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A Faculty development program integrating cross cultural care into a gastrointestinal pathophysiology tutorial benefits students, tutors, and the course.
Helen Shields, MD and Stephen Pelletier, Ph.D.
In response to the national mandate to improve health care for all in the United States, which was articulated in 2002 in Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care, many medical schools have introduced disparities-reducing educational programs. To accomplish this goal, in 2004 Harvard Medical School initiated a uniform evaluation of each course at the preclinical level for the discussion of cross-cultural care topics in the course overall and active teaching by the tutor in the tutorial. End-of-course anonymous student evaluations asked each student to rate whether the course as a whole and the tutor actively discussed cross-cultural care at a "frequently," "sometimes," or "never" category level.
In 2007 we developed a one-hour faculty development program for the second-year Gastrointestinal Pathophysiology Course. We used tutorial case "triggers" to stimulate discussion. Triggers are cultural, ethnic, racial, socioeconomic factors integrated into problem-based cases that are relevant to understanding pathophysiology and science and foster active discussion if Objectives are created to specifically cover each of the triggers. The program was created with "hands-on" help and advice from the Student Subcommittee on Cross-Cultural Care at Harvard Medical School.
The mechanics of the one-hour program have remained the same and are listed below:
- Begin the session with an overview of the importance of cross-cultural care.
- Move on to a discussion on disparities in healthcare that are relevant to the diseases being covered.
- Divide the teachers into small groups to discuss the tutorial cases where cross-cultural care triggers are in bold lettering. Ask tutors to develop questions to use in their own tutorial groups to promote the discussion of the case triggers in relation to the pathophysiology of the disease.
- Discuss each case's trigger's relevance to the etiology, management and possible cure of a disease.
- View and discuss a 5-minute video clip made of a tutorial with a faculty member leading a focus group with real students.
- Provide references for each of the trigger elements to help tutors understand cross-cultural care and its importance and relevance.
- At the weekly required tutors' session, reinforce the importance of teaching cross-cultural care by asking each tutor specifically about the discussion of cross-cultural care objectives. Experienced tutors are asked to help new tutors by sharing their own anecdotes and tips.
We achieved a positive impact on the frequency of teaching cross-cultural care in the overall course and the tutorial from 2007-2012. The statements "This tutor actively teaches culturally competent care" and "Issues of Culture and Ethnicity were addressed" were both significantly improved (P<0.001) over baseline 2004 data according to anonymous student evaluations. These increases were sustained over six years.
A tutor's overall rating as a teacher was moderately correlated with his/her "Frequently" actively teaching cross-cultural care (r=0.385) (p<0. 001). Course evaluation scores were excellent and put the course into the group of pre-clinical courses with the top ratings. Students in the Race in Curriculum Group found the integration of cross-cultural care discussions into the tutorials valuable and asked that the program be expanded to other pre-clinical courses.
In summary, from 2007 through 2012, a faculty development program for teaching cross-cultural care increased the discussion of cross-cultural care in the tutorial and the course over each year beginning with 2007 compared to the baseline year of 2004. Our data suggest that cross-cultural care can be effectively integrated into pathophysiology tutorials and helps improve students' satisfaction and tutors' ratings. Teaching cross-cultural care in a pathophysiology tutorial did not detract from the course's overall evaluations, which remained in the top group over the six-year period.
Smedley BD, Stith AY, Nelson AR; Institute of Medicine, U.S. Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. 2002. Washington, DC: National Academies.
Shields HM, Leffler DA, White AA 3rd, Hafler JP, Pelletier SR, O'Farrell RP, Llerena-Quinn R, Hayward JN, Salamone SA, Lenco AM, Blanco PG, Peters AS. Integration of racial, cultural, ethnic and socioeconomic factors into a Gastrointestinal Pathophysiology Course. Clin Gastroenterol Hepatol 2009; 7: 279-284.
Shields HM, Nambudiri VE, Leffler DA, Akileswaran C, Gurrola ER, Jimenez R, Saltzman A, Samuel PA, Wong K, White AA 3rd, Hafler JP, Hayward JN, Pelletier SR, O'Farrell RP, Blanco PG, Kappler SM, Llerena-Quinn R. Using medical students to enhance curricular integration of cross-cultural content Kaohsiung J Med Sci 2009; 25: 493-502.
Shields H.M, Leffler DA, Peters AS, Llerena-Quinn R, Nambudiri VE, White AA, 3rd, Hayward JN, Pelletier SR.A faculty development program integrating cross-cultural care into a gastrointestinal pathophysiology tutorial benefits students, tutors, and the course. Adv Physiol Educ 2015;39: 81-90.
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