©2003 Community Faculty Development Center Teaching Culture and Community in Primary Care: Teaching Culturally Appropriate Communication Skills

©2003 Community Faculty Development Center

Teaching Culture and Community in Primary Care: Teaching Culturally Appropriate Communication Skills


OBJECTIVESOBJECTIVES

1. Understand the middle stages of the cultural sensitivity ladder

2. Explain concept of patient-centered interviewing and the LEARN communication tool

3. Facilitate skill building as students move beyond minimization

By the end of this module, trainees will be able to:


Where have we been?Where have we been?


CULTURALLY SENSITIVE(Empathy, Integration, Celebration)


CULTURALLY EGOCENTRIC(Fear, Overgeneralization, Superiority)


Cultural Sensitivity ScaleCultural Sensitivity Scale


Needs AssessmentNeeds Assessment

• Focus your teaching on learner’s cultural sensitivity level

• At egocentric stages, attempt to explore values and raise awareness


Where do we go from here?Where do we go from here?






MINIMIZATIONMINIMIZATION




MINIMIZATION

Learner acknowledges that cultural difference exists, but views it as unimportant against a backdrop of basic human similarity.

“I don’t see this culture stuff as important. It’s simple, just treat people with respect and there won’t be any problems.”


POTENTIAL EGOCENTRIC REACTIONPOTENTIAL EGOCENTRIC REACTION

“I tried to help these people and they ended up walking out on me.”


CULTURALLY EGOCENTRIC

CULTURALLY SENSITIVE

Minimization


Objectives for minimization stageObjectives for minimization stage

• Debunk that “common sense” is common

• Discuss that “respect” may be different in other cultures

• Help move them forward and prevent sliding back after “tripping up”.







ACCEPTANCEACCEPTANCE

“The learner respects that being attentive to cultural issues is an important component of a satisfactory provider-patient encounter.”



Student needs at acceptance Student needs at acceptance stagestage

• Learners can be overwhelmed by the immense scope of information with a variety of cultures

“I’m having a difficult enough time learning medicine, how can you expect me to learn this culture stuff too?”


Objective to meet this need

• Attend to the need of feeling overwhelmed with empathy

• Frame the opportunity to learn about other cultures

• Teach a framework for obtaining cultural information generically


Student needs at acceptance Student needs at acceptance stagestage

• WARNING! DANGEROUS STAGE

• Focus on knowledge can foster stereotyping and assumption of causation

“I bet that mother thought her child was suffering from empacho and didn’t bring him in for evaluation because of this.”


Objective to meet needObjective to meet need

• Teach the difference between generalizing and stereotyping

• The patient should be the source for learning about their cultural identities


CULTURALLY SENSITIVECULTURALLY SENSITIVE

CULTURALLY EGOCENTRIC(Fear, Overgeneralizing, Superiority)

CULTURALLY EGOCENTRIC(Fear, Overgeneralizing, Superiority)


ACCEPTANCEACCEPTANCE

EMPATHYEMPATHY

How do you spell success?How do you spell success?


Patient Centered InterviewingPatient Centered Interviewing

• Patients as experts about themselves and their own culture

• Patient as a partner with the caregiver

• Growing evidence:– Better satisfaction– Better outcomes


The LEARN MnemonicThe LEARN Mnemonic

• LISTEN actively with respect• ELICIT the health beliefs of the patient• ASSESS priorities, values and supports• RECOMMEND a plan of action with

adequate explanation and understanding

• NEGOTIATE by involving the patient in next steps and decisions


LISTENINGLISTENING

• Appropriate greetings• Interpreter?• Open ended questions• Avoid interruption

Could you please tell me your reason for the visit today?

How can I help you today?


ELICITING Patient’s PerspectiveELICITING Patient’s Perspective

• What worries you the most?

• Are you afraid that you might have something serious?

• What do you think has caused your problem?

• Why do you think it started when it did?

• How can I be most helpful to you?


ASSESSING: Values, supports, ASSESSING: Values, supports, needs and prioritiesneeds and priorities

• Medicine in the US may be foreign.

• Decision maker may be family or elder.

• Deference to the professional

I’d like to get to know you more today. Could you tell me about yourself?

What brought you here to this country?


Ask about:

• Control over the environment• Change in the environment• Social stressors and support network• Literacy and language

Social Context Review of Social Context Review of SystemsSystems


RECOMMEND a plan of actionRECOMMEND a plan of action

• Physicians tend to:– Underestimate the

desire for information– Use language that

patients do not understand

To make sure that we understand one another, can you tell me what it is that I explained to you?


NNEGOTIATE: EGOTIATE: Involve your patient in decisionsInvolve your patient in decisions

• What are your ideas about what should happen next?

• Involving the patient in care is shown to improve:– Satisfaction

– Compliance

– Improved clinical outcomes


Teaching LEARN:Teaching LEARN:Use all of the teaching stylesUse all of the teaching styles

• Assertive: “Have you heard about the LEARN interview? Let me give a 3 minute summary of the technique….”

• Suggestive: “Would it be helpful to understanding Mr. Saq’s non-adherence to know what he thinks about Western medicine?”

• Collaborative: “She won’t consent to the lumbar puncture? What do we know about her thinking on that?”

• Facilitative: “How do you think her culture is playing into her decision to forego further treatment?”


Teaching LEARN:Teaching LEARN:Modeling with the POSEModeling with the POSE

• Be specific in POSEing the question:

“I’m going to try to get at her health beliefs with some questions about her background. Let me know what you think worked in the process”.


Teaching LEARN:Teaching LEARN:Acknowledge riskAcknowledge risk

• There is a chance of misunderstanding

• Empathize with the difficulty, highlight the benefit.

“I think that this is a very challenging situation. Sometimes, I really feel like I don’t understand what the patients are thinking.”

Documents

©2003 Community Faculty Development Center Teaching Culture and Community in Primary Care: Teaching Culturally Appropriate Communication Skills