Overcoming the cultural boundaries that can divide or prevent a patient-doctor relationship from forming can be a difficult task. If a language barrier exists, or a mutual understanding between the parties cannot be reached, important information can be withheld or misinterpreted.
In a 2004 survey conducted at Albert Einstein College of Medicine in the Bronx, NY, more than half of the staff members said they would benefit from additional support and training on how to teach about cultural disparities and how to overcome cultural boundaries.
"Each residency program was looking for ways to include training on cultural competency in their curriculum," says Nereida Correa, MD, MPH, associate clinical professor, department of OB/GYN and women's health, and family and social medicine, and education core director at Albert Einstein College of Medicine.
With funding from the National Institute of Health (NIH) to eliminate health disparities and faculty members recognizing the need for training, program coordinator Shoshana Silberman and Correa began developing a task force to help include cultural competency training in the curriculum. The resulting program has improved how staff members address patients of many cultures, and has encouraged multicultural patients to ask more questions about their care.
Task forces and workshops to educate and inform
Staff members from Einstein's two campuses were included in the first brainstorming session of the Albert Einstein College of Medicine's Faculty Task Force for Elimination of Disparities and Cross-Cultural Training.
The main purpose of this brainstorming was to get a better feel for the level of resistance each department was getting from the faculty, what those department leaders wanted to do, and what kind of tools would help them implement a program in their department that would be acceptable to students and residents.
From this first brainstorm, the task force decided the first step toward a better implementation of cultural awareness would be through conducting workshops. From the start, the department heads and medical directors at Einstein-affiliated hospitals supported the work of the task force.
"Prior to our first workshop, the chief medical officer had been on call and came to the brainstorming session telling us of the stories from the night before," says Correa. "He believed that something should be done because while he was on call, he had three patients, all from different nationalities, that did not speak English."
From there, the group invited Debbie Salas-Lopez, MD, an expert in cultural competency and chief of the division of academic medicine, geriatrics, and community programs at New Jersey Medical School, to help with the workshops.
Correa felt that an outside expert would have more of an effect than someone who was on Einstein's staff. Students and staff members find it easier to tune out department leaders, simply because they are used to hearing them repeatedly convey the same messages, says Correa. Salas-Lopez grabbed the attention of staff members partially because she was a new voice.
In the task force's first workshop, Lopez helped develop cases dealing with cultural competency along with asking workshop members to bring in patient cases of their own.
Here, the task force was divided into work groups and each group developed their own scenarios around the patient cases that were brought to or developed at the workshop. Once each group developed its own patient case, it presented to the other members of the task force. After the presentation of the idea, the group received critiques.
At the conclusion of the workshop, the task force members were asked to go home and develop the case further and give suggestions on how these topics could be taught.
Each group had to come up with the learning objectives of the case, a narrative or case summary, a teacher's guide (explanation of case background), and then provide a bibliography and any visual aids that may have been acquired.
For example, one group created a case scenario on a pregnant HIV-positive patient who wanted the obstetrics team to lie about her condition, while another team explored issues of culture and trust: human trafficking, gynecology, and contraception.
"The biggest frustration of the task force was that they still did not know how to implement these processes," says Correa. "So we brought Lopez back, and did a role play with the case studies we had developed from the first workshop."
In this workshop, two or three work cases were chosen to role play. Members of the task force would take one of the cases, and then act it out. The group would then critique the case that was acted out, and learn how to actually put this into practice with their teachings.
To learn more about the cross-cultural residency training program that Albert Einstein College of Medicine developed, see the November issue of Briefings on Patient Safety.