Cross-cultural Medical Education at Stanford University

1. Cross-cultural Medical Education at Stanford University Clarence H. Braddock III, MD, MPH Ronald D. Garcia, PhD

2. NIH(NHLBI) Sponsorship • PI: CH Braddock III, MD, MPH • RFA Goal: “To enhance the ability of physicians and other health professionals to address disparities in cardiovascular, pulmonary, hematologic, and sleep disorders in a culturally sensitive manner.” • Five-year grant (2004-2009)

3. AAMC Sponsorship PI: Ronald D. Garcia, PhD • GOAL: Develop an integrated model curriculum throughout the preclinical and clinical curriculum.

4. Challenges • Access to time in the required curriculum • Teaching resources • Development of cases • Evaluation

5. Leveraging opportunities • Complimentary backgrounds • Physician; bioethics, patient-physician communication • Psychologist; leader in cross-cultural medical education, diversity • Complimentary projects • NHLBI - focus on preclinical students, residents, faculty development • AAMC - focus on clinical students

6. Leveraging opportunities • Combining resources • Staff support • Needs assessment • Teaching activities • Critical mass • “Cross-cultural Medical Education Initiative”

7. Teaching Methods • Interactive and experiential • Role plays • Workshop formats • Patient simulations • Web-based resources

8. Outcomes • Teaching modules • Interpreters • Communication models • Patient simulations Teaching methods Simulations Reflective experiences

9. NHLBI Cultural Competence and Health Disparities Education Collaborative Who we are - What we’re doing Clarence H. Braddock III, MD, MPH Stanford University

10. NHLBI Health Disparities Program • Goal: “To enhance the ability of physicians and other health professionals to address disparities in cardiovascular, pulmonary, hematologic, and sleep disorders in a culturally sensitive manner.” • Funding: Five-year academic awards to support faculty time for curriculum development

11. Deliverables • Curriculum development & implementation • Medical students • Residents • Practicing physicians • Evaluation • Dissemination to all U.S. medical schools

12. NHLBI Cultural Competence and Health Disparities Education Collaborative * * *

13. Mission Statement • Our Collaborative seeks to develop curricula that enhance the ability of physicians and other health care professionalsto address disparities in the U.S. in a culturally sensitive manner. • Our ultimate goal is to develop, evaluate, and disseminate a comprehensive cultural competence curriculum to medical schools throughout the U.S., thereby providing support and leadership to medical educators nationwide.

14. Strategies • Foster inter-institutional collaboration • Annual collaboration & planning meeting • Monthly conference calls • Collaborative projects • Forge alliances with other organizations • AAMC • OMH • Professional societies: STFM, SGIM, AMA

15. Current collaborative projects • Curriculum needs assessment: AAMC’s Tool for Assessing Cultural Competence Training (TACCT) • Dissemination: Web Portal • Faculty development: Stanford Faculty Development Center

16. Curriculum Dissemination Web Portal Project

17. Web Portal: Goals To provide: • Resources for curriculum needs assessment and development • Platform to disseminate curricular materials • Forum for medical educators to share curricular materials • Links to other supporting materials for cultural competence education.

19. Faculty Development Stanford Faculty Development Center (SFDC)

20. Stanford Faculty Development Center

21. Dissemination ModelNationally & internationally since 1986 Stanford Faculty Development Center Clinical Teaching Program -1986 Professionalism in Contemporary Practice Program - 2003 Seminar Facilitators Previous Programs: • Preventive Medicine • Medical Decision Making • End-of-Life Care • Geriatrics in Primary Care Seminar Participants (Faculty & Residents) Learners Institution

22. SFDC: Professionalism in Contemporary Practice • One-month fellowship to enhance faculty teaching: • Reflective practice, • Patient-centered care, • EBM, • QI, patient safety • Developed pilot module on cultural competence • Review data on health disparities; definitions of race, culture,cultural competence • Build skills in cross-cultural communication • Gain insight into personal biases • Develop effective strategies to teach cultural competence

23. Professionalism in Contemporary Practice Cultural Competence Reflective Practice Shared Decision Making Defining Professionalism Quality Improvement Patient Safety Evidence-Based Practice Working in Teams

24. Cultural Competence Module Learning Goals Participants will be able to: • Define cultural competence • Reflect on personal cultural attitudes • Describe how communication impacts health disparities • Apply tools to improve cross-cultural communication • Reflect on specific ways you can use what you’ve learned in this module to improve • your teaching • your clinical practice • your institution

25. Health Belief and Attitudes Survey (HBAS) • 15 items scored on 6-point Likert scale. • Items are distributed into four domains assessing the learner’s attitudes towards: • Opinion – Importance of assessing patients’ perspectives and opinions • Belief – Importance of determining patients’ beliefs for history taking and treatment • Context – Importance of assessing patients’ psychological and cultural contexts • Quality – Importance of knowing the patients’ perspective for providing good health care Dobbie 2002

26. Design HBAS “Pre” Cultural Competence Module HBAS “Retro-Pre” & “Post”

27. HBAS: Results (RetroPre v Post):

28. HBAS: Results (RetroPre v Post)

29. Coming soon…“Enhancing multicultural education & practice”SFDC - In Development • Health disparities – overview of evidence & causes • Definitions of culture, race, ethnicity • Reflective practice and self-awareness of beliefs and biases • Linguistic barriers– use of interpreters, CLAS standards, etc. • Exploring health beliefs & explanatory models of illness • Educational methods/resources • Evaluation & assessment methods & tools