“Hispanic Cultural Competence for Medical Education Curriculum”

Hispanic Cultural Competence for Medical Education Curriculum

Hispanic Cultural Competence Medical Education Curriculum Introduction

Hispanics are the largest ethnic group in the United States (40 million or 14.5 of the total U.S. population)

In order to promote the health of Hispanics, the largest group of the workforce of the near future, it has been recognized that it is important to develop cultural competence staff training in various sectors of the health system.

Hispanic Cultural Competence Medical Education Curriculum IntroductionThrough this project, the NHMA will complete the following:

Collect Cultural Competence definitionsCollect Cultural Competence books and journal articlesDevelop a virtual library of information focused on cultural competence and Hispanic healthConduct a literature search of medical articles regarding Hispanic health Collect examples of medical education curriculumPlan and coordinate a Hispanic Health for the Office of Minority Health, U.S. Department of Health and Human ServicesConvene a one day meeting of cultural competence experts to produce recommendations for guidelines for cultural competence medical education curriculum

Hispanic Cultural Competence Medical Education Curriculum MethodologyNHMA Conference Plenary Session Guidance

The relationship between mind and body (biology of belief)The physiology of the healingThe relationship between nutrition and health, with a focus on the typical Hispanic dietThe current health seeking behavior of Hispanics with focus on traditional healing and conventional medicineThe importance of family dynamics and health promotion and treatment information among HispanicsTraditional healing practicesHispanic history in the Southwest with a focus on developing and understanding of the unique transfer of information from the health provider to different generations in the Mexican American family.

Hispanic Cultural Competence Medical Education Curriculum MethodologyCultural Competence DefinitionCultural Competence is a set of attitudes, skills, behaviors, and policies that enable organizations and staff to work effectively in cross cultural situations. It reflects the ability to acquire and use knowledge of the health related beliefs, attitudes, practices, and communication patterns of patients and their families to improve services, strengthen programs, increase community participation, and close the gaps in health status among diverse population groups.Cultural competency also focuses attention on population-specific issues, including health-related beliefs and cultural values (the socioeconomic perspective), disease prevalence (the epidemiological perspective), and treatment efficacy (the outcome perspective). [HRSA Cultural Competency: A Journey.www.bphc.hrsa.gov.2000]

Hispanic Cultural Competence Medical Education Curriculum MethodologyDr. Likes Framework

The society of Teachers of Family Medicine Core Curriculum Guidelines, Recommended Core Curriculum Guidelines on Cultural Sensitive and Competent Health Care [Robert C. Like, M.D., M.S.]A focus on Attitude Change [Information on perceptions (views, customs, traditions, values and behavior) that can generate awareness and self-awareness on the part of practitioner and patient]A focus on Knowledge [Knowledge on the attitudes, values, beliefs, and behaviors of certain cultural groups] A focus on Skills [Tools and skills]

Hispanic Cultural Competence Medical Education Curriculum MethodologyLiterature Review

A broad but cursory search of the literature on Latino Health was conducted to identify the type of information that is relevant to developing Hispanic cultural competence for medical education curriculum.

Hispanic Cultural Competence Medical Education Curriculum MethodologyLimitations of DataMany of the search terms used tended to produce the same content results.None of the searches appeared to produce sufficient information on subgroup knowledge (Dominicans, Puerto Ricans, Mexicans, South Americans, regional, and local)Few curriculum models were found, and few of these focused on Hispanic culture.Little information was found on self-awareness of physicians, experiences with self-awareness activities or attitude change per se, in medical students or physicians

Hispanic Cultural Competence Medical Education Curriculum MethodologyLimitations of Data (Continued)The eventual goal and future goal is to review a critical mass of these studies and codify the findings.Future searches should explore the databases California, New York, Puerto RicoFuture searches should explore the databases belonging to the 10 Regions of the USDHHS for Hispanic Health informationFocus groups in New York will be used to gather additional knowledge to cultural health patterns amongst Puerto Ricans, Mexicans, and Dominicans.

Hispanic Cultural Competence Medical Education Curriculum Core Competencies for Hispanic Cultural Competence

Demographics of Hispanics in the U.S.Hispanic are 40 million, 14.5 % of the population.Heterogeneous Sub-groupsMexican-American, Puerto-Rican, Dominican, Cuban-American, Central and South AmericansSocial Economic Status (SES)Poor, young, less educatedOccupationsFew managers


Health Policy Issues

Access to Health CareCultural CompetenceHispanic Health Professions DevelopmentManaged Care IssuesData CollectionResearchRacial and Ethnic Disparities in HealthHispanic Childrens HealthHispanic Womens HealthHispanic Elderly HealthImmigrants Health


Health Policy Issues (Continued)

Priority Issues SummaryLEP and Title VI of the Civil Rights ActQuality of Health CareCLAS Standards


Crossing the Quality ChasmThe report, Crossing the Quality Chasm from the Institute of Medicine, in 2001, proposes six areas for improvement to address key dimensions in which todays health care system functions at far lower levels than it can and should.Health care should be:Safe,Effective,PatientCentered,Timely,Efficient, andEquitable


Crossing the Quality Chasm (Continued)

Care based on continuous healing relationshipsCustomization based on patient needs and valuesThe patient is the source of controlShared knowledge and free flow of informationThe need for transparency


Crossing the Quality Chasm (Continued)Hispanics are less involved in their health care than they would likeHispanics find it harder to understand instructions from their doctorsHispanics find it less easy to understand instructions on prescription bottlesHispanics had more communication problems with their doctors Hispanics have the highest rate of self-rating of health as fair or poorHispanics have less satisfaction with their quality of health care


Culture and HealthAztec HistoryThe Aztecs believed that: Just as the balance of the opposing forces in the cosmos must be maintained.Imbalances in the human body led to diseaseDisease could also be caused by uncleanlinessHerbs used to treat several illnessBody and Spirit was one inseparable entity.SanteriaCuranderismo


Understanding Health StatusThe Hispanic ParadoxFor the past twenty years, there has been widespread evidence of a Hispanic paradox regarding health in the United States, in which most Hispanic groups are characterized by low socioeconomic status, but better than expected health and mortality outcomes.A closer look reveals variation by age, gender, Hispanic subgroup, acculturation, country of birth and cause of death.Possible under-reporting of Hispanic deaths, salmon bias and healthy migrant effects, and risk profile may contribute to, but do not explain, the paradox the Reasons for this paradox are likely to be multi factorial and social in origin.


Understanding Health Status

Acculturation and AssimilationThe detrimental and beneficial effectsThe family as a positive social support Connections to health outcomes not satisfactorily documented


Cultural Competence and Hispanics - CategorizedStressAttitudesKnowledge PsychoneuroimmunologySkills


Cultural Competence and Hispanics - CategorizedNutrition AttitudesKnowledge Advances in Nutritional ScienceSkills

Hispanic Cultural Competence Medical Education Curriculum Core Competencies for Hispanic Cultural CompetenceCultural Competence and Hispanics - CategorizedDiabetes 2-3 times more common in Hispanics than in whites700,000 Hispanics and Mexican-Americans have diabetes and dont know itDietHigh use of saturated fatStats higher in Mexican-AmericansObesityEspecially in childrenHigher rates of complicationsAmputations, eye and kidney disease

Hispanic Cultural Competence Medical Education Curriculum Core Competencies for Hispanic Cultural CompetenceCultural Competence and Hispanics - CategorizedDiabetes AttitudesFear of insulinFear of becoming blindFatalismSkillsTo discuss diabetes with familyTo understandReferrals to resources

Hispanic Cultural Competence Medical Education Curriculum Core Competencies for Hispanic Cultural CompetencePhysician Patient Interaction and Communication

A fundamental skill that must be learned by medical students, residents, and physicians is how to communicate with patients effectively.

Communication Issues with HispanicsLack of TrustFamiliarity with subjectPersonal Bias


Physician Patient Interaction and CommunicationProviders must be aware and be able to communicate with persons speaking other languages.

Providers must be aware of basic communication precepts such as how to recognize patterns in non-verbal and verbal communication: Non-verbal communication Verbal Communication


Physician Patient Interaction and Communication (Continued)Non-verbal communicationSilence, Distance Hispanic Prefer close proximityEye contactEmotional expressivenessBody languageTouchInvisible person syndrome Treating adults like childrenThe feeling of linguistic isolationTechnical Talk


Physician Patient Interaction and Communication (Continued)

Verbal CommunicationTone of voiceAddressing a personFormalityImportance of verbal communicationDirect questions and appropriateness of requesting certain types of information


Physician Patient Interaction and Communication (Continued)Spanish Language There are some 32 million Americans who speak a language other than English at home.Spanish is the main other language in the U.S.A majority of Hispanics in the U.S. are bilingual and likely to retain their Spanish language skills as their communities are replenished with new Spanish speaking immigrants and the increasing growth of Spanish media.Only 24% of Hispanics were born outside the U.S. and Puerto Rico, 77% report Spanish as their primary language and the language they speak at home.

Hispanic Cultural Competence Medical Education Curriculum Core Competencies for Hispanic Cultural CompetencePhysician Patient Interaction and Communication (Continued)Spanish Language Approaches to language used in the U.S. in various business services include:Bilingual StaffInterpretersLanguage Skills TrainingInternal Language BanksPhone-based Interpreter ServicesWritten Translators The Robert Wood Johnson Foundation has recently established a national effort, Hablamos Juntos, to develop and evaluate language technology for use in the health care system in emerging Spanish markets across the country.

Hispanic Cultural Competence Medical Education Curriculum Core Competencies for Hispanic Cultural CompetencePhysician Patient Interaction and Communication (Continued)Use of Medical Interpreters Due to the prevalence of Spanish language by Hispanics, it is critical to provide training for physicians and medical students about the proper use of interpreters.

We know that language can be a major barrier in the physician-patient interaction when there is no understanding between the two.


Physician Patient Interaction and Communication (Continued)Use of Medical InterpretersThese barriers can lead to: Misdiagnoses,medical errors,lack of informed consent,under use as well as over use of testing and referrals,poor compliance, patient dissatisfaction, patient mistrust, patient increased stress, malpractice claims andpoor health outcomes.


Physician Patient Interaction and Communication (Continued)Use of Medical InterpretersThe use of medical interpreters is a major challenge that needs to be promoted in order to deliver quality of health care to an increasing number of LEP patients in the U.S. Certification of medical interpreters as a unique occupation and the subsequent reimbursement policy development by the public and private sector is seen as a promising mechanism to move forward.


Physician Patient Interaction and Communication (Continued)Communication Skills for Cultural Competence CurriculumA curriculum about cultural competence should address communication issues for Physician-Patient Communication focused on the ethnic patients and their communication patterns.


Physician Patient Interaction and Communication (Continued)Building a Cultural BaseA practical way to understand some from another culture is to be aware and learn to recognize the ways in which their culture and yours differ.Americans have a tendency to be more informal but reserved in their initial contacts and relationships in general.Traditional Hispanics, on the other hand, tend to be more formal on first encounters and to address people by their last names.In relationships, Hispanics tend to share more about their personal lives, and more of the talk about their family, children, and husbands, whereas Anglo Saxons tend to be reserved regarding their personal lives.


Physician Patient Interaction and Communication (Continued)

Building a Cultural BaseTo effectively communicate with Hispanics, you need to get to know who they are, how they live, their likes and dislikes and what they enjoy in life.


ConclusionGiven the increasing growth of the Hispanic population in the United States, it is imperative that the health professions continue to develop curricula that address attitudes, knowledge and skills about cross-cultural education.Cultural Competence Curriculum should include a component that is ethnic specific, in this case, on Hispanics.Hispanics are regional and sub-group dominant with their own cultural peculiarities.Hispanics have demographic trends, historical traditions, traditional medicine knowledge, fundamental values and beliefs, policy issues, language and communication needs,And a growing body of medical literature.

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“Hispanic Cultural Competence for Medical Education Curriculum”