1. ©2003 Community Faculty Development Center Teaching Culture and Community in Primary Care: The Community as Teacher

2. ©2003 Community Faculty Development Center Teaching Culture and Community: The Community as Teacher After this session, you will be able to: Address knowledge needs regarding cultural issues in the community setting Augment the GNOME planning process to include service-learning methodologies Use the principles of service-learning to plan a community-based learning experience for incorporation into your practice

3. ©2003 Community Faculty Development Center Where have we been?

4. ©2003 Community Faculty Development Center Needs Assessment Self-assessment Assess level of ethno- sensitivity Assess skill level of learner in the context of trans-cultural interviewing CULTURALLY EGOCENTRIC CULTURALLY SENSITIVE MINIMIZATION

5. ©2003 Community Faculty Development Center Attitudes and values: –Celebration of diversity –Recognition of cultural biases –Respect for all health beliefs –Avoid assumptions and stereotypes Skills: –Patient Centered Interviewing –Social Context Review of Systems –LEARN model Objectives

6. ©2003 Community Faculty Development Center Methods Appropriate Use of Teaching Styles Reflection Modeling Role Play

7. ©2003 Community Faculty Development Center Evaluation Characteristics feedback in context of cultural learning objective Encourage self-assessment –Facilitates self-reflection –Promotes self-awareness Refer to specific, observed behaviors –No presumption of attitude –Provides opportunity for change and growth

8. ©2003 Community Faculty Development Center Knowledge Objectives –Population health –Outcome disparities –Exploring history and cultural norms of specific groups –Explore the culture of the community in which you are practicing What’s missing?

9. ©2003 Community Faculty Development Center A Little Knowledge is … ENLIGHTENING! –Historical context –Geography –Cultural Norms Facilitate asking pertinent positive and negative questions Leads to efficiency

10. ©2003 Community Faculty Development Center A Little Knowledge is … DANGEROUS! –Context needs to be seen as general –To avoid stereotype, still must get patient’s perspective

11. ©2003 Community Faculty Development Center Scenario A student from your practice in Worcester, MA is seeing a Mexican American with Type II diabetes mellitus. The student comments on the apparent frequency of diabetes in Hispanics and wonders if this is a problem for Mexican-Americans as well as Puerto Ricans (the majority Latino culture). To what resources would you point your learner?

12. ©2003 Community Faculty Development Center Population Health - HHS Race and Health Home PageHHS Race and Health Home Page - Census Bureau Home PageCensus Bureau Home Page - CDC Diabetes Resource - CDC's Diabetes Program - StatisticsCDC's Diabetes Program - Statistics Links

13. ©2003 Community Faculty Development Center Scenario, Part 2 Now that the student knows about the increased prevalence of diabetes, she is interested in knowing if there is specific help with dietary counseling available.

14. ©2003 Community Faculty Development Center Latinos and Diabetes - Welcome to DiversityRx-MarchWelcome to DiversityRx-March - Mexican American Diets and Diabetes - Nutritional Materials in Spanish - Latin American Food Pyramid Links

15. ©2003 Community Faculty Development Center Other Reference Materials Bibliographies for web sites Bibliographies “Pocket texts” Its in your handout!

16. ©2003 Community Faculty Development Center But, is knowledge enough??? General information –May not apply in your community –Acculturation: Process of adapting from one culture to another. Expertise –Doctors are “experts” –May not be the expert on this. Solution –Draw on expertise of others –Structure community experiences for deep learning

17. ©2003 Community Faculty Development Center The Community as Teacher: How have you done it? Please think for a minute of an educational experience in which you were sent out into a non-medical community setting? What did you learn? How?

18. ©2003 Community Faculty Development Center CONCEPT:SERVICE- LEARNING "A structured learning experience that combines community service with preparation and reflection. Service-learning students not only provide community service, but also learn about the context in which the service is provided” S. Saefer, 2002 The Community as Teacher

19. ©2003 Community Faculty Development Center Service-Learning VolunteerismPracticum Community ServiceField Education Service-Learning Community Beneficiary Provider Service Activity Learning

20. ©2003 Community Faculty Development Center Include more community sites and build long term relationships. Develop a service learning experience using service-learning objectives Develop an orientation component Develop a reflection component Integrate an evaluation component Promote the professional ethic of service Service Learning Protocol for Health Professionals Schools

21. ©2003 Community Faculty Development Center IS: Partnership: educators and community Learning objective connected to service. Real service, meeting an unmet need. Reflection component. Applicable in future personal and professional life. Equitable IS NOT Not just volunteering. Not just a clinical experience Not a chance to show how much you know. Not a chance to hone your skills. Not just an individual relationship* *(although it can start there) What is Service-Learning?

22. ©2003 Community Faculty Development Center WHAT NEXT? Abstract Conceptualization SO WHAT? Reflective Observation WHAT? Concrete Experience ACTION! Active Experimentation Reflection is the hyphen in Service-Learning

23. ©2003 Community Faculty Development Center Reflective Methods Before: –Briefing, essay(pre), self evaluation(pre), writing goals/ learning contract, on-line journal During: –Self-evaluation, community partner or faculty review. After: –Essay(Post), Self-Evaluation(Post), essay based on on- line journal, review of learning contract.

24. ©2003 Community Faculty Development Center How to make it work? Medical student has just seen a 6 y/o well child whose mother is deaf, and for whom the child is the interpreter. The student doesn’t know ASL, available resources for deaf persons nor much about deaf culture. You don’t know much about it either. What can you do? How could you structure the experience? Please discuss with your neighbor for 2 minutes.

25. ©2003 Community Faculty Development Center Surveys and Scavenger Hunts SurveysScavenger Hunts Community reading day Visit a home with a home visitor Writing newspaper articles. Consulting with HeadStart on lead poisoning Interviewing the family of a CSHCN Service-Learning in Practice

26. ©2003 Community Faculty Development Center Practical Aspects of Service- Learning Build on existing relationships Negotiate the objectives Empower partners to teach Reflect with your learner

27. ©2003 Community Faculty Development Center What about Culture? S-L enables growth in the empathic stages: –Models collaboration and power-sharing –Demands reflection and insight –Values all participants S-L requires time and energy –Need to establish and maintain relationships –Need time and expertise to reflect

28. ©2003 Community Faculty Development Center Summary Knowledge about culture is available, but requires context. Service-learning is a teaching method that can provide that context. Preceptors can incorporate service-learning into their precepting by building on existing relationships.