The Third National Conference on
Quality Health Care for Culturally Diverse Populations:
Advancing Effective Health Care through Systems Development, Data, and Measurement

October 2 - 4, 2002, Chicago, IL
Westin Chicago River North Hotel

Workshop C: Cross-cultural education across the continuum

Addressing cultural competency across the medical education continuum: Training the faculty, creating the tools, and evaluating the Impact Sociocultural Medicine refers to the understanding, incorporation, and application of sociocultural factors in medicine, health, and patient care. We elect to use this term in place of? Cultural diversity? or ? Cultural competency? As it reflects, more specifically, the culture of clinical medicine.

In response to the growing diversity of the US population and the vast research literature documenting disparities in health between social and cultural groups, the Liaison Committee on Medical Education (LCME) recently adopted? Cultural diversity? As a topic all medical school programs must include to meet accreditation standards. The Accreditation council for graduate medical education (ACGME) has also included cultural diversity within one of the six competencies all house officers must demonstrate. The goals for workshop are to address the process of training medical students, house officers, and faculty how to effectively care for diverse patient communities. Three specific areas of discussion include: (1) recruiting and training the faculty (2) designing educational tools and methods, and (3) evaluating educational outcomes. Ultimately, workshop participants will generate effective tools, strategies, and approaches to incorporating? Sociocultural medicine? curricula that are viable for their respective undergraduate and graduate medical programs.

Objectives:
The overall purpose of this workshop is to discuss and generate effective approaches and strategies for developing, implementing, and evaluating an undergraduate and graduate medical curriculum in? Sociocultural medicine? Utilizing the experience of the workshop leaders at Massachusetts General Hospital and the University of Michigan Medical School. This workshop will place a special emphasis on three components: faculty recruitment and training, educational tools and interventions, and evaluation methods.

• To discuss faculty recruitment mechanisms and faculty development opportunities
  
• To generate innovative tools, strategies, and methods for teaching this curricula
• To develop evaluation methods to assess educational impact

Brief Summary:
The workshop will be structured as follows:

1. Introduction
2. Faculty recruitment and training
3. Educational Tools and Methods
4. Evaluation methods
5. Wrap-up discussion

Within the Faculty Recruitment and Training, Educational Tools and Methods, and Evaluation segments, participants will have the opportunity to discuss existing challenges, observe one model to addressing these barriers (Workshop leaders? experience), and brainstorm novel solutions viable for their institutions. The small group discussions will be organized in a curriculum team format.

Introduction: (15 minutes)
Workshop leaders will give introductions regarding their background, academic affiliation, and specific interest in workshop topic.

Following the introduction, a brief presentation will be given describing the rationale for the workshop. Objectives of the workshop will be presented. Workshop leaders will raise three main challenges to developing and implementing a curriculum in sociocultural medicine based on their experience and those of other educators in this field.

Faculty Recruitment and Training: (30 minutes)
Workshop leaders will initiate a discussion on the challenges to faculty recruitment and faculty training for this curriculum. This discussion will be followed by a presentation on recruitment strategies and faculty development programs that have been successful. Small group curriculum teams will convene to brainstorm approaches to recruiting faculty and designing faculty training programs. Curriculum teams will re-convene to larger group to report ideas discussed.

Educational tools and methods: (30 minutes)
Workshop leaders will initiate a discussion on challenges to teaching this curriculum. Leaders will then present several educational tools and methods that have been effective in teaching the curriculum including video trigger tapes, student and faculty generated sociocultural training cases, interdisciplinary approaches (culture and bioethics), small group case conferences, OSCE stations, etc.

Small group curriculum teams will convene to brainstorm educational tools and approaches that will work within the structure and curriculum of their respective institutions. Curriculum teams will re-convene to the larger group to report ideas generated.

Evaluation: (30 minutes)
Workshop leaders will initiate a discussion on challenges to evaluating the impact of these curriculum programs. Leader will then present several qualitative and qualitative approaches to evaluation utilized to assess changes in attitudes, behaviors, and clinical skills including paper-pencil surveys, standardized patients, reflective exercises, etc. Small group curriculum teams will convene to brainstorm approaches to evaluating this curriculum across the four years of medical training. Curriculum teams will re-convene to larger group to report ideas discussed.

Wrap-up: (15 minutes)
The workshop will conclude with ideas for collaboration and future directions for Sociocultural Medicine-type curriculum programs. Participants will be invited to discuss possible areas where collaborative relationships can be formed among departments and schools within an academic institution as well as collaborative efforts across academic institutions. A specific emphasis will be placed on collaboration related to designing and piloting curriculum evaluation approaches

Narrative biosketches of workshop presenters
Dr. Betancourt’s primary interests include cross-cultural medicine, minority recruitment into the health professions, and minority health/health policy research. He is currently a Principal Investigator on grants from the Center for Medicare and Medicaid Services and the Commonwealth Fund, in addition to being co-investigator on a project funded by the National Cancer Institute.

Dr. Betancourt served on the New York Academy of Medicine’s Racial/Ethnic Disparities Working Group and the Greater New York Hospital Association’s Steering Committee on Racial/Ethnic Disparities. He is on the CDC’s National Expert Council for the Diabetes Today Program, and is a reviewer for the American Medical Association’s Journal Consortium and Annals of Internal Medicine.

Dr. Betancourt served on the Institute of Medicine’s (IOM) Committee on Understanding and Eliminating Racial/Ethnic Disparities in Health Care and Physician’s for Human Rights Blue Ribbon Panel on Racial/Ethnic Disparities in Health. He was recently named to an IOM Committee on developing a national health care disparities report. He is the author of several publications on issues such as hypertension in minority communities, cross-cultural care, ethics, workforce diversity, and the impact of language barriers on health care. Dr. Betancourt also teaches cross-cultural medicine to medical students and residents at MGH-Harvard Medical School.

Joseph Betancourt, MD, MPH
Senior Scientist, Institute for Health Policy
Director for Multicultural Education, Multicultural Affairs Office
Massachusetts General Hospital-Harvard Medical School
50 Staniford Street, Suite 942
Boston, MA 02114
Phone: 617-724-9713
Fax: 617-724-4738
E-mail: jbetancourt@pol.net

Dr. Tricia S. Tang is an assistant professor in the Department of Medical Education and the Director of the Sociocultural Medicine Program at the University of Michigan Medical School. Her work in medical education includes the development, implementation, and evaluation of curriculum in Sociocultural Medicine.

Sociocultural Medicine is a new curricular area that addresses the understanding, incorporation, and, application of sociocultural factors in health, medicine, and patient care. Dr. Tang is involved in faculty development and evaluation/outcomes research associated with the Sociocultural Medicine Program. Specific areas of focus include designing educational tools and methods to facilitate learning across all four years of undergraduate medical training as well as training faculty and residents how to effectively care for diverse patient communities. Listed below are representative publications related to Dr. Tang’s work.

1. Tang TS, Fantone JC, Bozynski MA, Adams BS: Implementation and evaluation of an Undergraduate Sociocultural Medicine Program. Acad Med (in press).
2. Tang TS, White CB, Gruppen L: Does spirituality matter: Establishing relevance and generating skills. Acad Med (in press).
3. Tang TS, Adams BS, Skye EP: Playing the role of a bioethics committee: Creative approaches to teaching culture and bioethics. Acad Med (in press).

   Tricia S. Tang, PhD
   Assistant Professor
   University of Michigan Medical School
   G1206 Towsley Center, Box 0201
   Ann Arbor, MI 4819-0201
   Phone: 734-936-1646
   Fax: 734-936-1641
   E-mail: tangts@umich.edu

Melanie Tervalon MD, MPH is a pediatrician, consultant, UCSF School of Medicine Faculty member, and a 30-year resident of Oakland, California. Dr. Tervalon brings twenty years of rich, textured health care experiences to her practice. Her work for clients includes: guiding leaders and teams from ideas to products as a project director and facilitator, crafting funding initiatives, writing position papers, and providing expert knowledge in public health, pediatrics, and culture in health.

In January 2000, Dr. Tervalon joined Dr. Nancy Adler, a behavioral scientist, as co-coordinator of the faculty work of integrating issues of culture, community and behavior into the UCSF School of Medicine curriculum redesign. Prior to this, Dr. Tervalon served as Senior Advisor, Special Projects, in the Office of the President at The California Endowment, from 1998-1999. In that capacity, Dr. Tervalon provided analysis and recommendations, at the request of the President, for achieving internal and external goals.

From 1992 through 1998, Dr. Tervalon was employed at Children’s Hospital Oakland where she provided direct patient care and instruction to pediatric interns and residents. In April 1994, under her direction, the Multicultural Curriculum Program was created at Children’s Hospital Oakland, a program based on a teaching partnership, which places community scholarship and leadership at the center of health care education and practice. In 1998, she co-authored the article: Cultural Humility versus Cultural Competence: A Critical Distinction in Defining Physician Training versus Cultural Competence: A Critical Distinction in Defining Physician Training Outcomes in Multicultural Education.

Dr. Tervalon completed her medical degree at the University of California, San Francisco, a pediatric residency-training program at Children’s Hospital Oakland, a Masters degree in Public Health at the University of California, Berkeley, and a Pew Fellowship in Health Policy studies at the Institute of Health Policy Studies, University of California, San Francisco. Dr. Tervalon currently serves as Vice Chair of Alameda County’s Children and Families Commission.

Melanie Tervalon, MD, MPH
2620 Cole Street
Oakland, CA 94601
Phone: 510-534-3117
Fax: 510-534-3011
E-mail: mtervalon@earthlink.net

Dr. Green is Associate Director of the Primary Care Internal Medicine Residency Program at the New York Presbyterian Hospital-Weill Medical College of Cornell University and an Assistant Professor of Medicine. He received his Bachelor of Science and medical degree from the University of California, San Diego, and completed his residency training in internal medicine at the New York Hospital-Cornell Medical Center. Following residency he served as a National Health Services Corps Fellow providing primary care in the culturally diverse and underserved community of Long Island City, Queens.

Dr. Green's interest in cultural issues in medicine and in caring for underserved patients dates back to college and medical school experiences in San Diego working in free clinics near the Mexican border and in Baja California. During residency at Cornell Medical Center he helped to organize a community-based family medicine residency program in Santiago, Chile. Starting in 1997 Dr. Green and colleagues have developed, implemented, and taught a successful and innovative curriculum in cross-cultural medicine to internal medicine residents and medical students which has received wide recognition as a model program.

His research interests center around understanding and improving health care delivery to socially and culturally diverse patient populations. His work has been funded by the Health Care Financing Administration, the Commonwealth Fund, and the National Institute of Health. Dr. Green has presented his work in the area of cross-cultural medicine many national conferences, and has guest lectured and presented grand rounds at medical schools and residency programs in New York and around the country. He is on the steering committee of the Northeast Consortium for Cross-Cultural Medical Education, the Greater New York Hospital Association's Health Disparities Workgroup, and several other academic and government panels. He has written several articles and a book chapter on the subject of cross-cultural medicine and medical education.

Alexander R. Green, MD
Assistant Professor of Medicine
Weill Medical College of Cornell University
E-mail: alexgreen@pol.net

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