NHLBI Cultural Competence Collaborative

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					             National Consortium for Multicultural Education for Health Professionals
                                        Conference Call
                                       August 13th, 2007
Teleconference:
Dial: 1.877.208.9784 or 1.877.246.9080 (Toll Free USA and Canada)
       1.206.315.8552 or 1.206.315.8580 (International and metro-Seattle)
Enter Participant Conference Entry Code: 80414 (followed by the # key)
WebEx (to use concurrently with the teleconference call):
To connect to WebEx, please click on the following link:

Meeting number:
Meeting password: cultural

   1) Updates and Group Announcements
   2) Face to Face 2007:
          Updates from small group planning committee
          Meeting will be held at the Bethesda Hyatt http://www.bethesda.hyatt.com/
                   i. Use code: BCGME to get a discount for 9/27-9/29
                  ii. Direct reservation link from website:
                           1. http://culturalmeded.stanford.edu/members/
                           2. Login: culturalmeded password: nhlbi
                           3. Click on: Annual Face to Face Meeting
                            Conference Rates:
                                  o Single $189.00
                                      Double $214.00
                                      Triple $239.00
                                      Quad $264.00
   3) AAMC Colloquium:
          This Colloquium, held just before our face-to-face meeting, will involve faculty
             from the AAMC-California Endowment group and as many of our group who are
             able and willing to participate. It will be held Thursday, September 27th. Our
             overall goal is to inventory known educational interventions, cataloging them by
             (1) TAACT category, (2) Learner group, and (3) "Level of evidence of educational
             effectiveness." The work products will include a submission to MedEd PORTAL
             and/or print journal, and by identifying gaps we will help AAMC formulate a future
             research agenda, especially around assessment.
          Please see attached informational sheet (page 4-5)
   4) MedEd Portal Update:
          MedEd Portal is requesting reviewers at this time, particularly for educational
             content on cultural competence and health disparities, as well as their “hot topic”
             of Cultural Diversity.
                   i. See: www.aamc.org/mededportal
   5) STFM Pre-Conference Workshop (Sonia)
          “Making the Case for Cultural Proficiency: A Workshop for Medical Educators”
                   i. Please see attached abstract (page 6-9)
                  ii. Please send Sonia any materials and resources that would be valuable
                      for the workshop, such as CDs, case vignettes, pdfs, etc.
   6) Upcoming conference call meeting times:
          First Monday of the month from 12:00pm-1:00pm (PDT)
                   i. September 10th
                  ii. October 8th
                 iii. November 12th




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          National Consortium for Multicultural Education for Health Professionals
                                         Conference Call
                                       August 13th, 2007
Working Groups:
   “Lessons Learned” collaborative manuscript:
         o Carlos Estrada (lead) (cestrada@uab.edu)
         o Desiree Lie (dalie@uci.edu)
   Letters to the editor (responses to current articles):
         o Olivia Carter-Pokras (co-lead) (opokras@umd.edu)
         o David Acosta (co-lead) (dacosta@u.washington.edu)
   Office for Civil Rights
         o Partner with OCR to develop a curriculum targeted at emerging physicians.
              Focus on educating medical students that physicians are an agent for change
              and are 1) knowledgeable about health disparities and the law, 2) can recognize
              discrimination, and 3) can act when discrimination occurs.
         o AAMC GEA submissions include: 1) pilot workshop on curriculum, 2) focus group
              session on what physicians want to see in curriculum and from the OCR.
                   Clarence Braddock (lead) (cbrad@stanford.edu)
                   Ana Nunez (AAMC focus group lead) (ana.nunez@drexelmed.edu)
                   Paul Haidet (AAMC workshop lead) (phaidet@bcm.edu)
                   Olivia Carter-Pokras (opokras@umd.edu)
                   David Acosta (dacosta@u.washington.edu)
                   Sonia Crandall (Crandall@wfubmc.edu)
   Assessment Tools
         o Perform a systematic review of current assessment tools. Working group to
              determine a framework for rating by developing an internal rating scale, followed
              by psychometric analysis (if appropriate) through a multi-site study.
                   Clarence Braddock (cbrad@stanford.edu)
                   Paul Haidet (phaidet@bcm.edu)
                   Carlos Estrada (cestrada@uab.edu)
                   Lynn Bickley (lynn.bickley@ttuhsc.edu)
                   David Acosta (dacosta@u.washington.edu)
                   Sonia Crandall (Crandall@wfubmc.edu)
                   Desiree Lie (dalie@uci.edu)
                   Ana Nunez (ana.nunez@drexelmed.edu)
                   Elizabeth Lee-Rey (eleerey@aecom.yu.edu)
   Advocacy at NBME
         o Collaborative member lead to be determined
         o General interest from group members
   SP Case Bank Development/Trigger Tapes
         o Collaborative member lead to be determined
         o General interest from group members
 Textbook review of race and ethnicity as biological constructs
      o Draft abstract of project: Medical schools are now required to provide cultural
         competency training. According to the Association of American Medical Colleges,
         cultural competence education for medical students should include epidemiology of
         health and health care disparities; factors underlying health and health care
         disparities; and definitions of race, ethnicity, and culture. Medical textbooks also
         reflect the norms, values and biases of society and medicine. We reviewed fifteen of
         the latest editions of the most widely used preclinical and reference textbooks in the
         U.S. for how each addressed race and ethnicity. Medical textbooks were identified
         for review from several standard lists of texts. Textbooks were individually reviewed
         using a pre-established set of search criteria: subject headings, definition of race
         and/or ethnicity, epidemiology, etiology and treatment recommendations.
         Information indexed by race/ethnicity varied greatly across texts—from chapter
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            National Consortium for Multicultural Education for Health Professionals
                                           Conference Call
                                           August 13th, 2007
           excerpts to no information. Few texts addressed the distinction between socio-
           political or genetically influenced race and ethnicity. Clinical texts mentioned a
           correlation between race and certain diseases but did not offer specific explanations.
           Consequently, some clinical references suggested different treatment procedures
           specific to ethnic groups. The majority of texts provided health statistics by
           racial/ethnic group and noted several related risk factors, yet offered no specific
           explanation for racial/ethnic disparities.
                Textbook review completed, manuscript development to be pursued
                         Olivia Carter-Pokras (lead) (opokras@umd.edu)
   TACCT
       o Multi-site administration of TACCT to determine reliability and validity in multiple
           settings. Responses by students and faculty to individual TACCT items at separate
           schools may show variability reflecting differences in their respective existing
           curriculums. TACCT can be used to systematically identify areas of CC education
           currently under-addressed in the curriculum.
       o Manuscript currently under review
                Desiree Lie (lead) (dalie@uci.edu)
                8 participating schools
   SP-Interpreter case development and checklist validations
       o Case development of standardized patient (SP) and standardized interpreter (SI) to
           validate two checklists: Faculty Observation Rating Scale (FORS) and the Interpreter
           Impact Rating Scale (IIRS), cross-validated on the Patient-Physician Interaction
           scale (PPI). The pilot was done with Spanish-speaking SP-SI pairs for a smoking
           cessation case during a CPX exam for MS3 students. We compared the IIRS,
           FORS, and PPI for four faculty observers, two SP-SI pairs, and the student’s PPI
           scores.
       o In use at UCI (MS2) and Stanford (MS1)
       o Currently, we are undergoing manuscript revision for submission to JGIM.
       o Future studies will include: multi-site, multi-language, multi-academic year students
           (comparison of reliability and validity of IIRS/FORS); as well as usability of scales in
           general clinical settings.
                Desiree Lie (lead) (dalie@uci.edu)
                Sylvia Bereknyei (sylviab@stanford.edu)
                Sonia Crandall




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          National Consortium for Multicultural Education for Health Professionals
                                     Conference Call
                                    August 13th, 2007
CULTURAL COMPETENCE EDUCATION AND ASSESSMENT COLLOQUIUM: MAPPING THE TERRAIN AND A
                                    RESEARCH AGENDA
                                                               Thursday, September 27, 2007
                                                              Fairmont Hotel, Washington, DC

An invitational colloquium to include California Endowment grant recipients and members of the
NHLBI collaborative to consider issues related to the assessment of educational interventions
used in cultural competence education, to
        a) Identify existing best available evidence for effective interventions, drawing upon
            literature on existing teaching methods, assessment tools, learner groups and
            intervention timing;
        b) Identify gaps; areas for which there is a paucity of robust interventions and
            supporting educational research.

Purpose and Objectives
Our overarching goal is define to scope of known educational interventions and the quality of
evidence regarding the effectiveness of these interventions in cultural competence education,
as well as identify associated research questions related to educational methods for and
efficacy of cultural competence education interventions. We will use TACCT as a framework to
guide this inquiry. Colloquium objectives include:

      Catalog existing interventions by TACCT category, learner group, and level of evidence
       by assessment methods
      Highlight existing assessment strategies and associated tools used with cultural
       competence curricula.
      Identify gaps and associated key research questions related to development and
       assessment of cultural competence interventions.
      Develop consensus around needed research and outline a future research agenda.

Colloquium Activity
To engage participants in activity using the TACCT framework to
       marry educational interventions with TACCT defined learning objectives
       sort these interventions by learner group and by level of evidence of effectiveness
       identify gaps and suggest areas that need further development

Background and Rationale
Several articles in the June 2006 issue of Academic Medicine called for an examination of
developing a considered and systematic approach to skill development and assessment in
educating for cultural competence. It is important to consider what interventions currently exist,
what need to be developed, and how best to evaluate if the intervention is effective in the way
intended. In so doing, a consensus might further be developed around identifying a research
agenda for the community of medical educators working on cultural competence.

      Cultural Competence and Medical Education: Many Names, Many Perspectives,
       One Goal. Commentary Betancourt, J. MD, MPH Acad Med. 81(6):499-501, June
       2006
      Losing Culture on the Way to Competence: The Use and Misuse of Culture in
       Medical Education. Gregg, J; Saha, S Acad Med. 81(6):542-547, June 2006.
      Medical Education for a Changing World: Moving Beyond Cultural Competence
       into Transnational Competence. Koehn, P; Swick, H Acad Med. 81(6):548-556, June
       2006.

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          National Consortium for Multicultural Education for Health Professionals
                                     Conference Call
                                    August 13th, 2007
Work Products?

                     Populated TACCT with associated educational interventions (see PogoE;
                      http://www.pogoe.org - for an example of a clearinghouse of educational
                      interventions that are cataloged by learner group, educational objectives;
                      we would add the dimension of “level of educational evidence”
                     MedEdPORTAL submission of above completed TACCT
                     IIME consensus proceedings report
                     topic featured at AAMC annual meeting session(s)
                     other


Working Agenda Wire Map

9:00am       – 9:20am      Introductions and Overview of the Colloquium Charge
9:20am – 9:50am     Introductory Framing:
9:50am – 10:00am Break
10:00am – 11:00am Large Group Discussion
                         Discuss the framing questions
                         Discuss assessment tools: currently available and needed
11:00am – 12:00pm Break into Working Groups to populate TACCT
Noon-12:45pm        Lunch
12:45pm – 1:30pm Working Groups Continued
1:00pm – 2:30pm     Working Groups report to Large Group
                         Synthesize findings, find common themes
2:30-3:00pm         Next Steps
3:00pm              Adjourn




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           National Consortium for Multicultural Education for Health Professionals
                                      Conference Call
                                     August 13th, 2007
       Making the Case for Cultural Proficiency: A Workshop for Medical Educators
                             STFM Pre-Conference Workshop

Abstract
Does your institution support the premise that providing culturally sensitive care promotes
positive health outcomes for patients? Would you like assistance in the practical aspects of
implementing and evaluating a cultural competence curriculum? This pre-conference workshop
will train the trainer. Teaching methods will be explored, a curriculum assessment instrument,
the Tool for Assessing Cultural Competency Training (TAACT) will be introduced as well as
learner assessment tools. The workshop will include lecture-discussions, small group
exercises, role plays, simulations, videotape reviews and individual reflection activities. The
workshop will target skill, knowledge and attitude elements and participants will come away with
resources they may apply at home.

Objectives
During this workshop, participants will:
1. Consider practical aspects of and challenges to implementing and evaluating cultural
   competency curriculum.
2. Apply one tool that can assist them with curriculum development and assessment.
3. Identify three teaching methods (best practices) and distinguish in which educational activity
   each method can best be used.
4. Evaluate one strategy each for assessment of learner attitudes, skills, and knowledge.
5. Experience one strategy each for attitudes, skills, and knowledge.
6. Design one activity (60-minute large group session or 90-minute small group activity) they
   can implement at home.

Rationale
The importance of providing cultural competence training as part of curricula for the training of
health professionals is no longer a question for debate. Medical educators and accreditation
bodies are increasingly recognizing cultural competency as critical to the professional
development of physicians. The level to which a health care professional can be culturally
sensitive (proficient) can influence patient health outcomes. The dilemma is how to best
approach this type of education in content-laden curricula. In light of the nation’s growing
diversity, family practice physicians should be at the forefront of the mission to develop culturally
competent patient care as they often serve as a family’s entry point into the healthcare system
and treat entire families from birth to death. The purpose of this pre-conference workshop is to
assist participants to develop and address practical aspects of implementing and evaluating a
cultural competence curriculum for multiple levels of learners.

Session content – how participants will be involved
This 8 -hour pre-conference workshop will apply known ‘best practices’ to assist medical
educators to develop, implement, and evaluate cultural competency curricula appropriate for
any level of learner (students, residents, other health professionals). Workshop format will be
approached from a train-the-trainer perspective. Educational strategies recognized as
successful for cultural competency instruction will be used and include lecture-discussion, small
group exercises, role play, simulation, demonstration, videotape review, as well as individual
reflection activities. A group of ethnically diverse workshop instructors with considerable
experience in faculty development for cultural competency has been convened. Instructors are
members of the National Consortium on Multicultural Education for Health Professionals and
are recipients of National Heart, Lung, and Blood Institute Cultural Competence and Health
Disparities Academic Awards.


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       National Consortium on Multicultural Education for Health Professionals
                                   Conference Call Agenda
                                                   th
                                   Monday, June 11 , 2007
                                     12:00-1:00pm PDT
Session Outline (time for each element):

Element                                    Topic                                        Time
                                                                                      Allotted
   1      Introduction of workshop participants and instructors (start time can      10 minutes
          be 8:00 or 8:30 am depending on STFM’s preference)                          8:30-8:40

   2      Learning Activity 1 (Knowledge) – Lecture-discussion                       20 minutes
          Making the Case for Cultural Proficiency: We Make the Road by               8:40-9:00
          Walking

          This activity includes definitions of cultural competency from an
          individual and institutional perspective; common terminology;
          scientific, legal and regulatory milestones; and clinical pearls and
          addresses practical aspects and challenges.

   3      Learning Activity 2 – (Knowledge/Skill) – Discussion and small group       60 minutes
          activity targeting the breadth of educational activities for learners:     9:00-10:00
          Participants will be introduced to and provided with a list of potential
          education strategies; they will be polled for the types of strategies
          they want to discuss. Small groups will be convened for those
          selected for discussion by group consensus. After a 20 minute
          discussion within small groups, the large group will discuss strengths
          and implementation and evaluation challenges for the strategies
          discussed. The workshop instructors will provide their experiences
          with the strategies they have used. (Some of the strategies can be
          provided for the audience to actually experience. However that will
          depend on which ones are chosen for discussion).

          Potential topics for small group discussion: Lecture/Discussion,
          Interdisciplinary sessions (medicine/health care industry as culture),
          Spirituality components w/in courses, Required pre-reading w/small
          group discussion, Story Telling – Use of Student, Patient Narratives,
          Diversity training and other skill development workshops, Essay on
          students’ cultural backgrounds, Simulations (Bafa Bafa), Role Plays,
          Reflective journals, SPAs (standardized patient assessments), Panel
          discussions, PBL cases, In-depth interviews with clients, Self-
          directed learning projects, Movie nights/Pizza and a Play, Ethnic
          Food Lunches, Clinical performance exams, Home Visits/Field Trips,
          Community Plunges/Windshield Tours, Reader’s Theater and other
          medical humanities assignments.

   4      Break                                                                      10 minutes
                                                                                       10:10-
                                                                                       10:20

   5      Learning Activity 3 (Skill) – Lecture-discussion of applications of the    15 minutes
          Tool for Assessing Cultural Competency Training (TACCT) and how              10:20-
          the TACCT can serve as a curriculum development and assessment               10:35



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     National Consortium on Multicultural Education for Health Professionals
                                 Conference Call Agenda
                                                 th
                                 Monday, June 11 , 2007
                                   12:00-1:00pm PDT
       tool. The modified version of the TACCT will also be presented.

6      Learning Activity 4 (Skill) – Small group activity – Participants will      30 minutes
       apply the TACCT to a course or clerkship of their choice and discuss          10:35-
       feasibility of using the TACCT. (We are assuming that many                    11:05
       participants have used the TACCT already. The revised version for
       tracking curriculum will be presented and the small groups will
       discuss how they might incorporate using it into their own
       curriculum.) Workshop instructors will present stories of how
       institutions have used this tool for curriculum review.

7      Learning Activity 5 (Attitudes/Knowledge) – Demonstration of tools          60 minutes
       that instructors have used to assess learner attitudes to include the         11:05-
       HBAS, Implicit Association Test (addresses bias and stereotyping),            12:05
       and websites that have free access quizzes (Native IQ, Quality and
       Culture Quiz, University of Michigan website, which highlights
       individual and institutional assessments of attitudes and knowledge.
       Participants will take a quiz of their choice, which will provide an
       opportunity for self-reflection on applications of these types of
       activities for their learners.

8      Lunch (if the participants want a 45 minute lunch break we can end at       60 minutes
       5:00)                                                                       12:05-1:05

9      Learning Activity 6 (Attitudes/Skill) – Videotape review of 1 segment       30 minutes
       of ‘Worlds Apart’ and dialogue of how these can serve as triggers for        1:05-1:35
       discussion of health disparities.

10     Learning Activity 7 (Skill) – Simulation and videotape review –             45 minutes
       Effective use of Interpreters (does not include American Sign                1:35-2:20
       Language). First, participants will experience 1st hand the challenges
       of being an interpreter via the ‘Radiotelephone Exercise’. Then they
       will view videotapes of effective/less effective patient encounters to
       learn the skills associated with interpreter use.

11     Learning Activity 8 (Skill) – Small group activity – Participants will      45 minutes
       view a trigger tape of a learner/patient/interpreter interview, apply the    2:20-3:05
       Interpreter Checklist to assess the skills of the learner and discuss
       the ease of use of the checklist.

12     Break                                                                       10 minutes
                                                                                    3:05-3:15

13     Learning Activity 9 (Skill) – Lecture-discussion of Learner                 30 minutes
       Assessment Tools, which will include simulated patients, patient-            3:15-3:45
       centered communications tools that address cultural proficiency
       (Kleinman, LEARN, Common Ground), role plays of case scenarios)

14     Learning Activity 10 (Skill) – Small group activity – Participants will     45 minutes



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       National Consortium on Multicultural Education for Health Professionals
                                   Conference Call Agenda
                                                   th
                                   Monday, June 11 , 2007
                                     12:00-1:00pm PDT
          design one activity (60-minute large group session or 90-minute         3:45-4:30
          small group activity) they can implement at home. They will identify
          the: target audience, goal/objectives, instructional methods, learner
          assessment, follow-up evaluation if applicable, and costs for
          personnel and materials needed to conduct the session.

  15      Learning Activity 11 (Knowledge) – Discussion – Instructors will        30 minutes
          discuss the types of resources available for curriculum design           4:30-5:00
          (textbooks, toolkits, cases, online sources) to include those made
          available from members of the National Consortium

  16      Wrap-up and Evaluation                                                  15 minutes
                                                                                   5:00-5:15




       Element              Time Allotted in
                               Minutes
           1                      10
           2                      20
           3                      60
           4                      10
           5                      15
           6                      30
           7                      60
           8                      60
           9                      30
          10                      45
          11                      45
          12                      10
          13                      30
          14                      45
          15                      30
          16                      15
   Total Time (8 hours           515
      and 35 minutes,
  includes 20 minutes
for breaks and 1 hour
             for lunch)

Actual contact time is
      7 hours and 15
             minutes




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