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 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 ( )

AAMC Sponsorship PI: Ronald D. Garcia, PhD GOAL: Develop an integrated model curriculum throughout the preclinical and clinical curriculum.

Challenges Access to time in the required curriculum Teaching resources Development of cases Evaluation

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

Leveraging opportunities Combining resources Staff support Needs assessment Teaching activities Critical mass “Cross-cultural Medical Education Initiative”

Teaching Methods Interactive and experiential Role plays Workshop formats Patient simulations Web-based resources

Outcomes Teaching modules Interpreters Communication models Patient simulations Teaching methods Simulations Reflective experiences

NHLBI Cultural Competence and Health Disparities Education Collaborative Who we are - What we’re doing Clarence H. Braddock III, MD, MPH Stanford University

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

Deliverables Curriculum development & implementation Medical students Residents Practicing physicians Evaluation Dissemination to all U.S. medical schools

NHLBI Cultural Competence and Health Disparities Education Collaborative * * *

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.

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

Current collaborative projects  Curriculum needs assessment: AAMC’s Tool for Assessing Cultural Competence Training (TACCT)  Dissemination: Web Portal  Faculty development: Stanford Faculty Development Center

Curriculum Dissemination Web Portal Project

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.

Faculty Development Stanford Faculty Development Center (SFDC)

Stanford Faculty Development Center

Clinical Teaching Program Professionalism in Contemporary Practice Program Seminar Facilitators Seminar Participants (Faculty & Residents) LearnersInstitution Dissemination Model Dissemination Model Nationally & internationally since 1986 Previous Programs: Previous Programs: Preventive Medicine Preventive Medicine Medical Decision Making Medical Decision Making End-of-Life Care End-of-Life Care Geriatrics in Primary Care Geriatrics in Primary Care

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

Shared Decision Making Evidence- Based Practice Evidence- Based Practice Working in Teams Quality Improvement Patient Safety Reflective Practice Professionalism in Contemporary Practice Defining Professionalis m Defining Professionalis m Cultural Competence

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

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

Design HBAS “Pre” HBAS “Retro-Pre” & “Post” Cultural Competence Module

HBAS: Results (RetroPre v Post): Opinion Retro- Pre Post Mean T-test P-value0.002 Belief Retro- Pre Post Mean T-test P-value<0.001

HBAS: Results (RetroPre v Post) Context Retro- Pre Post Mean T-test-3.96 P-value<0.001 Quality Retro- Pre Post Mean T-test-2.6 P-value0.006

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