-Evaluation(Post), essay based on on-

line journal, review of learning contract.


How to make it work?How to make it work?

Medical student has just seen a 6 y/o well child whose mother is deaf, and for whom the child is the interpreter. The student doesn’t know ASL, available resources for deaf persons nor much about deaf culture. You don’t know much about it either.

What can you do?How could you structure the experience?

Please discuss with your neighbor for 2 minutes.


• Surveys and Scavenger Hunts• Community reading day• Visit a home with a home

visitor• Writing newspaper articles.• Consulting with HeadStart on

lead poisoning• Interviewing the family of a

CSHCN

Service-Learning in PracticeService-Learning in Practice


Practical Aspects of Service-Practical Aspects of Service-LearningLearning

• Build on existing relationships

• Negotiate the objectives

• Empower partners to teach

• Reflect with your learner


What about Culture?What about Culture?

• S-L enables growth in the empathic stages:– Models collaboration and power-sharing– Demands reflection and insight– Values all participants

• S-L requires time and energy– Need to establish and maintain relationships– Need time and expertise to reflect


SummarySummary

• Knowledge about culture is available, but requires context.

• Service-learning is a teaching method that can provide that context.

• Preceptors can incorporate service-learning into their precepting by building on existing relationships.

teaching culture and community in primary care: the community as teacher

Documents

community service

community settingaugment

deep learningthe community

diabetes welcome

diabetes mellitus

nonmedical community

cultural issues

cultural biasesrespect