AAMC_2006_IIME_Bradd..

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  • Key Content /Instructions (Time: 10 mins)
    We have just discussed definitions of professionalism. (click)
    Here are the other areas that we have identified as important in the world of “professionalism in contemporary practice.” (click)
    These represent a partial list, but an important list, of key domains of thought and skill necessary for contemporary practice. Our goal in this course is to provide you with an introduction to these ideas and skills, so that you can incorporate them into your work and into your teaching.
    Ask learners to think about the following areas. Ask them “What are some key elements you hope to get out of each module topic?”
    Participants will have two minutes for a free-write. Then open up the class for group sharing while you map responses onto the board.
    As you review the topics of the curriculum, explain that participants’ experiences may not map onto the PCP curriculum roadmap perfectly; these categories are meant to represent some and not all of the themes in contemporary practice. Explain that we will try our best to touch on each of these topics or provide resources for the learners.
    Q: What is this course going to do? A: Help you to meet challenges, help you to be a better teacher of this content, which adds another layer of new roles and responsibilities.
    Educational purpose
    [This is a brainstorming exercise to formulate a light Learning Plan for the course. This is a starting point and will not likely fulfill all of the learners’ goals, but presents an opportunity for self-directed learning.]
    Background information for the facilitator
  • Key Content/Instructions (Time: 2 mins)
    Remember these are your goals for the learner. They are not an agenda for the module.
    OUR GOAL: to have the learners work toward a plan for using the material in this module to improve (1) their teaching (2) their practice and (3) their institution. The thinking and discussion they do in this module will be a means to that end.
    This module will motivate an attitudinal shift in cultural perception and communication through self reflection. Our overall goal is to increase self-awareness of attitudes.
    Educational purpose
    Background information for facilitator
  • AAMC_2006_IIME_Bradd..

    1. 1. Cross-cultural Medical Education at Stanford University Clarence H. Braddock III, MD, MPH Ronald D. Garcia, PhD
    2. 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. 3. AAMC Sponsorship PI: Ronald D. Garcia, PhD  GOAL: Develop an integrated model curriculum throughout the preclinical and clinical curriculum.
    4. 4. Challenges  Access to time in the required curriculum  Teaching resources  Development of cases  Evaluation
    5. 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. 6. Leveraging opportunities  Combining resources  Staff support  Needs assessment  Teaching activities  Critical mass  “Cross-cultural Medical Education Initiative”
    7. 7. Teaching Methods  Interactive and experiential  Role plays  Workshop formats  Patient simulations  Web-based resources
    8. 8. Outcomes  Teaching modules  Interpreters  Communication models  Patient simulations Teaching methods Simulations Reflective experiences
    9. 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. 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. 11. Deliverables  Curriculum development & implementation  Medical students  Residents  Practicing physicians  Evaluation  Dissemination to all U.S. medical schools
    12. 12. NHLBI Cultural Competence and Health Disparities Education Collaborative * * *
    13. 13. Mission Statement  Our Collaborative seeks to develop curricula that enhance the ability of physicians and other health care professionals to 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. 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. 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. 16. Curriculum Dissemination Web Portal Project
    17. 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.
    18. 18. Faculty Development Stanford Faculty Development Center (SFDC)
    19. 19. Stanford Faculty Development Center
    20. 20. Stanford Faculty Development Center Clinical Teaching Program -1986 Professionalism in Contemporary Practice Program - 2003 Seminar Facilitators Seminar Participants (Faculty & Residents) Learners Institution DisseminationDissemination ModelModel Nationally & internationally since 1986 Previous ProgramsPrevious Programs:: •• Preventive MedicinePreventive Medicine •• Medical Decision MakingMedical Decision Making •• End-of-Life CareEnd-of-Life Care •• Geriatrics in Primary CareGeriatrics in Primary Care
    21. 21. 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
    22. 22. Shared Decision Making Shared Decision Making Evidence- Based Practice Evidence- Based Practice Working in TeamsWorking in Teams Quality Improvement Quality ImprovementPatient Safety Patient Safety Reflective Practice Reflective Practice Professionalism in Contemporary Practice Defining Professionalis m Defining Professionalis m Cultural Competence Cultural Competence
    23. 23. 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
    24. 24. 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
    25. 25. Design HBAS “Pre” HBAS “Retro-Pre” & “Post” Cultural Competence Module
    26. 26. HBAS: Results (RetroPre v Post): Opinion Retro- Pre Post Mean 4.94 5.13 T-test -3.040 P-value 0.002 Belief Retro- Pre Post Mean 4.69 5.06 T-test -5.516 P-value <0.001
    27. 27. HBAS: Results (RetroPre v Post) Context Retro- Pre Post Mean 5.19 5.53 T-test -3.96 P-value <0.001 Quality Retro- Pre Post Mean 4.64 4.93 T-test -2.6 P-value 0.006
    28. 28. Coming soon… “Enhancing multicultural education & practice” SFDC - In Development 1. Health disparities – overview of evidence & causes 2. Definitions of culture, race, ethnicity 3. Reflective practice and self-awareness of beliefs and biases 4. Linguistic barriers– use of interpreters, CLAS standards, etc. 5. Exploring health beliefs & explanatory models of illness 6. Educational methods/resources 7. Evaluation & assessment methods & tools

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