Developing culturally competent community faculty: a model program. Ferguson WJ, Keller, DM, Haley HL, Quirk M. Acad Med 2003;78(12):1221-1228. Reviewed by Su-Ting Li, University of California, Davis
Developing culturally competent community faculty: a model program. Ferguson WJ, Keller, DM, Haley HL, Quirk M. Acad Med 2003;78(12):1221-1228.
Reviewed by Su-Ting Li, University of California, Davis
This article describes a cultural competence curriculum for training community preceptors. The cultural competence training is integrated into a community faculty development program, Teachers of Tomorrow program, which is a series of four, two-day workshops spread out over 18 months. The cultural competence portion of the curriculum consists of four 2.5 hour modules combining interactive lectures, and large and small-group role-playing exercises. The paper reports on the curriculum and the experiences of the 137 community preceptors from 15 medical schools in New England and New York who have participated in the first two years of this program.
The Curriculum: Workshop 1 focused on doing a cultural needs assessment of your student based on a simplified ethnosensitivity scale, with the lower end of the scale being learner-centered (egocentric), the middle of the scale being minimalist (treat everyone the same and minimize the importance of culture), and the upper end of the scale being patient-centered. Workshop 2 focused on teaching patient-centered interviewing using a modified LEARN mnemonic (Listen, Elicit, Assess, Recommend, Negotiate). Workshop 3 focused on planning community-based learning experiences for students and Workshop 4 focused on how to observe and give feedback to students using the "plus/delta" tool about what are positive behaviors and what are behaviors that need to change.
The Experiences of the Preceptors: Overall, the community preceptors appeared to value the cultural competence curriculum, with mean scores of 4.11 and 4.36 on a 5-point Likert scale. The most interesting part of the study was measurement of each participant's self-reported intention to change and self-reported changes to teaching cultural competency based on the program. Workshop 2 (and the LEARN mnemonic) appeared to make the most impact, with 48.1% of preceptors reporting that they intended to make changes after Workshop 2 and 21.4% reporting that they actually made changes to their teaching behaviors!
Comment: As our patients and students come from more and more diverse backgrounds, cultural competence training becomes even more important. I'd be interested in hearing more about the LEARN mnemonic and finding out a year or two out if the community preceptors are continuing to use this tool with their students.
(Do you teach an explicit model of cultural competence in the approach to specific patients, such as LEARN or the Kleinman Model? If yes, which one do you use?
Steve Miller, MD)