Cultural CompetenceCultural Competence

Culture is the widening of the mind Culture is the widening of the mind and of the spirit and of the spirit --- Jawaharlal --- Jawaharlal NehruNehru

© 2002 Sayantani DasGupta

COMMUNITY PEDIATRICSCOMMUNITY PEDIATRICS COLUMBIA UNIVERSITY

D escribe how health insurance,entitlem ent p rog ram s and the healthcare system affect access to care for

patients in the com m unity

A pp ly bas ic ep idem iolog ica l concep tsand p rinc ip les to health re la ted

issues in the com m unity

P erform a com m unity needs and assestsanalys is and d iscuss the ir in fluence

on health care p rob lem s and outcom es

D escribe the W ashing ton H eights andH arlem com m unities and how the ir

resources affect ch ild health

E xp la in m ajor env ironm enta l,soc ia l, econom ic, and politica l factors

affecting ch ildren 's health

COMMUNITY HEALTH

D ev elop sk ills to com m unicate andelic it in form ation from the patient andfam ily about the ir health belie f system

and soc io-cu ltura l backg round

R ecognize and m anage the cu ltura la ttr ibutes and b iases that the

p rov ider b rings in to any c lin ica lencounter

D em onstrate an ab ility to formtherapeutic a lliances w ithpatients from a varie ty o f

soc io-cu ltura l backg rounds

E xp la in how belie fs , cu ltures, and ethnicp ractices can in fluence health s tatus

and care for ch ildren of the com m unity

CULTURAL COMPETENCY

H elp patients w ith com p lex m edica lp rob lem s negotia te the health care system

U se advocacy sk ills to dev elopa p lan of action regard ing re lev ant

com m unity health issues

A rticu la te the im portance of thepediatric ian 's ro le as an advocate at

every leve l ( ind iv idual, com m unity, national)

ADVOCACY

COMMUNITY PEDIATRICS

Workshop GoalsWorkshop Goals

Define cultural competency and discuss Define cultural competency and discuss rational for use/learning rational for use/learning

Physician Culture - To explore the rich Physician Culture - To explore the rich cultural backgrounds and potential cultural backgrounds and potential biases that physicians bring to clinical biases that physicians bring to clinical encounters.encounters.

To discuss medical culture and the To discuss medical culture and the hidden curriculum.hidden curriculum.

To introduce second year residents to To introduce second year residents to the cultural competency curriculumthe cultural competency curriculum

© 2002 Sayantani DasGupta

NormsNorms

One person at a timeOne person at a time Respect the opinions of others - all Respect the opinions of others - all

opinions are validopinions are valid Share depending on your level of Share depending on your level of

comfortcomfort Confidentiality - don’t share Confidentiality - don’t share

information you may have learned information you may have learned about othersabout others

Have fun!Have fun!© 2002 Sayantani DasGupta

Problem statementProblem statement

1. Racial and ethnic disparities in 1. Racial and ethnic disparities in health carehealth care

2. Many people who go to their 2. Many people who go to their doctor are not satisfied doctor are not satisfied

3. Most medical visits are not for 3. Most medical visits are not for biologically based illnessesbiologically based illnesses

© 2002 Sayantani DasGupta

The Name GameThe Name Game

Tell the story of your name and its Tell the story of your name and its origins origins

- ethnicity- ethnicity - family history- family history - birthplace/where you are from- birthplace/where you are from

© 2002 Sayantani DasGupta

DefinitionsDefinitions

Race: Classification of individuals Race: Classification of individuals who possess distinctive physical who possess distinctive physical characteristics that are transmitted characteristics that are transmitted genetically.genetically.

Ethnicity: Races or groups of Ethnicity: Races or groups of people who are classed according people who are classed according to common background, languages, to common background, languages, traits, customs, or appearance. traits, customs, or appearance.

© 2002 Sayantani DasGupta

DefinitionsDefinitions

Cultural Group: People with Cultural Group: People with common origins, customs, and common origins, customs, and styles of living; sense of identity styles of living; sense of identity and a shared language. No and a shared language. No cultural group is homogenous, but cultural group is homogenous, but contains diversity.contains diversity.

© 2002 Sayantani DasGupta

Cultural CompetencyCultural Competency

Synonyms:Synonyms: Culturally effective health careCulturally effective health care Culturally sensitive health careCulturally sensitive health care Cross-cultural medicineCross-cultural medicine MulticulturalismMulticulturalism

““Culturally Effective Culturally Effective Healthcare:”Healthcare:”

Appropriate physician knowledge, Appropriate physician knowledge, understanding, and appreciation of understanding, and appreciation of cultural distinctionscultural distinctions

Takes into account the beliefs, values, Takes into account the beliefs, values, actions, customs, and unique health actions, customs, and unique health care needs of distinct population groupscare needs of distinct population groups

Strengthens the physician-patient Strengthens the physician-patient relationship and maximizes the health relationship and maximizes the health status of patientsstatus of patients

Increased Focus on Increased Focus on TrainingTraining

AAPAAP APAAPA AMAAMA STFMSTFM LCMELCME State Legislatures State Legislatures Department of Health and Human Department of Health and Human

ServicesServices

AAP Committee on AAP Committee on Pediatric Workforce policy Pediatric Workforce policy

statement statement

Advocates training at all levelsAdvocates training at all levels– Medical schoolMedical school– ResidencyResidency– Continuing Medical EducationContinuing Medical Education

Research: “Can Cultural Research: “Can Cultural Competency Reduce Racial Competency Reduce Racial

and Ethnic Disparities?”and Ethnic Disparities?”

Racial and Ethnic disparity dataRacial and Ethnic disparity data Data documenting increased Data documenting increased

satisfaction with Interpreter usesatisfaction with Interpreter use Data documenting increased Data documenting increased

trainee knowledge and skillstrainee knowledge and skills

Physician CulturePhysician Culture

To know others, we must first know To know others, we must first know ourselves ourselves --- --- AdageAdage

© 2002 Sayantani DasGupta

Workshop ExerciseWorkshop Exercise

This exercise is designed to help This exercise is designed to help you assess your own cultural you assess your own cultural heritage, including experiences heritage, including experiences that may influence your ability to that may influence your ability to work with patients from diverse work with patients from diverse backgrounds. backgrounds.

There are no right or wrong There are no right or wrong answers.answers.

© 2001 Sayantani DasGupta

Workshop ExerciseWorkshop Exercise

What ethnic group, socioeconomic What ethnic group, socioeconomic class, religion, age group and class, religion, age group and community do you belong to?community do you belong to?

What is the first experience you had What is the first experience you had with people from an ethnic group, with people from an ethnic group, religion, age group or community not religion, age group or community not your own? What was that experience your own? What was that experience like? How did you feel about it?like? How did you feel about it?

© 2001 Sayantani DasGupta

Workshop ExerciseWorkshop Exercise What socio-cultural factors in your What socio-cultural factors in your

background might contribute to your background might contribute to your being rejected by others? Have you being rejected by others? Have you experienced prejudice from others?experienced prejudice from others?

What personal qualities do you have What personal qualities do you have that will help you establish that will help you establish interpersonal relationships from interpersonal relationships from other cultural groups? What personal other cultural groups? What personal qualities may be detrimental? qualities may be detrimental?

© 2001 Sayantani DasGupta

Exercise SummaryExercise Summary

What were the assumptions you What were the assumptions you made about your partners before made about your partners before they talked? Did you predict what they talked? Did you predict what they were going to say?they were going to say?

Was anything difficult to discuss? Was anything difficult to discuss? Did anything make you Did anything make you uncomfortable?uncomfortable?

What did you learn?What did you learn?© 2001 Sayantani DasGupta

AwarenessAwareness

Individual Cultural HeritageIndividual Cultural HeritageIncludes provider’s own cultural family Includes provider’s own cultural family

beliefs and upbringing re: health beliefs and upbringing re: health etiology, treatments and illness etiology, treatments and illness behaviors.behaviors.

How does provider culture impact How does provider culture impact the health encounter?the health encounter?

AwarenessAwareness

How does the provider’s culture How does the provider’s culture impact the clinical encounter?impact the clinical encounter?– Arthur Kleinman’s work: Arthur Kleinman’s work:

Disease vs. Illness Disease vs. Illness– Discordant explanatory models can Discordant explanatory models can

disrupt the clinical encounter.disrupt the clinical encounter.

Individual Health Beliefs Individual Health Beliefs ExerciseExercise

What were some of the values in What were some of the values in your family around health?your family around health?

What were some of the beliefs and What were some of the beliefs and healing methods used?healing methods used?

AwarenessAwareness

Biomedical CultureBiomedical CultureNot Value-NeutralNot Value-Neutral

Every Patient Encounter is a “Cross-Every Patient Encounter is a “Cross-Cultural Experience”Cultural Experience”

The Anger IssueThe Anger Issue

What are patients expectations of What are patients expectations of doctors?doctors?

What are our expectations of What are our expectations of patients?patients?

How do institutional policies How do institutional policies increase this conflict?increase this conflict?

Medical CultureMedical Culture

What are the positive values of What are the positive values of medical culture?medical culture?

What are the values of medical What are the values of medical culture you would like to change?culture you would like to change?

How are these values passed on?How are these values passed on? Have you ever been in an Have you ever been in an

uncomfortable cultural situation uncomfortable cultural situation among colleagues?among colleagues?

© 2002 Sayantani DasGupta

The Hidden CurriculumThe Hidden Curriculum

What was being taught that was What was being taught that was consistent with biomedical consistent with biomedical curricula?curricula?

What was being taught that was What was being taught that was outside the biomedical curriculum?outside the biomedical curriculum?

CurriculumCurriculum

YR1: Introduction to Cultural YR1: Introduction to Cultural Competency & Language Skills Competency & Language Skills

YR2: Issues of Provider and Patient YR2: Issues of Provider and Patient Culture Culture

YR3: Communication Skills and YR3: Communication Skills and Cultural ExchangeCultural Exchange

© 2002 Sayantani DasGupta

Components of TeachingComponents of Teaching

AwarenessAwareness KnowledgeKnowledge SkillsSkills

Intake EthnographyIntake Ethnography

An exercise designed to give a hands-An exercise designed to give a hands-on example of the hidden curriculumon example of the hidden curriculum

Intake rounds will be both audio taped Intake rounds will be both audio taped and you will take notes regarding the and you will take notes regarding the nature of the interaction.nature of the interaction.

Your observations will be discussed in a Your observations will be discussed in a meeting subsequent to the experience.meeting subsequent to the experience.

© 2002 Sayantani DasGupta

Wrap upWrap up

Name gameName game Definitions of Race, Ethnicity, Culture Definitions of Race, Ethnicity, Culture

and cultural competenceand cultural competence Mandates and rational for learning Mandates and rational for learning

about these issuesabout these issues Individual health beliefsIndividual health beliefs Medical culture: Illness Vs DiseaseMedical culture: Illness Vs Disease AngerAnger Hidden CurriculumHidden Curriculum