Transcript Understanding the Role of Diversity in Faculty Development

Understanding the Role of
Diversity in Faculty Development
Joan Y. Reede, MD, MPH, MS
Harvard Medical School
Office for Faculty Development and Diversity
December 4, 1999
A Time of Change
Understanding the Role of
Diversity in Faculty Develoment
The Diversity Imperative
Projected “Minority” Percentage
50
45
40
35
30
25
20
15
10
5
0
47.5
By Year 2056, whites will
probably by a “nondominating” group.
25
By Yr 2000
By Yr 2050
Facts…
% of Population Foreign-Born
14
14
11.6
12
10
9.3
8
6
Percentage of
population
4.8
4
2
0
1800's
1930
1970
1996
• There is variation by Race, Ethnicity, and Gender in
the health care services individuals receive.
Hypotheses to Explain this Variation
• Physiologic differences including variations
in the natural history of disease.
• Failure to account for externalities such as
availability of services.
• Patient preferences for procedures varies by
sub-population
• Physicians are biased toward certain groups.
• Poor doctor-patient communication
Cultural Variation – Biological
• Risk of genetically inherited disorders such
as thalassemia
• Biologic variations such as lactose tolerance
• Physiologic or metabolic differences that
may affect the administration of
medications
• Mortality and morbidity rates which may
vary
Cultural Variation – Attitudes & Values
• Importance of individual or community
• Roles for women, men, and children
• Preferred family structure – nuclear, extended, one
generation, multigenerational
• Importance of folk wisdom
• How time is used and valued
• Role of religious life, spirituality, and secular life
• Body language
Culture
• “Culture refers to the dominant set of
symbolic codes (linguistic, moral, aesthetic)
and material practices (dietary/behavioral)
that characterize a group.”Pierce, Earls, Kleinman, 1999
• Culture is a body of beliefs and customs
that define a group of people as being
connected and that determines their identity.
Health Care is a Cultural
Construct
• Culture of the Biomedical Model
• Culture of Individual Professions – allopathic &
osteopathic medicine, nursing, social work…
• Culture of Individual Discipline – pediatrics,
internal medicine, surgery, cardiac surgery…
• Culture of Academic Medical Center
• Culture of Community Health Center
• Culture of Managed Care Organization
• Patient’s Culture
Perceptions of Disease and
Illness
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•
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•
•
Invasion of microorganism
Deterioration of body due to age, accident
Body imbalance
Punishment by God
Result of offending ancestors
Perceptions of Healing and
Curing
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•
•
Fighting an intruder
Putting the body back in balance
Making atonement to God for wrongdoing
Making peace with ancestors
Perceptions of Doctors
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•
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•
•
Healer
Expert/miracle worker
God’s worker
Shaman
Pill dispenser
• Confidant or friend of
family
• Authority figure
• Last resort for healing
• Someone who inflicts
pain
Impact of Culture on PhysicianPatient Relationships
• Patient
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Level of comfort with physician
Understanding of the health care system
Fear of rejection of personal health beliefs
Expectation of physician and health providers
• Physician
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•
•
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Socialized in Western bio-medical context
Disclosure
Authority
Communication
Communication Barriers
Patient-Related
Barriers
Physician-Related
Barriers
Communication
Barriers in Providing
Quality Health Care
Insurer-Related
Barriers
Institutional
Barriers
What is Cultural Competence?
• “Cultural competence is the ability to
deliver effective medical care to people
from different cultures. By understanding,
valuing, and incorporating the cultural
differences of America’s diverse population
and examining one’s own health-related
values and beliefs, health providers deliver
more effective and cost-efficient care.”
HRSA 1998
Cultural Competency
An integration and Interaction of…
Health-related
beliefs and
cultural values
Disease-incidence
and prevalence
Treatment
efficacy
Case for Cultural Competence
• Improve quality of care
– Improve health outcomes
– Increase customer
satisfaction
• Improve acceptance,
salience, and efficacy of
interventions
• Social justice
• Reduce potential liability
• Satisfy accreditation
standards
• Gain and maintain market
share
• Gain community support
• Satisfy payor demands
• Increase productivity
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–
–
–
Improve recruitment
Increase commitment
Decrease turnover
Increase creativity in
problem solving
Understanding the Role of Diversity
in Faculty Development
Academic Medicine’s Response
The Challenge
Philosophy
• Most physicians are committed to providing
culturally competent, high quality care.
• Cultural competency encompasses more than race
and gender.
• Prejudice, fears, and stereotyping are learned
behavior that can interfere with communication
and trust.
• Cultural competency workshops and electives
alone will not change long-held attitudes.
• Cultural competency and diversity should be seen
as part of a continuous learning process
Underrepresented Minority
Participation in Medical
Education
25.00%
20.00%
15.00%
Students
Faculty
U.S.
10.00%
5.00%
0.00%
1970
1980
1990
1994
1997
Recruitment Issues?
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Location defense
Pipeline defense
Budgetary defense
Market forces
No raid policy
Turnover problem
Diversity “Taxes”
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Assumptions and stereotyping
Chilly climate
Excessive student/resident demands
Excessive committee assignments
Undervaluing scholarship on minority issues
“Token Hire” misconception
Cumulative professional disadvantage
Retention Steps
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Make commitment to diversity explicit
Prepare department for change
Establish a mentoring process
Involve senior faculty
• Networks
• Collaboration
• Chair/division chief assume responsibility for
protection from committee assignments
• Provide orientation before and after hire
Where?
Rewards and Recognition
Research
Clinical care
Teaching
Public service
Administration
Diversity and Promotion
• Clinical Service
• Marketing, Time constraints
• Research
• Definition of merit
• Administration
• Service burden, “Typecasting syndrome”
• Teaching
• Non-traditional courses
• Collegiality
• Subjectivity, “Hairsplitting concept”
3P’s – Pro-active, Persistent,
Positive
• A Time of Change
– Training extending into diverse communities with
diverse populations
• Cultural competence training integrated into
– Faculty development training programs
– Continuing education
– Student and resident education and training
• Increasing representation of faculty of color
– Recruitment
– Retention
– Promotion