A Cultural Competency Curriculum for Academic Medical Center Housestaff

Cheryl S. Al-Mateen, M.D.

Department of Psychiatry Virginia Commonwealth University School of Medicine Richmond, Virginia

Introduction

 In 2001The Institute of Medicine published Unequal Treatment (1) which delineated the existence of healthcare disparities on both an individual and institutional basis throughout the practice of medicine in the United States. Although the most clear initial step in resolving healthcare disparities is to ensure cultural competency in treating healthcare personnel, no clear guidelines have yet been established for this monumental task (2). The ASIM recommends that learners explore their own potential for subconscious bias, learn about specific healthcare disparities, their etiology and solutions and develop communication skills with different cultures (2). Physicians have little insight into patients’ perceptions that health care is affected by race or ethnicity (3). The American Council on Graduate Medical Education (4) requires each residency training program to “define…knowledge, skills, attitudes, and educational experiences required...to demonstrate….sensitivity to a diverse patient population,” so that housestaff have “sensitivity and responsiveness to patients’ culture....”

Richmond, Virginia

The Richmond area has become increasingly diverse in the past decade. The patient population served by VCUHS is 50% African-American, 39% White, 2% Hispanic, 0.6%

Asian/Pacific Islander and 7% other/unknown. Percentages of Hispanic and other/unknown are increasing. Our housestaff is 62% White, 9% African-American, 2% Hispanic, 22% Asian and 4% unknown.

Statement of the Problem and Program Objectives

Despite the multicultural nature of healthcare in the United States today, cultural awareness and competence are not present at levels that might be expected. This project is a step toward the improvement of patient care and medical team functioning by increasing cultural awareness, sensitivity and competence among members of hospital housestaff. Questions to be answered include:  

1. Will introducing a cultural competence curriculum positively affect patient care?
2. Can an effective curriculum for cultural competency be implemented in a University Health Center?

The specific objectives are to compare residents who complete the curriculum with those who do not and to assess if they will:

1. define more cultural competency terms
2. demonstrate an increased familiarity with objective and subjective aspects of the culture of groups frequently seen at VCUHS
3. describe potential effects of cultural differences on the provision of healthcare
4. score higher on a 360 degree evaluation of cultural competency behaviors

 Description of the project

 The program will involve a 6 session introduction to cultural competency issues in the practice of medicine. The Harvard-Macy Project is the development and implementation of the curriculum. The process involves planning, obtaining buy-in, developing the objectives, designing the educational methods, identifying resources and development of assessment and evaluation tools. (See Table 1)

The effectiveness of the curriculum will be assessed through self assessment measures and a 360 degree feedback measure which gives summative feedback. The measures will assess cultural competency, comfort in cross-cultural patient care interactions, and knowledge base in regards to the most prevalent ethnic and racial groups in the Richmond area. The 360 survey will be given to patients, students and healthcare team members throughout the hospital regarding the cultural competence of housestaff members. Follow up surveys will be given at intervals to assess the effectiveness of the curriculum and the housestaff member’s incorporation of the information into his/her daily practice of medicine.

 Accomplishments to date 

Buy- in

1. Residency training directors - survey
2. Health Sciences Interdisciplinary Cultural Competency Committee
3. Office of Public Policy Training of the Center for Public Policy
4. Associate Vice President for Health Sciences Academic Affairs

Presentation to Project on Research In Medical Education (PRIME) Meeting

Awaiting Buy-in Residents

Key lessons learned so far and unexpected opportunities

1. There are multiple stages to buy-in on every level - Resident cooperation
2. Although I will be able to implement the pilot, I will need help for final implementation. Coursework will need to be administered by an individual in every department unless my clinical faculty responsibilities change. Residency Training Directors will need to complete the final assessment of cultural competency skills. This will require additional buy-in.
3. IRB application in development
4. A.D. Williams Grant Application for 360°feedback measure
5. Primary Investigator for Health Sciences Interdisciplinary Cultural Competency Committee R-01 Grant Submission (NIH NHLBI Cultural Competence and Health Disparities Academic Award)

Questions

1. How to develop Residency Training Directors’ ability to assess cultural competency?
2. How to integrate the Harvard-Macy Project into the Cultural Competence and Health Disparities Award?

 Literature cited

1. Institute of Medicine of the National Academies. Smedley, BD; Stith AY; Nelson AR (editors) (2002). Unequal Treatment – Confronting Racial and Ethnic Disparities in Health Care. Washington, D.C.: The National Academies Press.
2. Smith, WR; Betacourt, JR; Wynia MK; Bussey-Jones, J (submitted, 2005). Guidelines for Teaching about Racial/Ethnic Disparities in Health and Healthcare. Annals of Internal Medicine.
3. The Kaiser Family Foundation (2002). National Survey of Physicians Part I: Doctors on Disparities in Medical Care. Accessed April 2, 2005. http://www.kff.org/minorityhealth/upload/13955_1.pdf
4. ACGME (1999). General Competencies. Accessed April 10, 2005. http://www.acgme.org/outcome/comp/compFull.asp