Transcript Fostering Cultural Awareness in Medical Education through

Fostering Cultural Awareness in
Medical Education through Refugee
Patient Encounters in the Primary Care Setting
Frances Saad, B.A., Psychology, MSW student, School of Social Work
Family Medicine Research Institute
Department of Family Medicine
University at Buffalo
Program website: www.refugeehealth.com
© 2005 CDHS College Relations
Group Buffalo State College/SUNY
at Buffalo Research Foundation
1
Refugee Health and Cultural
Awareness Training Program
Training Program Description
NYS DOH funded
Community-based medical student
training
Collaboration with refugee
resettlement agencies
Volunteer student participation
Weekly “Refugee Health Nights”
Mostly 1st year medical student
© 2005 CDHS College Relations
participation Group
Buffalo State College/SUNY
at Buffalo Research Foundation
2
Refugee Health and Cultural
Awareness Training Program
Program Goals
Self-awareness regarding one's
own ethnicity/culture
Understanding and appreciation
for cultural diversity in the health
care setting
Enhanced communication skills
• Ability to utilize interpretive services
Establishing collaborative partnerships between care providers and
patients
© 2005 CDHS College Relations
Group Buffalo State College/SUNY
at Buffalo Research Foundation
3
Refugee Health and Cultural
Awareness Training Program
Cultural Immersion Experience
Refugee Health Nights
• Pre-clinical cultural orientation and
post-clinical debriefing
• Identify cultural, communication
and psychosocial issues in health
care delivery to diverse populations
Storytelling sessions
Health presentations
Mentoring / Tutoring
Monthly discussion / Educational
© 2005 CDHS College Relations
presentations Group
Buffalo State College/SUNY
at Buffalo Research Foundation
4
Research Evaluation Question
What kinds of cultural awareness
lessons do medical student derive
from their clinical encounters with
refugee patients?
© 2005 CDHS College Relations
Group Buffalo State College/SUNY
at Buffalo Research Foundation
5
Design and Methods
Homogeneous sample of 1st and 2nd medical
students (N=27) in an elective rotation
Sixteen students (one refugee encounter)
Eleven students (two refugee encounters)
Intervention
Briefings on culture, communication, refugees (1 hr)
38 clinical encounters with refugee (1½ - 2 hrs)
Refugees’ country of origin (N=30)
Cuba (6), Sudan (3), Vietnam (5), Iran (1), Bosnia
(2), Iraq (7), Somalia (4), Ukraine (2)
© 2005 CDHS College Relations
Group Buffalo State College/SUNY
at Buffalo Research Foundation
6
Data Collection
Student debriefing after the refugee health
evaluation (1/2 hr)
Debriefing topics:
General experience
Cultural issues
Communication challenges
Clinical problems
Psycho-social issues
Student’s emotions
© 2005 CDHS College Relations
Group Buffalo State College/SUNY
at Buffalo Research Foundation
7
Text Analysis
Four text analysts
Project Dir (MD, MPH), Culture Instructor (PhD),
Project Coordinators (1 MSW, 1 BA)
Immersion-crystallization approach
Culture and communication theme search
Critical assessment of learning experiences
Trustworthiness
Multiple analysts
Search for disconfirming evidence
© 2005 CDHS College Relations
Group Buffalo State College/SUNY
at Buffalo Research Foundation
8
Cultural Awareness Experiences
Key Language/Communication Lessons
Effective use of interpretive services was of utmost
concern
Key Cultural Awareness Lessons
Challenge discerning what is “cultural” and what is not
Key Lessons in Cultural Humility
Refugee plight provoked self-reflection and cultural
humility
© 2005 CDHS College Relations
Group Buffalo State College/SUNY
at Buffalo Research Foundation
9
Key Communication Lessons
Gender match between interpreter & patient
Staying focused while using an interpreter
Differences between in-person and telephonic
interpretation
Problems with relying on family interpreters
© 2005 CDHS College Relations
Group Buffalo State College/SUNY
at Buffalo Research Foundation
10
Key Communication Lessons
Gender match between interpreter & patient
“…we had a Vietnamese interpreter but chose not to
use him because he was male, and used the [phone]
service for all three [women].”
Staying focused while using an interpreter
“The most trouble was thinking of things to ask…you
are worrying about the interpreter, the patient…you
tend to forget the important stuff…”
© 2005 CDHS College Relations
Group Buffalo State College/SUNY
at Buffalo Research Foundation
11
Key Communication Lessons
Problems with relying on family interpreters
“[They] may be loving and concerned toward their
family members, but are less reliable…”
Differences between in-person and telephonic
interpretation
“…using the in-person there’s a lot of talking w/ the
patients…to me the phone is a direct translation…”
© 2005 CDHS College Relations
Group Buffalo State College/SUNY
at Buffalo Research Foundation
12
Student Assessment of
Methods of Interpretation
In-Person
Telephonic
Too wordy
More subjective
More personable
Allows greater patientcare provider interaction
Includes non-verbal
communication
Cost of service not a
major concern
Gender match important
More concise
More objective
More impersonal
Allows lesser patientcare provider interaction
Excludes non- verbal
communication
Cost of service was a
major concern
Gender match important
© 2005 CDHS College Relations
Group Buffalo State College/SUNY
at Buffalo Research Foundation
13
Key Cultural Awareness Lessons
Religion/spirituality in health care
Family structure and relationships
Gender roles and relations
Ethno-medical (folk) treatments and beliefs
© 2005 CDHS College Relations
Group Buffalo State College/SUNY
at Buffalo Research Foundation
14
Key Cultural Awareness Lessons
The role of religion/spirituality in health care
“The Vietnamese worship in their homes in their own
way…when someone passes away they celebrate...for
them to have a good voyage.”
“Pentecostals abstain from drinking and smoking…”
Family structure and relationships
“in Iran, even if her daughter was 50 [she] would still
be considered a child…it would’ve had the same family
dynamic…my own parents and I have a very different
relationship…” © 2005 CDHS College Relations
Group Buffalo State College/SUNY
at Buffalo Research Foundation
15
Key Cultural Awareness Lessons
Gender roles and relations
“I walked into the room...shook hands w/ the woman
…the interpreter quickly whispered to me not to shake
hands with the [Iraqi] man.”
Ethno-medical (folk) treatments and beliefs
“[The Vietnamese] have a plaster that is used for
pains…herbal remedies that they put on as a paste…”
“She didn’t view malaria as a disease, it’s so common
[in Sudan].”
© 2005 CDHS College Relations
Group Buffalo State College/SUNY
at Buffalo Research Foundation
16
Key Lessons in Cultural Humility
Awareness of privilege in light of refugees’ plight
Refugee patients as ‘teachers’ of their culture
Awareness of patients’ perception of provider
Meeting patient emotional needs with empathy
Concern for refugee integration into community
© 2005 CDHS College Relations
Group Buffalo State College/SUNY
at Buffalo Research Foundation
17
Key Lessons in Cultural Humility
Awareness of privilege in light of refugees’ plight
“…all her family is in Somalia, her father was shot and
killed…she’s [here] all by herself…I’m even wondering how I’m
going to get home from downtown…”
Refugee patients as ‘teachers’ of their culture
“…we tried to find words in common. They taught [us] some
Spanish words...this kind of bond was formed...”
Awareness of patients’ perception of provider
“I’m going to be more conscious of how patients see me,…the
patient’s views…it adds certain sensitivity.
© 2005 CDHS College Relations
Group Buffalo State College/SUNY
at Buffalo Research Foundation
18
Key Lessons in Cultural Humility
Meeting patient emotional needs with empathy
“I was going through the checklist…as she started to cry it shook
me…I stopped the interview…as the empathy kicked in the
checklist started to fall out of my head.”
Concern for refugee integration into community
“…I wished we had asked ‘what are you looking forward to do
now you’re in America?’…If there’s anything they need to attain
those goals…language classes, [job] training, any services…”
© 2005 CDHS College Relations
Group Buffalo State College/SUNY
at Buffalo Research Foundation
19
Study Limitations
Potential bias of volunteers
Small number of study participants
Variability in the number of clinical
encounters
© 2005 CDHS College Relations
Group Buffalo State College/SUNY
at Buffalo Research Foundation
20
Developing Cross-Cultural Patient
Care Skills by Immersion Experience
Highlights challenges in cross-cultural
communication in the health care setting
Facilitates learning about other cultures
through patients’ stories about family,
community and way of life
Allows recognition of personal biases and
first-hand appreciation of cultural diversity
© 2005 CDHS College Relations
Group Buffalo State College/SUNY
at Buffalo Research Foundation
21
Reflections
– “…It’s really humbling when people
share their stories like that with you.
You’re meeting them for the first
time and yet you know you’ve made
such a contact with them that
they’re willing to open up to you, it’s
very touching…”
- 1st yr. medical student
© 2005 CDHS College Relations
Group Buffalo State College/SUNY
at Buffalo Research Foundation
22