LIME 2009 Culturally Safe Clinicians

Training and Education Undergraduate, graduate coursework Undergraduate, graduate coursework Prevocational and vocational training Prevocational and vocational training Vertical integration of curriculum and clinical experience Vertical integration of curriculum and clinical experience CME CME Responsibility across sector, health workforce Responsibility across sector, health workforce

Systems Issues Creating culturally safe environments Creating culturally safe environments Systems reform inclusive of attitudinal and behavioural change Systems reform inclusive of attitudinal and behavioural change Zero tolerance for racist, discriminatory behaviours Zero tolerance for racist, discriminatory behaviours Accountability – incentives, consequences Accountability – incentives, consequences Facilitate advocacy – students, clinicians, community Facilitate advocacy – students, clinicians, community

What does a culturally safe clinician look like? Critical self-awareness Critical self-awareness Understands the impact of own culture & that of the health system on patient outcomes Understands the impact of own culture & that of the health system on patient outcomes Committed to indigenous health and reducing inequities Committed to indigenous health and reducing inequities

Ensuring culturally safe clinicians Undergraduate: Undergraduate: –Encourage critical self-reflection and lifelong learning –Engage learners as ‘disciples’ –Evidence-based assessment to identify unsafe students Postgraduate: Postgraduate: –Integrate competencies, teaching and assessment into specialty training programmes –CME to monitor cultural safety, not just participation in cultural competence activities

One example: University of Hawaii John A. Burns School of Medicine In 1999, Native Hawaiian Center of Excellence In 1999, Native Hawaiian Center of Excellence –Federally funded, HRSA –Director realized few faculty aware of Native Hawaiian Health Disparities –Many faculty were clinical, volunteer faculty Faculty trained in era of “treat all patients the same” Faculty trained in era of “treat all patients the same” –Failure of that mindset –Health disparities not improved Photo courtesy of: NHCOE and Herb Kane (the artist)

Faculty Development in Cultural Competency Series of conferences to teach faculty about Native Hawaiian health and health disparities Series of conferences to teach faculty about Native Hawaiian health and health disparities  Traditional medicine and concepts of health and well being  Improving teaching skills Addressing the needs of Native Hawaiian Doctors Addressing the needs of Native Hawaiian Doctors  Can cultural competency in providers improve the poor health statistics for Native Hawaiians? Can physicians trained in western medicine and western ways of thinking bridge the gap that exists with traditional Native Hawaiian approaches to health and healing? Can physicians trained in western medicine and western ways of thinking bridge the gap that exists with traditional Native Hawaiian approaches to health and healing?

Cultural Immersion 5 Day experience on the island of Kahoolawe, damaged by bombs, goats, cattle 5 Day experience on the island of Kahoolawe, damaged by bombs, goats, cattle –Healing the land, healing the people Participants: physicians, faculty, medical students, nurses, traditional healers, family members Participants: physicians, faculty, medical students, nurses, traditional healers, family members Intense cultural immersion experience Intense cultural immersion experience Incorporate traditional Hawaiian values and protocol Incorporate traditional Hawaiian values and protocol CME courses CME courses

Photos courtesy of ‘Ahahui o na Kauka and Martina Kamaka

Post Immersion Physician Focus Groups Native Hawaiian Physicians Faculty/community, male/female, various ages and specialties represented. All underwent “cultural competency” curriculum Kaho‘olawe. (Questions: centered on whether previous experiences with cultural competency training had an effect, and on the use of cultural immersion as a teaching strategy) Primary Theme 1: Cultural sensitivity/humility training leading to personal transformation Increased cultural awareness, pride Understood connectedness to land, spirituality Acquired sense of generational responsibility Photo courtesy of ‘Ahahui o na Kauka

Secondary Theme 1: Improved medical practice –Improved patient communication –Awareness of conflict of cultures (Western vs. Traditional) –Increased knowledge of/openness to traditional healing Secondary Theme 2: Cultural sensitivity/humility related student training –Allow time for self discovery and reflection –Discuss culture of medicine, potential conflicts –Consider diversity of backgrounds, stages of readiness –Sustainability of lessons; need follow-up activities –Cultural Immersion experiences should include:  spiritual/emotional preparation  training in protocol and history  exposure to traditional healing

Additional steps Native Hawaiian research fellowship (new grant) Native Hawaiian research fellowship (new grant) Yearly departmental conferences that include cultural competency training in some way Yearly departmental conferences that include cultural competency training in some way Cultural competency curricula being introduced at residency level in various specialties Cultural competency curricula being introduced at residency level in various specialties Standardized cultural patients being used in FP residency Standardized cultural patients being used in FP residency –Surgery residency is piloting cases More regular immersion experiences for clincians, faculty being proposed More regular immersion experiences for clincians, faculty being proposed

Looking to the Future AAMC: USMLE II standardized patient clinical skills stations-must pass!!! Specialty boards online courses in cultural competency coming soon to a specialty board near you….. standardized patient clinical skills stations!! Photo courtesy of ‘Ahahui o na Kauka