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PROJECT INTERACT : A Predoctoral Training Program for Cultural and Interdisciplinary Competency The University of Medicine and Dentistry of New Jersey.

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Presentation on theme: "PROJECT INTERACT : A Predoctoral Training Program for Cultural and Interdisciplinary Competency The University of Medicine and Dentistry of New Jersey."— Presentation transcript:

1 PROJECT INTERACT : A Predoctoral Training Program for Cultural and Interdisciplinary Competency The University of Medicine and Dentistry of New Jersey School of Osteopathic Medicine (UMDNJ-SOM) Department of Family Medicine.

2 Presenters Carman A. Ciervo, D.O., FACOFP Carman A. Ciervo, D.O., FACOFP Chair, Department of Family Medicine Frank A. Filipetto, D.O., FACOFP Frank A. Filipetto, D.O., FACOFP Vice Chair, Department of Family Medicine Claudia A. Switala, M.Ed. Claudia A. Switala, M.Ed. Program Development Specialist

3 Funding This project is supported by funds received from the Department of Health and Human Services (DHHS), Health Resources and Services Administration (HRSA), Bureau of Health Professions (BHPr), under Predoctoral Training Grants. The information or content and conclusions are those of the authors and should not be construed as the official position or policy of, nor should any endorsements be inferred by, the DHHS, HRSA, or the U.S. Government.

4 Rationale and Process Presented by Carman A. Ciervo, D.O., FACOFP

5 Cultural Competency Definition The Association of American Medical Colleges: The Association of American Medical Colleges: an awareness of self and ones own value systems; an understanding of culture and its role as a factor in health and health care; a sensitivity to cultural issues for each patient; and an understanding and ability to use specific methods to deal effectively with cultural issues in interacting with individual patients, their families, members of the healthcare team and the wider community. an awareness of self and ones own value systems; an understanding of culture and its role as a factor in health and health care; a sensitivity to cultural issues for each patient; and an understanding and ability to use specific methods to deal effectively with cultural issues in interacting with individual patients, their families, members of the healthcare team and the wider community.

6 Challenges to Healthcare Providers In todays health care environment, physicians must know how to communicate, negotiate, interact, make decisions and problem-solve with other healthcare professionals to effectively deliver health care services. In todays health care environment, physicians must know how to communicate, negotiate, interact, make decisions and problem-solve with other healthcare professionals to effectively deliver health care services.

7 Cultural Competence and Interdisciplinary Skills The Association of American Medical Colleges put forth recommendations on curriculum that establish the principle that cultural diversity programs be integrated throughout medical curricula with a focus on interdisciplinary learning.[1] The Association of American Medical Colleges put forth recommendations on curriculum that establish the principle that cultural diversity programs be integrated throughout medical curricula with a focus on interdisciplinary learning.[1][1] [1] Association of American Medical Colleges, Resolution on Cultural Diversity as a LCME Accreditation Standard. [1]

8 Project Interact A HRSA funded Predoctoral Training Grant A HRSA funded Predoctoral Training Grant A Collaborative Model A Collaborative Model Standardized Patient Lab as Focal Point Standardized Patient Lab as Focal Point

9 Project Interact Committee UMDNJ School of Osteopathic Medicine UMDNJ School of Osteopathic Medicine Family Medicine Family Medicine Internal Medicine Internal Medicine Pediatrics Pediatrics OB/Gyn OB/Gyn Psychiatry Psychiatry Center for Aging Center for Aging Predoctoral Students Predoctoral Students

10 Project Interact Committee School Health Related ProfessionsSchool Health Related Professions School of NursingSchool of Nursing School of Public HealthSchool of Public Health School of Dental MedicineSchool of Dental Medicine New Jersey Area Health Education CenterNew Jersey Area Health Education Center

11 A Collaborative Model Through three Components Through three Components Curriculum Curriculum Standardized Patient Lab Standardized Patient Lab Community Service Rotation Community Service Rotation

12 Incorporating Cultural and Interdisciplinary Competencies into the Predoctoral Curriculum Presented by Frank A. Filipetto, D.O., FACOFP

13 Family Medicine Faculty Identified all FM Curriculum throughout the four years. Identified all FM Curriculum throughout the four years. Discussed where competencies could be learned. Discussed where competencies could be learned. Developed curriculum modules. Developed curriculum modules. Developed Standardized Patient Cases with cultural considerations and interdisciplinary needs Developed Standardized Patient Cases with cultural considerations and interdisciplinary needs

14 Establishing Competencies Intensive faculty development Intensive faculty development Identified cultural and interdisciplinary competencies Identified cultural and interdisciplinary competencies Incorporated competencies into all Family Medicine courses Incorporated competencies into all Family Medicine courses Creation of standardized patient cases Creation of standardized patient cases

15 First Year Health disparities, health beliefs and barriers to healthcare Health disparities, health beliefs and barriers to healthcare Cultural awareness Cultural awareness Interdisciplinary principles and concepts Interdisciplinary principles and concepts Cultural heritage and lifestyle assessment Cultural heritage and lifestyle assessment

16 Second Year Performing cultural and lifestyle assessments Performing cultural and lifestyle assessments Communicating through an interpreter Communicating through an interpreter Implement interdisciplinary concepts via core projects Implement interdisciplinary concepts via core projects Identify subcultures and its impact on healthcare Identify subcultures and its impact on healthcare

17 Third Year Two weeks after rotation exposing students to health disparities and interdisciplinary care Two weeks after rotation exposing students to health disparities and interdisciplinary care Telling bad news Telling bad news Resolving conflict Resolving conflict

18 Fourth Year Troublesome bequests – cultural explanations and interdisciplinary solutions to ethical dilemmas Troublesome bequests – cultural explanations and interdisciplinary solutions to ethical dilemmas Physician assisted suicide Truth telling HIV confidentiality

19 Student Outcomes Presented by Claudia A. Switala, M.Ed.

20 Demographic Data on Project Interact Participants Academic Year n=322 Sex Sex Females 163 Females 163 Males159 Males159 Class Class MS I 89 MS II 81 MS III71 MS IV81

21 Demographic Data on Project Interact Participants Academic Year n=322 Ethnic Racial Demographics Ethnic Racial Demographics 73 Underrepresented minorities 73 Underrepresented minorities (African American, Hispanic, Native American, Vietnamese) (African American, Hispanic, Native American, Vietnamese) 74 Other Minorities (Chinese, Japanese, Philipino, Indian) 74 Other Minorities (Chinese, Japanese, Philipino, Indian) 175Caucasians 175Caucasians

22 Assessment of First Year Students n=89 Cultural Self Awareness Tool Cultural Self Awareness Tool 78% Willing to identify own culture 78% Willing to identify own culture 54% Willing to identify and share health beliefs and practices 54% Willing to identify and share health beliefs and practices 7% Willing to identify stereotypes that they have of other cultures 7% Willing to identify stereotypes that they have of other cultures 52% Willing to identify typical stereotypes you have heard about other cultures 52% Willing to identify typical stereotypes you have heard about other cultures 48% Willing to identify biases and prejudices. 48% Willing to identify biases and prejudices.

23 Assessment of First Year Students n=89 S P Case I : Conducting Cultural Heritage Assessment / Completion of Genogram S P Case I : Conducting Cultural Heritage Assessment / Completion of Genogram 91% Identified Cultural considerations 91% Identified Cultural considerations 84% Identified Interdisciplinary needs 84% Identified Interdisciplinary needs 88% Identified Psychosocial issues 88% Identified Psychosocial issues 76% Identified Economic issues 76% Identified Economic issues

24 Assessment of First Year Students n=89 S P Case II: Overweight Adult S P Case II: Overweight Adult 92% Identify cultural aspects impacting on case (Family, Religion and Diet) 92% Identify cultural aspects impacting on case (Family, Religion and Diet) 87% Identify interdisciplinary support system for patient. (Church, Nutritionist and Family) 87% Identify interdisciplinary support system for patient. (Church, Nutritionist and Family)

25 Assessment of Second Year Students n=81 S P Case I: Migrant Worker with Back Pain and Language Barrier S P Case I: Migrant Worker with Back Pain and Language Barrier 80% Provided appropriate instruction to interpreter 80% Provided appropriate instruction to interpreter 78% Placed interpreter in appropriate position in relation to patient 78% Placed interpreter in appropriate position in relation to patient 82% Focused on patient, not interpreter 82% Focused on patient, not interpreter 81% Conducted a cultural and lifestyle assessment 81% Conducted a cultural and lifestyle assessment 72%Identified impact of cultural issues on patients health (family support, family not in this country) 72%Identified impact of cultural issues on patients health (family support, family not in this country) 68%Identified interdisciplinary resources for patient 68%Identified interdisciplinary resources for patient

26 Assessment of Second Year Students n=81 S P Case II – Physical Exam S P Case II – Physical Exam 71% Treated the patient respectfully with regards to privacy 71% Treated the patient respectfully with regards to privacy 52% Asked permission of patient to begin the exam 52% Asked permission of patient to begin the exam 55%Prepares patient for what they are about to do during the exam 55%Prepares patient for what they are about to do during the exam 73%Does not use medical jargon 73%Does not use medical jargon

27 Assessment of Third Year Students Two week Community Service Rotation n=71 Comments taken from their logs. Comments taken from their logs. 91% Rated experience as meaningful, positive, worthwhile. 91% Rated experience as meaningful, positive, worthwhile. 78% Indicated appreciation for work of interdisciplinary team members 78% Indicated appreciation for work of interdisciplinary team members 47% Were more appreciative of their own lives 47% Were more appreciative of their own lives 69% Indicated they had a better understanding of the complex psychosocial and economic issues impacting on health 69% Indicated they had a better understanding of the complex psychosocial and economic issues impacting on health

28 Assessment of Third Year Students n=71 42% Appreciated the dedication and hard work of physicians in medically underserved communities. 42% Appreciated the dedication and hard work of physicians in medically underserved communities. 52%Recognized that patients in underserved communities respect and appreciate the physician. 52%Recognized that patients in underserved communities respect and appreciate the physician. 22%Would want to continue to volunteer time at their rotation site 22%Would want to continue to volunteer time at their rotation site 29% Said they would work in a medically underserved community after graduation 29% Said they would work in a medically underserved community after graduation

29 Assessment of Third Year Students n=71 S P Case I: Telling Bad News S P Case I: Telling Bad News 78% Asked what patient knew about illness 78% Asked what patient knew about illness 81%Asked if patient wanted someone with them. 81%Asked if patient wanted someone with them. 84%Assessed willingness of patient to hear bad news 84%Assessed willingness of patient to hear bad news 82%Demonstrated verbal or non verbal empathy to patient. 82%Demonstrated verbal or non verbal empathy to patient.

30 Assessment of Third Year Students n=71 S P Case II: Interdisciplinary Team Meeting S P Case II: Interdisciplinary Team Meeting 82% Communicated effectively with team members 82% Communicated effectively with team members 85%Demonstrated respect for team members 85%Demonstrated respect for team members 78%Demonstrated knowledge of team members roles. 78%Demonstrated knowledge of team members roles. 79%Interacted as an equal with team members 79%Interacted as an equal with team members

31 Assessment of Fourth Year Students n=81 S P Case I: Ethical Request to assist with suicide (End Stage lung cancer) S P Case I: Ethical Request to assist with suicide (End Stage lung cancer) 81% discussed physician responsibilities with patient 81% discussed physician responsibilities with patient 84%identified psychosocial issues of case and negotiated with patient 84%identified psychosocial issues of case and negotiated with patient 86%determined and discussed interdisciplinary interventions with patient 86%determined and discussed interdisciplinary interventions with patient

32 Assessment of Fourth Year Students n=81 SP Case II: Truth Telling Case (Terminal Diagnosis of lung cancer and physician is meeting with daughter) SP Case II: Truth Telling Case (Terminal Diagnosis of lung cancer and physician is meeting with daughter) 95%Listened to family members concerns 95%Listened to family members concerns 78%Discussed physicians responsibilities with family members. 78%Discussed physicians responsibilities with family members. 79%Explored cultural aspect of truth telling (why you dont want mother to hear the diagnosis) 79%Explored cultural aspect of truth telling (why you dont want mother to hear the diagnosis)

33 Assessment of Fourth Year Students n=81 S P Case III: HIV / AIDS S P Case III: HIV / AIDS 82%Discussed and negotiated with patient regarding informing spouse 82%Discussed and negotiated with patient regarding informing spouse 78%Knowledgeable about N Js resources and requirements regarding HIV/AIDS 78%Knowledgeable about N Js resources and requirements regarding HIV/AIDS 86%Determined with patient the appropriate interdisciplinary interventions 86%Determined with patient the appropriate interdisciplinary interventions

34 Institutional Outcomes Changed the curriculum of SOM to include cultural and interdisciplinary training Changed the curriculum of SOM to include cultural and interdisciplinary training Changed the culture of Family Medicine and SOM Changed the culture of Family Medicine and SOM Placed Family Medicine in leadership role with regards to cultural and interdisciplinary training in the State of New Jersey Placed Family Medicine in leadership role with regards to cultural and interdisciplinary training in the State of New Jersey Governor of New Jersey signed Cultural Competency bill on our campus Governor of New Jersey signed Cultural Competency bill on our campus


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