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Pages 199-214

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From page 199...
... 6 Interventions: Cross-Cultural Education in the Health Professions BACKGROUND The 2000 U.S. Census confirmed what demographers had been predicting all along -- our country has become more diverse than ever before (U.S.
From page 200...
... 200 UNEQUAL TREATMENT and therapeutic procedures) , and adherence to preventive measures and medications (Einbinder and Schulman, 2000; Flores, 2000; Betancourt et al., 1999; Denoba et al., 1998; Gornick, 2000; Coleman-Miller, 2000; Williams and Rucker, 2000)
From page 201...
... 201 INTERVENTIONS: CROSS-CULTURAL EDUCATION tients based on race, culture, language proficiency, or social status (Schulman et al., 1999; van Ryn and Burke, 2000; Donini-Lenhoff and Hedrick, 2000)
From page 202...
... 202 UNEQUAL TREATMENT healthcare (Kleinman et al., 1978)
From page 203...
... 203 INTERVENTIONS: CROSS-CULTURAL EDUCATION important part of baccalaureate curricula, there is virtually no information published on the extent to which cultural competence is included in undergraduate courses or the specifics of the material that is included (Clinton, 1996; Janes and Hobson, 1998)
From page 204...
... 204 UNEQUAL TREATMENT TABLE 6-2 Conceptual Approaches to Cross-Cultural Education Sensitivity/Awareness Approach • Primary focus on provider attitudes o Goal is to increase provider awareness of impact of sociocultural factors on individual patients' health values, beliefs, behaviors, and ultimately quality of care and outcomes • Exploration and reflection on culture, racism, classism, sexism, etc. o Discussion of these factors as they relate to the provider and the patient culture, and what impact they may have on clinical decision-making o Importance of curiosity, empathy and respect in the medical encounter highlighted • Approach primarily taught in early in medical school and in certain residencies Gonzalez-Lee and Simon, 1987)
From page 205...
... 205 INTERVENTIONS: CROSS-CULTURAL EDUCATION example, methods to care for the "Asian" patient or the "Hispanic" patient would present a list of common health beliefs, behaviors, and key practice "do's and don'ts." With the huge array of cultural, ethnic, national, and religious groups in the United States, and the multiple influences such as acculturation and socioeconomic status that lead to intragroup variability, it is difficult to teach a set of unifying facts or cultural norms (such as "fatalism" among Hispanics, or "passivity" among Asians) about any particular group (Chin, 2000; Hill et al., 1990)
From page 206...
... 206 UNEQUAL TREATMENT TABLE 6-3 Conceptual Approaches to Cross-Cultural Education Multicultural/Categorical Approach • Primary focus on increasing provider knowledge of cross-cultural issues o Previous focus on teaching unifying cultural characteristics of cultural groups (patients of culture x believe.
From page 207...
... 207 INTERVENTIONS: CROSS-CULTURAL EDUCATION TABLE 6-4 Conceptual Approaches to Cross-Cultural Education Cross-Cultural Approach • Primary focus on developing tools and skills for providers • Process-oriented instruction that melds medical interviewing and communication skills with sociocultural and ethnographic tools of medical anthropology • Approaches to elicit patient's explanatory model (patient's conceptualization of illness) • Methods to assess patient's social context • Strategies for provider-patient negotiation and facilitation of participatory decision making • Foundation to care for diverse populations through development of interviewing frameworks • Practical approach for clinical years; taught in undergraduate, graduate, and continuing medical education focuses on the patient, rather than theory, as the starting point for discovery (Shapiro and Lenahan, 1996)
From page 208...
... 208 UNEQUAL TREATMENT ally competent" approaches to treating specific clinical conditions in targeted populations (i.e. "Hypertension in African Americans," or "Managing Diabetes in Latinos")
From page 209...
... 209 INTERVENTIONS: CROSS-CULTURAL EDUCATION tional Board of Medical Examiners is exploring methods of incorporating questions that address cross-cultural issues in medical care on licensing exams. Certain medical malpractice insurers are offering premium discounts to providers who complete provider-patient communication courses, and are now considering applying the same discounts to providers who complete cross-cultural communication courses.
From page 210...
... 210 UNEQUAL TREATMENT nication skills (without a focus on cross-cultural communication) have shown mixed results (Haynes et al., 1984; Davis et al., 1992; Davis et al., 1995)
From page 211...
... 211 INTERVENTIONS: CROSS-CULTURAL EDUCATION TABLE 6-6 Evaluation of Cross-Cultural Curricula Key Question Evaluation Strategy Do providers learn what is taught? Pre-, Post -Test Unknown Clinical Cases Objective Structured Clinical Exam Do they use what is taught?
From page 212...
... 212 UNEQUAL TREATMENT evidence that would substantiate the claim that improving provider crosscultural communication will help eliminate disparities in healthcare, there are yet to be published studies to support this hypothesis. Despite these challenges, several opportunities exist for the field.
From page 213...
... 213 INTERVENTIONS: CROSS-CULTURAL EDUCATION of cross-cultural education in the training of health professionals. Despite this, curricula in this area have been implemented to a limited degree in health professions education.
From page 214...
... 214 UNEQUAL TREATMENT measurement in these types of curricula, with a strategic, step-wise, mixed-method, process-driven approach as a starting point for future research. Finding 6-1: Sociocultural differences between patient and provider influence communication and clinical decision making.

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