Transcript Name of Presentation

Dealing with Diversity:
an alternative to
Cultural Competence
Jim Ross, Kristin Kenrick, Chrys Jaye, Peter Radue
Cultural competence
• Required by the HPCA Act (2003) and the Medical Council
• Implies that there is some standard of knowledge, skills and attitudes
in this area which can be taught and assessed
• Practitioner-centred (unlike Cultural Safety)
• Confusing when combined with Biculturalism (like Cultural Safety)?
• Does its teaching change knowledge, skills and attitudes?
• Does it lead to changes in health outcomes for marginalised groups?
• Individual-focused Patient-centred Medicine not enough
4th Year ‘Diversity in Practice’ Objectives
• Reflect on vexed concept of cultural competence
• Explore ‘culture’ and its relationship to medical practice
• Defamiliarise the familiar
• Make links between diversity and Patient-centred Medicine
• Start to develop frameworks and strategies to help deal with the
diverse needs of patients and patient groups
0.
Suggest students review 2nd Year module (+/- pre-readings)
3 HOUR WORKSHOP
1.
Overview
2.
Revise concepts from HIC – culture, cultural competence/safety,
etc
3.
Divide into 4 ‘culturally mixed’ groups (+/- a tutor)
4.
Ice-breaker – what is the origin of your name?
5.
A group/subculture you identify with: insights about subcultures
6.
Your experiences of Medicine as (sub)culture,
discuss (“subculture of 1 – overlapping cultures/subcultures”)
7.
Patient-centred Medicine (whole group)
8.
Can we improve PCM model to better include culture/diversity?
What specific points can we take from medical practice models?
9.
Take home message(s) from each group
HOMEWORK
12. Articles to take away
13. Observe events which relate to these issues at your General
Practice
1 HOUR FOLLOWUP SESSION
14. Discuss observations in original small group
15. Take home messages from each group and from tutors
16. Evaluation
Take Home Messages
Tutorial 1
1.
Be aware of cultural stereotypes to guide discussions with
individual patients
2.
ASK if there are cultural issues
3.
Take opportunities to inform ourselves about cultures and
subcultures
4.
Whole person understanding (including cultural aspects) is
essential (see 1,2,3 above)
5.
Rapport is necessary to allow patients to raise things
Tutorial 2
1.
Find out where patient is at, what is important for them, what
information they want
2.
Communication is the key thing (speak slowly, avoid jargon and
slang, think of synonyms, & consider interpreters)
3.
Understand individuals in context; beware cultural stereotypes
4.
Show respect, be adaptable, develop knowledge about cultures
(for relationship-building, to avoid obvious pitfalls, to prepare for
possible situations, e.g. whanau involvement)
Evaluation question 1: What useful thing(s) will you take
away from the two sessions and the practical exercise on
diversity in medical practice? (1st Quarter 2011)
• “Culture is more than ethnicity”
• “ Understand the patient – culture is one aspect but may not even be
a large part of it – But useful viewing the patient in his/her own
context”, “Having an awareness of people’s cultures will help you
gain rapport and build a relationship.  may help you to avoid
insulting people” (6 such comments)
• Interpreting phone services are available when the patient does not
speak English” (2)
• “Some practical ideas regarding communication” (2)
• “The take home messages are good, succinct: highlighting what’s
important is useful”
2. How relevant do you think the material in these sessions
and the practical exercise will be to your future medical
practice? Please circle one response.
2. How relevant do you think the material in these sessions
and the practical exercise will be to your future medical
practice? Please circle one response.
3. Please comment on anything that made you feel
uncomfortable or offended.
• “Nothing”(2), “No”, “Nope”(2), “Nil (2)”, “n/a”, -- (5)
• “I felt uncomfortable talking about different cultures when trying to
explain stereotypes whilst trying not to sound as though those
stereotypes were my personal view”
• “Awkward silences when people wait for other people to answer”
4. What could have been improved in these sessions and how?
• More information about specific cultures. Common pitfalls to explore
with the patient
• Case studies or scenarios to work through (6) – e.g. “in case our
own clinical experiences are a bit thin”
• Some role plays
• Slightly more whole group work (2)
• Less theoretical discussion and more of what we did in the second
tutorial
5. General comments
Several positive comments (e.g. “Choice”, ‘Is good”, Enjoyable and
very relevant”).
Best overall summary of themes was:
“I found the sessions enjoyable and very relevant and it was good to
hear others’ stories, and hear how other Doctors deal with tricky
situations. But in general I think that ‘cultural competency’ is
something that is gained over time from experience”
In particular, “Listening to people’s experiences was the most
interesting”
Summary
• Small group learning session regarding Diversity/Culture, using
personal experience and discussion as much as possible
• Guest tutors, to add diversity
• Followed by component of real-world clinical practice observation,
with reflection in same small groups
• Modification of course content iteratively using formal and informal
evaluation
• Generally positive evaluations from students
• Speculations on reasons for less positive reaction from second and
third groups - Timing of session? Group differences? Discussion
issues?
• Questions and comments – e.g. is this research? Where to now?