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Workshop D-7: Cultural competence training in academic health centersA Model for Integrating Cultural Competence into a Medical Student CurriculumSociety is demanding more enlightened health care, particularly in terms of awareness of the immense diversity in cultures currently represented and growing in the American population. Physician-patient communication greatly influences health behavior, health care delivery, and treatment, especially among U.S. minority and underserved patient communities. Medical educators agree that medical school graduates need to possess sufficient ability and knowledge to deliver high-quality health care to all patients, including those with diverse cultural backgrounds and practices and diverse health beliefs. At the University of Michigan Medical School, we implemented a new curriculum in which students are challenged to acquire the knowledge, skills and attitudes vital to providing culturally competent health care. Our approach is integrated and longitudinal; there is a biomedical, clinical or health care context in which the cultural issues are embedded, and learning occurs and is assessed throughout the four year curriculum. In addition, expectations become progressively more complex as students advance. Learning methods are active in order to assure understanding (knowledge) and application (skills and attitudes). Examples of methods in first and second years include case-based reflective reading and discussion, longitudinal patient cases in which health care is intertwined with cultural issues, and interactions with standardized patients. Examples in the third and fourth years include skills-based seminars (e.g., how to determine an interpreter is needed and how to find and choose one), and interactions with more complex standardized patients such as a multicultural women’s health simulated patient interaction. Assessment is performance-base. It challenges each student to demonstrate cultural competence through their ability to listen carefully to what their patients are telling them, to explore beliefs and rituals that deepen their understanding of the patient’s perspective, and to frame responses and suggestions in a cultural context appropriate for the patient. This workshop will present an educational model used at the University of Michigan for integrating cultural competence longitudinally into a medical student curriculum. Activities will be designed to engage attendees in discussion about connections between relevant learning theories and effective methods for helping students achieve true cultural competence, practical health care contexts in which to embed learning, and assessment methods to assure competence has been achieved. Dr. Hammoud is Assistant Professor and director of the undergraduate medical education in the Department of Obstetrics and Gynecology at the University of Michigan Medical School. She has special interest in multicultural health care, menopause and preventive health care. She is the director of the Middle Eastern Women’s Health Program at the University of Michigan Hospital. She has given many lectures on providing health care to the Middle Eastern Population and has written a book chapter on the topic. Dr. Hammoud is also very involved with medical student education and actively participates in the development and assessment of the cultural competence curriculum at the University of Michigan Medical School. Casey White is Assistant Dean for Medical Education at the University of Michigan Medical School. Her training and expertise is in learning theory and curriculum design. Ms. White's experience and responsibilities include writing intended learning outcomes, designing and reviewing student essays related to cultural and psycho-social issues and dilemmas, designing the psycho-social and cultural aspects of longitudinal patient cases for first and second year medical students, and standardized patient scenarios and assessments for educational exercises throughout the four years of the curriculum. Broadly, Ms. White is responsible for integrating cultural training across the curriculum, and for designing and implementing appropriate assessments of student mastery.
TACCT—Approaches to Evaluating Cultural Competence Education for Medical StudentsCultural competence in health care combines the tenets of patient/family-centered care with an understanding of the social and cultural influences that affect the quality of medical services and treatment. The Liaison Committee on Medical Education (LCME) standards implemented in 2002 state: “The faculty and students must demonstrate an understanding of the manner in which people of diverse cultures and belief systems perceive health and illness and respond to various symptoms, diseases and treatments, medical students should learn to recognize and appropriately address gender and cultural biases in health care delivery, while considering the health of the patient”. Educational theory and practice make clear that to meet this standard, educational experiences must be integrated throughout the curriculum. Thus, medical schools require a valid and effective instrument to assess and enhance education for culturally appropriate care. In 2004, the Association of American Medical Colleges completed a curriculum evaluation instrument (Tool for the Assessment of Cultural Competence Training-TACCT) to assist medical schools in assessing and revising educational programs to assure culturally appropriate care. A panel with expertise in culturally appropriate care, medical education and other fields was convened for this purpose. The final instrument identifies key domains as well as the knowledge, skills and attitudes for each domain. This instrument is now being used at a number of medical schools. This session will provide an opportunity to learn from these experiences. Elements of the presentations will include:
This project is supported by a grant from the Commonwealth Fund. Ella Cleveland has been a senior staff member in the Division of Diversity Policy and Programs at the Association of American Medical Colleges for over six years. She is the Deputy Director for 26 Health Professions Partnership Initiatives, where her main function includes technical assistance on evaluation techniques. She also consults with learning specialists in the Minority Medical Education Program to increase awareness of learning styles that can enhance students’ applications to medical schools. In addition, she provides curriculum expertise to projects on cultural competence and expanding admissions. Dr. Cleveland has been developing and evaluating education projects for over thirty years—for the U.S. Congress, National Science Foundation, the Psychological Test Corporation, and for the Cleveland Public Schools. She has conducted extensive quantitative and qualitative evaluations. Dr. Cleveland holds a Ph.D. in Education Curriculum from Case Western Reserve University. Dr. Danoff is Associate Vice President, Division of Medical Education at the Association of American Medical Colleges. She is presently coordinating programs related to the practice of medicine including professionalism and teaching and learning about cultural competence. Her work on education to assure culturally appropriate care includes serving as principal investigator on The Commonwealth Fund supported project “Medical Education and Cultural Competence: A Strategy to Eliminate Racial and Ethnic Disparities in Health Care”. Since 2001, she has also been responsible for coordinating activities for the AAMC-CDC cooperative agreement (CA). This work includes the development of regional public health-medical education consortia to enhance medical student on public health and prevention as well as the development of curricular materials on topics including bioterrorism, injury prevention, and appropriate use of antibiotics. Prior to her appointment at the AAMC, Dr. Danoff was Associate Dean, Undergraduate Medical Education and Student Affairs and Professor of Medicine at McGill University.
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National Conference is presented by State University of New York Downstate Medical Center, Resources for Cross Cultural Health Care, Arthur Ashe Institute for Urban Health, US Department of Health and Human Services, Joint Commission on Accreditation of Healthcare Organizations |
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| As with the rest of Diversity Rx, this section
is a work in progress and we welcome information on other efforts, programs,
and reports that will expand upon the information offered here. Please
let us know if you have other examples to include here. |
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Diversity Rx is sponsored by: |
 The National Conference of State Legislatures |
 Resources for Cross Cultural Health Care |
 Henry J. Kaiser Family Foundation |
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