cross-cultural medical education at stanford university
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Cross-cultural Medical Education at Stanford University. Clarence H. Braddock III, MD, MPH Ronald D. Garcia, PhD. NIH(NHLBI) Sponsorship. PI: CH Braddock III, MD, MPH - PowerPoint PPT PresentationTRANSCRIPT
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Cross-cultural Medical Education at Stanford University
Clarence H. Braddock III, MD, MPHRonald D. Garcia, PhD
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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)
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AAMC SponsorshipPI: Ronald D. Garcia, PhD GOAL: Develop an integrated model
curriculum throughout the preclinical and clinical curriculum.
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Challenges Access to time in the required
curriculum Teaching resources Development of cases Evaluation
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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
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Leveraging opportunities Combining resources
Staff support Needs assessment Teaching activities
Critical mass “Cross-cultural Medical Education
Initiative”
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Teaching Methods Interactive and experiential Role plays Workshop formats Patient simulations Web-based resources
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Outcomes Teaching modules
Interpreters Communication models Patient simulations Teaching methods
SimulationsReflective experiences
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NHLBI Cultural Competence and Health Disparities Education Collaborative
Who we are - What we’re doing
Clarence H. Braddock III, MD, MPH
Stanford University
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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
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Deliverables Curriculum development &
implementation Medical students Residents Practicing physicians
Evaluation Dissemination to all U.S. medical
schools
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NHLBI Cultural Competence and Health Disparities Education Collaborative
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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.
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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
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Current collaborative projects Curriculum needs assessment:
AAMC’s Tool for Assessing Cultural Competence Training (TACCT)
Dissemination: Web Portal Faculty development: Stanford Faculty
Development Center
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Curriculum Dissemination
Web Portal Project
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Web Portal: GoalsTo 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.
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Faculty Development
Stanford Faculty Development Center(SFDC)
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Stanford Faculty Development Center
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Stanford Faculty Development Center
Clinical Teaching Program -1986
Professionalism in Contemporary Practice
Program - 2003
Seminar Facilitators
Seminar Participants(Faculty & Residents)
Learners Institution
DisseminationDissemination Model ModelNationally & 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
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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
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Shared Decision Making
Evidence-Based
Practice
Working in Teams
Quality Improvement
Patient Safety
Reflective Practice
Professionalism in Contemporary Practice
DefiningProfessionalis
m
Cultural Competence
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Cultural Competence Module Learning GoalsParticipants 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
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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
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Design
HBAS“Pre”
HBAS“Retro-Pre” &
“Post”
Cultural Competence Module
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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
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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
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Coming soon…“Enhancing multicultural education & practice”SFDC - In Development
1. Health disparities – overview of evidence & causes2. Definitions of culture, race, ethnicity 3. Reflective practice and self-awareness of beliefs and
biases4. Linguistic barriers– use of interpreters, CLAS standards,
etc.5. Exploring health beliefs & explanatory models of illness6. Educational methods/resources 7. Evaluation & assessment methods & tools
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