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Service Delivery Innovation Profile

Training on Culturally Sensitive Patient Care Leads to Reports of Enhanced Knowledge and Cultural Awareness


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Snapshot

Summary

Albert Einstein College of Medicine developed a program to build faculty members' skills and knowledge with respect to teaching cultural competency and to increase residents' ability to manage cross-cultural challenges in the practice of medicine. The program included initial training on culturally sensitive patient care and case-based cross-cultural teaching, a case-based teaching monograph, train-the-trainer sessions, and ongoing forums to discuss the application of the training to clinical practice. The program has enhanced faculty member knowledge of how to teach cultural competency and has increased student awareness of cross-cultural issues.

Evidence Rating (What is this?)

Suggestive: Evidence consists of post-implementation survey data on faculty knowledge and anecdotal reports on the program's impact on student knowledge and cultural awareness; no formal evaluation has been conducted.
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Developing Organizations

Albert Einstein College of Medicine
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Date First Implemented

2006

Problem Addressed

Lack of cross-cultural awareness leads to misunderstandings and less effective patient care. Although cultural competency training has been found to improve provider understanding of cultural issues and provider–patient communication, it is not widely available.1,2
  • Lack of cross-cultural awareness as a cause of disparities: People of color frequently receive a lower standard of care than do their white counterparts, even when income, insurance status, age, and severity of conditions are comparable. Key factors contributing to these disparities include cultural and linguistic barriers within the health care system, greater clinical uncertainty among providers when interacting with minority patients, and beliefs or stereotypes held by providers about the health or behavior of minorities.1
  • Unrealized potential of training and education: Cross-cultural education for medical students and physicians can be an important tool in reducing health disparities. Research suggests that training focusing on culturally competent attitudes, knowledge, and skills is effective in improving providers' understanding of the cultural aspects of health care and in building effective patient communication strategies.1 However, health care organizations are often hesitant to offer such training due to the high cost, time lost, and/or a general reluctance to face problems they might be experiencing.2 In many cases, however, caregivers would like to receive such training. For example, more than one-half of Albert Einstein College of Medicine residency directors reported in a survey that they would benefit from additional support and training on how to teach about cultural disparities and how to overcome sociocultural barriers to care.

What They Did

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Description of the Innovative Activity

Albert Einstein College of Medicine's Faculty Task Force for Disparities and Cross-Cultural Training developed a program to build faculty members' skills and knowledge with respect to teaching cultural competency and to increase residents' ability to manage cross-cultural challenges in the practice of medicine. The program included initial workshops, a case-based teaching monograph, follow up train-the-trainer sessions, and ongoing forums to discuss the application of the training to clinical practice. Key elements of the program include the following:
  • Initial workshops: The medical school hosted two workshops, facilitated by an outside expert in teaching cross-cultural care, for 38 faculty and physicians from the medical school's two campuses. Each of the sessions, which were identical in scope and content, consisted of two parts, with the first half guiding participants through the basic components of culturally sensitive patient care and case-based cross-cultural teaching, and the second half showing them how to develop cases that can be used as teaching tools.
  • Case-based teaching monograph: Under the guidance of an editorial team, seven cases from the initial workshops were compiled into a monograph, entitled Teaching Cases Exploring Cross-Cultural Care. In aggregate, the cases reflect diverse areas of clinical expertise and cultural perspectives. Each offers a case study in narrative form, a list of learning objectives, a teacher's guide, and a bibliography. The monograph was distributed to all faculty members who attended the train-the-trainer workshop (see below) and is also available on an ongoing basis in print form and from the Albert Einstein College of Medicine Web site. (See the Tools and Other Resources section for information on how to access this monograph.)
  • Train-the-trainer sessions: In the fall of 2007, the medical school provided two follow up train-the-trainer sessions for 50 faculty members and physicians, using cases from the finished monograph to demonstrate the principles of teaching cross-cultural care. These sessions were intended to promote ongoing dissemination of cultural competence training.
  • Ongoing discussions of cross-cultural care: Ongoing classroom discussions allow faculty and residents the opportunity to discuss situations in which they have used cases from the workshops and teaching monograph to inform their care of culturally diverse patients. In particular, the Patient, Doctor, and Community class, a course that combines practice and small group discussion, allows participants to share situations in which they applied lessons of cultural sensitivity to their medical practice. Examples of situations in which this influence has been noted include the following:
    • Puerto Rican boy in need of speech, behavioral therapy: A pediatrician treating a 4-year-old boy of Puerto Rican descent learned that the child was not receiving needed services, such as speech and behavioral therapy. Using information from the workshop, the pediatrician spoke with the parents to explore whether their cultural beliefs and values were affecting the child's medical care. The pediatrician learned from the father that, as a Puerto Rican, it was important that his son receive a Catholic school education. With this information, the doctor was able to work with the family to develop a plan to receive the needed medical services while the child also attended a Catholic preschool.
    • French-speaking patient in need of surgery: In addition to probing to better understand cultural beliefs and values, physicians and residents learn to advocate for patients experiencing language barriers. For example, presented with a patient who spoke only French and needed emergency surgery, a group of medical students arranged for a translator to speak to the patient over the telephone to fully explain the procedure and help obtain an informed consent.

Context of the Innovation

Albert Einstein College of Medicine is a graduate school of Yeshiva University. Located in the Bronx, the school is affiliated with five hospitals, three mental health facilities, and four long-term care facilities, offering more than 150 residency programs to more than 2,500 physicians in training. The medical school's cultural competency workshops and case-based teaching monograph were created as a result of a faculty needs assessment conducted by the Faculty Task Force for Disparities and Cross-Cultural Training. The task force was an outgrowth of the Health Disparities Education Core of the Bronx Center to Reduce and Eliminate Racial and Ethnic Health Disparities (also known as BronxCREED), a National Institute of Health–funded initiative to reduce and eliminate health disparities through research, community outreach, education, training, and collaboration.

Did It Work?

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Results

Post-implementation surveys suggest that the program has enhanced faculty member knowledge of how to teach cultural competency, whereas anecdotal reports suggest that it has increased student awareness of cross-cultural issues.
  • Enhanced knowledge of how to teach cultural competency: Among the 35 faculty members who attended the train-the-trainer workshop and completed an evaluation form, 97 percent reported that the session increased their knowledge of how to teach cultural competency to students and residents. Anecdotal comments expressed appreciation for the content of the workshops.
  • Positive anecdotal response to casebook: Verbal reports on the value of the casebook from faculty and physicians within and outside the medical school have been overwhelmingly positive.
  • Anecdotal reports of increased cultural awareness among students: Faculty report that medical students and residents have exhibited greater awareness of cross-cultural issues in patient care after being exposed to the case-based teaching methods modeled in the workshops and casebook.

Evidence Rating (What is this?)

Suggestive: Evidence consists of post-implementation survey data on faculty knowledge and anecdotal reports on the program's impact on student knowledge and cultural awareness; no formal evaluation has been conducted.

How They Did It

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Planning and Development Process

Key steps in the planning and development process included the following:
  • Conducting needs assessment: In 2004, BronxCREED's Education Core Coordinator conducted a telephone-based needs assessment and assets survey of residency and clinical clerkship directors of the major clinical departments within Albert Einstein College of Medicine. A majority reported that their departments offered at least some cultural competency education, but most believed they would benefit from receiving further support and training.
  • Forming task force: Each department identified faculty members interested in teaching cultural competency to serve on the Faculty Task Force for Disparities and Cross-Cultural Training. The task force met periodically over the course of 1 year, identifying what cross-cultural teaching was already being done and exploring ways to expand its scope. During these discussions, task force members identified case-based teaching as an effective way to address health disparities and culture and expressed a need for a best practices workshop to support the development of this model for in-house use.
  • Recruiting workshop facilitator: The task force invited Dr. Debbie Salaz-Lopez, an expert in cultural competency and then Chief of the Division of Academic Medicine, Geriatrics, and Community Programs at New Jersey Medical School, to give a presentation to medical school leadership on her experiences with establishing cultural competency initiatives in clinical settings. After the presentation, she was recruited to lead the workshops.
  • Developing cases for monograph: Faculty members participating in the initial workshops were invited to develop and submit cases for the monograph according to specific criteria designed to maximize cross-cultural teaching. These criteria included the development and/or incorporation of learning objectives, a narrative case study touching on specific cross-cultural teaching points, and a teacher's guide explaining case background, references, and optional visual aids. An editorial team comprised of a subset of task force members worked closely with submitting faculty to ensure that each case presented a complex and nuanced teaching opportunity.

Resources Used and Skills Needed

  • Staffing: The Albert Einstein College of Medicine Task Force on Disparities and Cross-Cultural Training, composed of 83 faculty and staff from across departments, worked collaboratively on developing the workshops and the casebook. An in-house five-person editorial team headed by Dr. Nereida Correa edited and finalized the casebook and prepared it for publication. All staff members participated in the project as part of their regular job responsibilities.
  • Costs: Production of the casebook cost approximately $6,000.
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Funding Sources

National Center on Minority Health and Health Disparities
The project was funded through BronxCREED's existing National Institutes of Health National Center on Minority Health and Health Disparities grant.end fs

Adoption Considerations

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Getting Started with This Innovation

  • Identify organizational needs: Conduct a careful assessment of the needs and interests of faculty and/or staff. Identifying and responding directly to stated needs will help promote participation and build capacity.
  • Build on existing work: Faculty may already be doing some cross-cultural teaching with their residents. Find out what is working and which areas may require additional support and training. Use institutional resources already in place to inform and drive new educational initiatives.
  • Bring in outside expertise: Invite an outside expert in cultural competency to motivate and spark the interest of faculty, because external speakers often bring a fresh perspective and command respect.

Sustaining This Innovation

  • Build institutional support for ongoing teaching: To sustain this type of program after temporary funding sources (e.g., grants) run out, keep institutional leadership informed about the program and its impact and about the importance of committing to the principles of cross-cultural education.
  • Keep health outcomes at the forefront: Emphasize the importance of teaching cultural competency in achieving better health outcomes and higher standards of care for patients, particularly those of color. Position cross-cultural education as a way to institute changes that will make a difference in the lives of patients.

More Information

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Contact the Innovator

Nereida Correa, MD, MPH
Associate Clinical Professor, Department of Obstetrics & Gynecology and Women's Health
Associate Clinical Professor, Department of Family and Social Medicine
Albert Einstein College of Medicine
Jack and Pearl Resnick Campus
1300 Morris Park Avenue
Belfer Building, Room 501
Bronx, NY 10461
(718) 430-3264
E-mail: correanereida@aol.com

Innovator Disclosures

Dr. Correa has not indicated whether she has financial interests or business/professional affiliations relevant to the work described in this profile; however, information on funders is available in the Funding Sources section.

References/Related Articles

The Albert Einstein College of Medicine Bronx Center to Reduce and Eliminate Ethnic and Racial Health Disparities (BronxCREED) Web site is available at http://www.aecom.yu.edu/bronxcreed/page.aspx.

Kearns S. Growth in cross-cultural competency improves patient care. HealthLeaders Media. 2009 Sept 23. Available at: http://www.healthleadersmedia.com/content/PHY-239460/Growth-in-CrossCultural-Competency-Improves-Patient-Care.html

Footnotes

1 Institute of Medicine Web site. Unequal Treatment: What Healthcare Providers Need to Know About Racial and Ethnic Disparities in Healthcare. 2002. Available at: http://www.iom.edu/~/media/Files/Report%20Files/2003/Unequal-Treatment-Confronting-Racial-and-Ethnic-Disparities-in-Health-Care
/Disparitieshcproviders8pgFINAL.pdf
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2 U.S. Department of Health and Human Services Office of Minority Health. Teaching Cultural Competence in Health Care: a Review of Current Concepts, Policies and Practices. 2002. Available at: http://minorityhealth.hhs.gov/assets/pdf/checked/1/em01garcia1.pdf
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Disclaimer: The inclusion of an innovation in the Innovations Exchange does not constitute or imply an endorsement by the U.S. Department of Health and Human Services, the Agency for Healthcare Research and Quality, or Westat of the innovation or of the submitter or developer of the innovation. Read more.

Original publication: August 05, 2009.
Original publication indicates the date the profile was first posted to the Innovations Exchange.

Last updated: November 20, 2013.
Last updated indicates the date the most recent changes to the profile were posted to the Innovations Exchange.

Date verified by innovator: October 09, 2012.
Date verified by innovator indicates the most recent date the innovator provided feedback during the annual review process. The innovator is invited to review, update, and verify the profile annually.

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