2
Scale of Empathy Health Profession Student ver- sion (JSE-HP-S). Focus groups were also used to explore the impact of the workshops and to explore students’ understanding of empathy. In total, 31 workshops (90 minutes each) were delivered over a 4-week period during August and September 2012 at four Australian universities. These workshops were attended by 321 students from all year levels (first to fifth year) and included participants from over 10 different health care pro- fessions (medicine, paramedics, nursing, radiogra- phy, midwifery, medical imaging, podiatry, biomedical science, occupational therapy, nutrition and dietitics, physiotherapy and social work). What lessons were learned? In total, 293 partici- pants completed follow-up results at 6 weeks with ID matched pre-workshop questionnaires. The majority of participants were from nursing (n = 59; 20.1%), paramedics (n = 55; 18.8%) and nutrition and dietitics (n = 47; 16%). The majority of partici- pants were female (n = 226; 77.1%) and enrolled in the first year (n = 123; 42%). Using a paired t-test, there was a statistically signif- icant difference between empathy scores before and at 6 weeks (114.34 versus 120.32; p < 0.0001) with a moderate effect size (d = 4.7). Qualitative findings also suggested greater understanding of their personal perceptions of empathy, patient centred- ness and workshop impact relating to practice-based education. The results from this study suggest that the work- shops have played a positive role in improving students’ self-reported empathy levels. Further research is needed to explore if these results can be replicated to achieve better empathetic behaviours leading to improved therapeutic relationships and positive health outcomes. REFERENCE 1 Del Canale S, Louis DZ, Maio V, Wang X, Rossi G, Hojat M, Gonnella JS. The relationship between physician empathy and disease complications: an empirical study of primary care physicians and their diabetic patients in Parma, Italy. Acad Med 2012;87: 12439. Correspondence: Brett Williams, Department of Community Emergency Health and Paramedic Practice, Monash University, PO Box 527, Frankston, Vic. 3199, Australia. Tel: 00 61 3 9904 4283; E-mail: [email protected] doi: 10.1111/medu.12343 Developing cultural competence in health care professionals: a fresh approach Neil K Aggarwal & Ravi DeSilva What problem was addressed? For the past 20 years, cultural competence initiatives in medicine have addressed quality improvement, language access, refugee health and systemic racism. Many initiatives encourage postgraduate trainees to share their biases in caring for diverse patients. However, trainees may feel disappointed and insulted when such initiatives assume no prior exposure to cultural competence programming, are viewed as efforts towards ‘political correctness’ rather than skill devel- opment, and presuppose social distance among patients and providers. 1 Medical educators need new cultural competence models as globalisation makes cross-cultural service provision a worldwide phenomenon. What was tried? We designed a course around hypothetical recommendations that cultural compe- tence initiatives should anticipate trainee resistance, occur early in training to make a professional differ- ence, include case-based learning and avoid uncom- fortable self-disclosures. 1 All second-year psychiatry trainees (n = 12) at Columbia University underwent a 12 week course based on the Cultural Formulation Interview (CFI). The CFI consists of 16 questions and will be included in the fifth revision of the Diagnostic and Statistical Manual of Mental Disor- ders (DSM-V); prior DSMs have had wide interna- tional circulation. The CFI revises the DSM-IV Outline for Cultural Formulation, the cultural assessment with the largest evidence base in psychi- atric education. The first 5 weeks consisted of reviewing social science theories underpinning CFI development (curriculum available) and residents sharing experiences surrounding their acculturation processes as doctors and psychiatrists. The last 7 weeks consisted of practising the CFI as class- mates reviewed one-page summaries of CFI ques- tions and answers with current patients. In each 50 minute lecture, instructors reviewed learning objectives, encouraged discussions on how cases cor- roborate or refute CFI social theories and solicited course feedback. Instructors met with trainees out- side of class to examine how culture affects diagnos- tic assessment, treatment planning and continuity of care for each patient presentation. What lessons were learned? All trainees stated that they had cultural competence training in medical school. They appreciated the individual approach to ª 2013 John Wiley & Sons Ltd. MEDICAL EDUCATION 2013; 47: 1119–1146 1143 really good stuff

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Page 1: Developing cultural competence in health care professionals: a fresh approach

Scale of Empathy – Health Profession – Student ver-sion (JSE-HP-S). Focus groups were also used toexplore the impact of the workshops and to explorestudents’ understanding of empathy.In total, 31 workshops (90 minutes each) were

delivered over a 4-week period during August andSeptember 2012 at four Australian universities.These workshops were attended by 321 studentsfrom all year levels (first to fifth year) and includedparticipants from over 10 different health care pro-fessions (medicine, paramedics, nursing, radiogra-phy, midwifery, medical imaging, podiatry,biomedical science, occupational therapy, nutritionand dietitics, physiotherapy and social work).What lessons were learned? In total, 293 partici-pants completed follow-up results at 6 weeks withID matched pre-workshop questionnaires. Themajority of participants were from nursing (n = 59;20.1%), paramedics (n = 55; 18.8%) and nutritionand dietitics (n = 47; 16%). The majority of partici-pants were female (n = 226; 77.1%) and enrolled inthe first year (n = 123; 42%).Using a paired t-test, there was a statistically signif-

icant difference between empathy scores before andat 6 weeks (114.34 versus 120.32; p < 0.0001) with amoderate effect size (d = 4.7). Qualitative findingsalso suggested greater understanding of theirpersonal perceptions of empathy, patient centred-ness and workshop impact relating to practice-basededucation.The results from this study suggest that the work-

shops have played a positive role in improvingstudents’ self-reported empathy levels. Furtherresearch is needed to explore if these results can bereplicated to achieve better empathetic behavioursleading to improved therapeutic relationships andpositive health outcomes.

REFERENCE

1 Del Canale S, Louis DZ, Maio V, Wang X, Rossi G,Hojat M, Gonnella JS. The relationship betweenphysician empathy and disease complications: anempirical study of primary care physicians and theirdiabetic patients in Parma, Italy. Acad Med 2012;87:1243–9.

Correspondence: Brett Williams, Department of CommunityEmergency Health and Paramedic Practice, Monash University,PO Box 527, Frankston, Vic. 3199, Australia. Tel: 00 61 3 99044283; E-mail: [email protected]

doi: 10.1111/medu.12343

Developing cultural competence in health careprofessionals: a fresh approach

Neil K Aggarwal & Ravi DeSilva

What problem was addressed? For the past20 years, cultural competence initiatives in medicinehave addressed quality improvement, languageaccess, refugee health and systemic racism. Manyinitiatives encourage postgraduate trainees to sharetheir biases in caring for diverse patients. However,trainees may feel disappointed and insulted whensuch initiatives assume no prior exposure to culturalcompetence programming, are viewed as effortstowards ‘political correctness’ rather than skill devel-opment, and presuppose social distance amongpatients and providers.1 Medical educators neednew cultural competence models as globalisationmakes cross-cultural service provision a worldwidephenomenon.What was tried? We designed a course aroundhypothetical recommendations that cultural compe-tence initiatives should anticipate trainee resistance,occur early in training to make a professional differ-ence, include case-based learning and avoid uncom-fortable self-disclosures.1 All second-year psychiatrytrainees (n = 12) at Columbia University underwenta 12 week course based on the Cultural FormulationInterview (CFI). The CFI consists of 16 questionsand will be included in the fifth revision of theDiagnostic and Statistical Manual of Mental Disor-ders (DSM-V); prior DSMs have had wide interna-tional circulation. The CFI revises the DSM-IVOutline for Cultural Formulation, the culturalassessment with the largest evidence base in psychi-atric education. The first 5 weeks consisted ofreviewing social science theories underpinning CFIdevelopment (curriculum available) and residentssharing experiences surrounding their acculturationprocesses as doctors and psychiatrists. The last7 weeks consisted of practising the CFI as class-mates reviewed one-page summaries of CFI ques-tions and answers with current patients. In each50 minute lecture, instructors reviewed learningobjectives, encouraged discussions on how cases cor-roborate or refute CFI social theories and solicitedcourse feedback. Instructors met with trainees out-side of class to examine how culture affects diagnos-tic assessment, treatment planning and continuity ofcare for each patient presentation.What lessons were learned? All trainees stated thatthey had cultural competence training in medicalschool. They appreciated the individual approach to

ª 2013 John Wiley & Sons Ltd. MEDICAL EDUCATION 2013; 47: 1119–1146 1143

really good stuff

Page 2: Developing cultural competence in health care professionals: a fresh approach

culture in the CFI that avoids stereotyping patientsthrough broad generalisations (‘the Asian patient’,‘the immigrant’, etc.). Certain themes elicited highparticipation: (i) trainees discussing their own accul-turation within the cultures of medicine and psychi-atry, (ii) cross-cultural miscommunication despiteusing hospital cultural and linguistic brokers, and(iii) The relevance of cultural competence to formu-lating and implementing care for actual patients.The least participation occurred when trainees wereasked to reflect on their racial, ethnic, linguistic orsocio-economic backgrounds in relation to individ-ual patients. Trainees may find self-reflection in cul-tural competence initiatives more productive whenthey can discuss professionalisation experiences oractual cases leading to skill development. This modeof self-reflection may feel less threatening than ask-ing trainees to imagine how their attitudes or biasesaffect clinical care. Future studies can examinewhether this model of cultural competence elicitsfeasibility and acceptability with larger trainee sam-ples over time.

REFERENCE

1 Willen SS, Bullon A, Good MJD. Opening up a hugecan of worms: reflections on a “cultural sensitivity”course for psychiatry residents. Harv Rev Psychiatry2010;18:247–53.

Correspondence: Dr Ravi DeSilva, Department of Psychiatry,Columbia University and New York State Psychiatric Institute,1051 Riverside Drive, New York, New York 10032, USA.Tel: 00 1 212 543 6162; E-mail: [email protected]

doi: 10.1111/medu.12323

Enhancing students’ communication in an ethniclanguage

Sultana Azam & Mark Carroll

What problems were addressed? Medical studentsshould be culturally competent individuals withwell-developed communication skills.1 In anethnically diverse area like London, it can bechallenging to converse sensitively with patientswhose mastery of English is limited. Furthermore,many of our students travel abroad in order toundertake electives in developing countries, wherean ability to use the local language might wellimprove their learning outcomes. Yet our multicul-tural student body has expertise in numerousforeign languages and cultures. Could we use this

resource to develop an online module that wouldenable students to gain a basic grasp of a commu-nity language, thereby enhancing communicationwith local patients and medical staff?What was tried? A clinical student fluent in Arabicdeveloped an extensively illustrated languageinstruction module. It was presented as an onlinelearning package, readily accessible via the medicalschool’s intranet; a ‘virtual patient’ frameworkhelped to contextualise the language and furtherengage the learner. The basics of Arabic script andpronunciation were followed by digitally recordedgreetings and introductions, presented in thecontext of a doctor–patient consultation. The namesof principal body parts and other commonly usedwords were then introduced in a clinically relevantway. System-based themes allowed the user toexplore the relevant vocabulary within eachspecialty, such as cardiology and respiratory disease,whilst concurrently reinforcing the earlier basiclanguage components. The audiotaped conversa-tions were complemented by a written guide, whichprovided a breakdown of the more complexsentences. Mechanisms such as self-test questionsand various multimedia formats emphasised themodule’s interactive nature. The package wasevaluated by academic staff with appropriateexpertise and by selected medical students with noprior understanding of Arabic.What lessons were learned? The Arabic languagemodule required about 100 student hours of workto develop, following training in the use of theappropriate software. The virtual patient templateproved satisfactory once minor technical limitationshad been overcome. Academic staff provided largelyfavourable feedback on the module’s structure andcontent, but stressed that students should use aforeign language only within the limits of theircompetence. Feedback from students was overallvery positive: their evaluation confirmed that themodule’s interactive features were instructive,engaging and user-friendly.We have thus developed an innovative, culturally

sensitive, Arabic language online learning packagethat has been positively evaluated by staff andstudents. A basic grasp of the language in a clinicalcontext should enhance our students’ communicationwith Arabic-speaking patients in London, althoughwe need to test this outcome in practice. Somefamiliarity with the language should also help clini-cal students who take electives in Arabic-speakingcountries to converse with health care workersthere. The basic template used here can bemodified flexibly for students to develop modulesin other appropriate community languages. Indeed,

1144 ª 2013 John Wiley & Sons Ltd. MEDICAL EDUCATION 2013; 47: 1119–1146

really good stuff