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CE Article: Growth in cross-cultural competency improves patient care*


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After reading this article you will be able to:

  • Describe the importance of using an outside source during workshops
  • Discuss ways to involve staff with cultural competency education

Overcoming the cultural boundaries that can prevent a patient-physician relationship from forming can be a difficult task. If a language barrier exists or a mutual understanding between the parties cannot be reached, important information might be withheld or misinterpreted.

In a 2004 survey conducted at the Albert Einstein College of Medicine in the Bronx, NY, more than half of staff members said they would benefit from additional support and training on how to teach about cultural disparities and how to overcome cultural boundaries.

“Each residency program was looking for ways to include training on cultural competency in their curriculum,” says Nereida Correa, MD, MPH, associate clinical professor in the departments of OB/GYN, women’s health, and family and social medicine.

With funding from the National Institutes of Health (NIH) to eliminate health disparities and to increase faculty recognition of the need for training, program coordinator Shoshana Silberman and

Correa began developing a task force to help include cultural competency training in the curriculum. The resulting program has improved how staff members address patients across cultures and encouraged multicultural patients to ask more questions about their care.

To read more on cultural competency, click here.

Task forces and workshops to educate and inform

Staff members from Einstein’s two campuses were included in the first brainstorming session of the Albert Einstein College of Medicine’s Faculty Task Force for Elimination of Disparities and Cross-Cultural Training.

The main purpose was to get a better feel for the level of resistance each department was getting from its faculty, what those department leaders wanted to do, and what kind of tools would help them implement a program that would be acceptable to students and residents.

During the first session, the task force decided the first step toward better implementation of cultural awareness would be through conducting workshops.

From the start, the department heads and medical directors at Einstein-affiliated hospitals supported the work of the task force.

“Prior to our first workshop, the chief medical officer had been on call and came to the brainstorming session telling us of the stories from the night before,” Correa says. “He believed that something should be done because while he was on call, he had three patients, all from different nationalities, that did not speak English.”

Next, the group invited Debbie Salas-Lopez, MD, an expert in cultural competency and chief of the Division of Academic Medicine, Geriatrics, and Community Programs at the New Jersey Medical School, to help with the workshops.

Correa felt that an outside expert would have greater influence than someone who was on Einstein’s staff. Students and staff members find it easier to tune out department leaders, simply because they are used to hearing them repeatedly convey the same messages, says Correa. Salas-Lopez commanded the attention of staff members partially because she was a new voice.

In the first workshop the task force conducted, Salas-Lopez helped develop cases dealing with cultural competency and asked workshop members to bring in patient cases of their own.

The task force was divided into work groups, and each group developed its own case scenarios around the patient cases that were brought to or developed at the workshop. Once each group developed its own patient case, it shared with the other members of the task force. After these presentations, the groups received critiques.

At the conclusion of the workshop, the task force members were asked to go home and develop the case further and give suggestions on how these topics could be taught. Each group had to come up with the learning objectives, a narrative or case summary, a teacher’s guide (explanation of case background), and provide a bibliography and any visual aids that may have been required.

For example, one group’s case scenario was about a pregnant HIV-positive patient who wanted the obstetrics team to lie about her condition. Another team explored issues of culture and trust, such as human trafficking, gynecology, and contraception.

“The biggest frustration of the task force was that they still did not know how to implement these processes,” says Correa. “So we brought Lopez back and did a role-play with the case studies we had developed from the first workshop.”

In this workshop, two or three work cases were chosen to role-play. Members of the task force would take one of the cases and act it out. The groups would then critique the case that was acted out and learn how to put this into practice with their teachings.

To read more examples of other tactics used in another facility, click here.

English is not the default language

In addition to the initial workshops, Einstein also has other means of cultural competency education and implementation. One particularly unique example is the way interns are greeted on their first day in the program to illustrate what it feels like to be unable to understand what is being said.

Instead of being greeted in English, as most interns in the United States would expect to be, the intern is instead greeted for a few short minutes in another language. It could be Spanish, Polish, German, or Russian.

“We ask the intern how being greeted in a different language feels and try to use that as an example with how the patient may feel when they do not understand what is going on,” says Correa.

Einstein also holds classes during which attendees share instances of how they applied cultural sensitivity to their medical practice.

One example involved a patient who needed emergency surgery and could only speak French. The group of medical students dealing with the patient arranged for the patient to speak to a translator over the phone.

To read additional information on helping non-English speaking patients feel more at ease in the hospital setting, click here.

Hosting monthly educational breakfasts and grand rounds covering cultural awareness are other ways Einstein keeps staff members educated on the topic.

Obstacles to overcome

From the very beginning, there was wide acceptance of the cultural awareness effort from everyone at Einstein, from the chief medical officer to the patients and medical students.

Although Einstein lost funding from the NIH for two years, Correa and her staff members continued educating staff members and students. It wasn’t easy, however. Correa was unable to pay for formal workshops or outside presenters.

“When you don’t have funding, you continue doing what you were doing, but you don’t have any money to pay speakers or hold workshops, so it makes things harder,” she says.

Task force two and results

Correa is now working to form a second task force to evaluate the necessary next steps in continuing to educate people on cultural issues.

“We are gathering feedback right now from the members of the first task force to see what challenges they have experienced and how we can improve on those challenges,” says Correa.

Even though no hard evidence was gathered, Correa has seen a vast improvement in staff members’ treatment of patients from different cultures. Patients open up and ask more questions, and doctors and medical students remember their training and case scenarios, she says.

“At the end of the day, what we want is residency programs to develop in their curriculum ways they could discuss every patient that is seen within the context of their culture,” says Correa. “My assessment so far is that the initial change has taken place, and that we have gradually changed the culture of our medical center by supporting cultural awareness at every level.”

Editor’s note: Visit http://bit.ly/m0yFE to find out more about the project from the Albert Einstein College of Medicine’s Faculty Task Force for Elimination of Disparities and Cross-Cultural Training.

Source: Patient Safety Monitor (Briefings on Patient Safety), November 2009, HCPro, Inc.

Resources:

  1. "The Office of Minority Health" at http://minorityhealth.hhs.gov/templates/browse.aspx?lvl=2&lvlID=11.
  2. Galanti, Geri-Ann,"An Introduction to Cultural Differences" at http://www.ggalanti.com/articles/Intro.pdf.
  3. New Jersey Hospital Association, "Operational Issues" at http://www.njha.com/publications/pdf/Operational_Issues.pdf.

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