How to teach for a culturally competent world PAMELA H.
MITCHELL 4 TH ANNUAL CULTURAL COMPETENCE CONFERENCE, MARCH 27, 2015
TEXAS TECH UNIVERSITY
Slide 2
Objectives Explore the many cultures involved in
interprofessional teaching and practice Identify ones own
experiences with cultural stereotyping in teaching and learning
Evaluate multiple approaches to inclusivity in interprofessional
teaching
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The many cultures involved in interprofessional teaching and
practice Cultural awareness Gender Race Ethnicity Geographic
Sociopolitical Professional and interprofessional culture
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Cultural Competence: Definition and Conceptual Framework
Cultural competence requires that organizations: have a defined set
of values and principles, and demonstrate behaviors, attitudes,
policies and structures that enable them to work effectively
cross-culturally. have the capacity to (1) value diversity, (2)
conduct self-assessment, (3) manage the dynamics of difference, (4)
acquire and institutionalize cultural knowledge and (5) adapt to
diversity and the cultural contexts of the communities they serve.
incorporate the above in all aspects of policy making,
administration, practice, service delivery and involve
systematically consumers, key stakeholders and communities.
Cultural competence is a developmental process that evolves over an
extended period. Both individuals and organizations are at various
levels of awareness, knowledge and skills along the cultural
competence continuum. (adapted from Cross et al., 1989)Cross et al.
http://nccc.georgetown.edu/foundations/frameworks.html#ccdefinition.
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Definitions - The idea of more effective cross-cultural
capabilities is captured in many terms similar to cultural
competence. Cultural knowledge, cultural awareness, and cultural
sensitivity all convey the idea of improving cross-cultural
capacity, as illustrated in the following definitions: Cultural
Knowledge: Familiarization with selected cultural characteristics,
history, values, belief systems, and behaviors of the members of
another ethnic group (Adams, 1995). Cultural Awareness: developing
sensitivity and understanding of another ethnic group. This usually
involves internal changes in terms of attitudes and values.
Awareness and sensitivity also refer to the qualities of openness
and flexibility that people develop in relation to others. Cultural
awareness must be supplemented with cultural knowledge(Adams,
1995). Cultural Sensitivity: Knowing that cultural differences as
well as similarities exist, without assigning values, i.e., better
or worse, right or wrong, to those cultural differences (National
Maternal and Child Health Center on Cultural Competency, 1997)
http://cecp.air.org/cultural/Q_howdifferent.htmhttp://cecp.air.org/cultural/Q_howdifferent.htm,
retrieved March 7,2015 Center for effective collaboration and
practice
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Cultural awareness Acknowledge cultural differences and be
aware of how these impact care. Recognize how ones own culture
impacts ones thoughts and actions. Understand cultural differences
at the practice level, when patients and providers bring unique
histories. Make a conscious effort to understand the meaning of the
others behavior within the context of his or her culture. Health
care providers should gain information as they can, but
comprehensive knowledge is not attainable. Providers should how
obtain information needed in the moment to reach a patient care
goal. (Cross et al., 1989, pp. 32-35)
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Cultural safety Cultural safety aims to improve the health
status and wellbeing of New Zealanders and applies to all
relationships through: 1) an emphasis on health gains and positive
health and wellbeing outcomes; 2) acknowledging the beliefs and
practices of those who differ from them. For example, this may be
by: age or generation, gender, sexual orientation, occupation and
socio-economic status, ethnic origin or migrant experience,
religious or spiritual belief, disability Arose from concerns of
Maori students and families about lack of understqnding of their
culture by non-Maori providers of health care
http://en.wikipedia.org/wiki/Cultural_safetyhttp://en.wikipedia.org/wiki/Cultural_safety,
retrieved March 7, 2015
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Core competencies for interprofessional collaborative practice
Values & Ethics (VE3). Embrace cultural diversity and
individual differences characterizing patients, populations, and
health care teams. Values and Ethics (VE4). Respect the unique
cultures, values, roles/responsibilities, and expertise of other
health professions. (Interprofessional Education Collaborative
Expert Panel, 2011, p. 19).
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UW School of Nursing Principles of Inclusion We affirm the
inherent dignity of each individual and group. We affirm that group
differences are socially, culturally, and historically constructed
and hierarchically arranged, resulting in the inequitable
distribution of resources among groups. This construction and
distribution can be changed and we commit to change it. We affirm
our commitment to address difference, privilege and power at the
School of Nursing. We will address privilege and power using
anti-racist and anti-oppression principles of on-going education,
open dialogue, skill building, challenging the status quo, and
accountability to people of color and other social groups. We
affirm our commitment to increase the numbers of faculty, students
and staff from underrepresented groups, and to support their
leadership within the school. We affirm our commitment to work
toward a climate of inclusiveness on all levels of the School of
Nursing. http://nursing.uw.edu/about/diversity
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Core principles UW School of medicine After participating in
and completing their medical education and training offered by the
University of Washington School of Medicine, every medical student
should be able to: Become aware of his/her own assumptions about
human behavior, values, biases, preconceived notions, and personal
limitations that may impact his/her clinical decision making and
care of his/her patients. Understand the world view of culturally
diverse populations (values, assumptions, practices, communication
styles, group norms, biases, experiences, perspectives, etc. of
culturally diverse faculty, colleagues, staff, patients and her/his
families, and the communities they are from). Develop and practice
appropriate, relevant and sensitive strategies and skills in
working with culturally diverse populations. Understand that the
process in becoming cultural proficient is a continuum. Advocate on
behalf of the needs of the diverse populations they work with.
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The culturally competent . Student Is one who has moved toward
being culturally aware, and is sensitive to his/her own cultural
heritage and to valuing and respecting differences. a. The student
has begun the process of exploring his/her own values, standards
and assumptions about human behavior and quality of life. b. Rather
than being ethnocentric and believing in the superiority of his/her
groups cultural heritage (customs, traditions, language, ability,
religion or spirituality, quality of life), there is acceptance and
respect for cultural differences and multiple identities. c. The
student understands that individual and group (social) identities
are a product of where we are in our personal development and in
what context, capacity and environment in which we are engaged.
From: Core Guiding Principles for Cultural Competence for Medical
Education David Acosta, MD, Amen Tsegai, MA, Victoria Gardner, EdD,
Pam Racansky, MA Version 2.0, March 31, 2011
http://depts.washington.edu/cedi/new/PDF/CoreGuidingPrinciples.pdf,
last retrieved March 10,
2015http://depts.washington.edu/cedi/new/PDF/CoreGuidingPrinciples.pdf
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Health care team as a culture team creates a new culture with
group norms for values and behavior. The cultural values: shared
goals, clear roles, mutual trust, effective communication, and
measurable processes and outcomes full inclusion of patients as
team members
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Multiple approaches to inclusivity Some resources Some
experiential exercises in context Cultural competence training
should encompass interactions with the patient in the context of
the team, rather than individual interactions as is often the
focus. Such training could begin in a simulated setting with a
standardized patient, but could also be accomplished in student
experiences in the clinical setting in learning activities with
objectives clearly focused on cultural competence. (from Buchanan
et al,
http://collaborate.uw.edu/blogs/main-blog/teaching-cultural-competence-for-the-health-
care-team.html) IPE exercises
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Learning about difference The study of diversity fosters
understanding of cultural traditions, histories, and influences;
sharpens critical and analytic thinking; explores sources of
inequality in society; and encourages a vibrant intellectual
community free of bias and prejudice.
http://www.washington.edu/diversity/learning-
about-difference/
Your own cultural identity What cultural identities do you
have? I am a woman A nurse and academic leader The daughter of
people who came of age in the Great Depression The granddaughter of
immigrants The wife of a retired physician The mother of 3
accomplished sons And grandmother to 3 adorable children Hans Jacob
Holtzklau came to America in 1714 He was our American immigrant
ancestor. Jacob changed the spelling of our name by signing his
will Jacob Holtzclaw. 14 individuals with families totaling 42
persons from the town of Siegen and Muesen in the principality of
Nassau-Siegen, Germany to come to Virginia. The First Germanna
Colony arrived in Virginia at Tappahannock in the spring of 1714,
and then came up the Rappahannock River where they settled 20 miles
west of Fredericksburg at a location that would be called Fort
Germanna.
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http://collaborate.uw.edu/educators-toolkit/faculty-development-training-toolkit/ipe-faculty-development-learning-activity-int
UW Center for Health Sciences Interprofessional Education .
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Identify own experience in cultural stereotyping Lets play
interprofessional pictionary
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Stereotyping related to professional roles, demographic &
cultural differences affect the health professions Stereotypes help
create ideas about a professions worth known as disparity diversity
(Edmondson & Roloff, 2009), eroding mutual respect. Inaccurate
perceptions about diversity prevent professions from taking
advantage of the full scope of abilities that working together
offers to improve health care. Role Clarity and Responsibility
Stereotyping and Biases
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Roles Across Professions Expert Medicine CommunicatorNursing
EducatorPharmacy AdvocatePhysical Therapy ProfessionalDentistry
CollaboratorSocial Work ManagerPublic Health LeaderPhysician
Assistant
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We may look in the same direction, even at the same lines, and
not see what our colleagues sees. (McKee, 2003)
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Interprofessional Pictionary As a team, decide who the health
care professional is based on information provided Draw a
representation of the health care professional without using
letters or numbers Be prepared to share how everyone has
contributed to the drawing After each team finishes drawing, the
other teams should guess the profession prior to discussion
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IP Pictionary: Reflection What assumptions am I making? Where
did I learn these values? What values/beliefs orient me? How might
someone whose role is different than mine look at this? Why do I
feel threatened when I am challenged on this? (McKee, 2003)
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Interprofessional Pictionary Acknowledgements: IP Pictionary
Game developed by Debbie Kwan at the Educating Health Professionals
for Interprofessional Care, University of Toronto (Ehpic 2011
Certificate Course) http://www.ipe.utoronto.ca/
http://www.ipe.utoronto.ca/ Edited and revised as Faculty
Development Toolkit to teach IPE Competency Domain: role clarity by
the University of Washington Macy Grant Team Core competencies for
interprofessional collaborative practice (IPEC, 2011)
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Interprofessional Pictionary Represent this professional Team
up with 3 or 4 people from different professions: decide who the
health care professional is based on information provided in the
box on the right Draw a representation of the health care
professional without using letters or numbers Be prepared to share
how everyone has contributed to the drawing Training Requirements:
Doctoral Degree Usual Practice settings: Hospitals (inpatient and
outpatient care), Community Settings, Clinics Scope of Practice
includes: Health and medication education, treatment consultation,
prescribe under protocol, administer medications, provide
immunizations Unusual Practice setting: NASA
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http://ethnomed.org/ More Resources
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http://ethnomed.org/culture
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Web Resources
http://odt.uwmc.washington.edu/pdfs/RespectThroughUnderstanding.pdf
- slide set
http://odt.uwmc.washington.edu/pdfs/RespectThroughUnderstanding.pdf
http://depts.washington.edu/ethnomed/HMCproject/hmcproject_talk_03
02/F_EthnoMed%20Home%20Page.htm
http://depts.washington.edu/ethnomed/HMCproject/hmcproject_talk_03
02/F_EthnoMed%20Home%20Page.htm
http://ethnomed.org/ethnomed/about/
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IPE Faculty Development Training Learning Activity: Barnga
Barnga is a simulation game that helps players address challenges
they may face when interacting with a different professions
culture. Each group of players receives a slightly different set of
instructions for a card game (ace is the weakest or strongest,
spades are the trumps cards or there is no trump card, etc.) The
winner and loser of each group will then rotate to play with
another group; the players are not told that the rules of the game
are different in this new culture and will be forced to resolve
communication problems with people who do not share their
understanding of the rules. Developed by: Educational psychologist
Sivasailam Thiagi Thiagarajan, PhD. Total time needed for the
activity is 90 minutes. Barnga covers IPE competencies in all four
domains.IPE competencies Materials needed: Some pencils and blank
sheets of paper. A bell. A deck of cards for each table. Each deck
must be modified so that it includes only the following cards:
Cards 2-7 in each suit as well as all four aces. The instructions
to play Five Tricks (Appendix 1, all ten versions of the game).Five
Tricks A copy of the Discussion Guidesheet (Appendix 3) for the
facilitator.Discussion Guidesheet
http://collaborate.uw.edu/educators-toolkit/faculty-development-training-
toolkit/ipe-faculty-development-training-learning-a-1
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Your preferred teaching tools What approaches have you found
helpful? What aspect of cultural competence are these aimed
at?
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References Acosta, D, Tsegai, A, Gardner, V, Racansky, P (2011)
Core guiding principles for cultural competence for medical
education. University of Washington School of Medicine
http://depts.washington.edu/cedi/new/PDF/CoreGuidingPrinciples.pdf,
last retrieved March 10, 2015
http://depts.washington.edu/cedi/new/PDF/CoreGuidingPrinciples.pdf
Buchanan, DT (3014) Teaching Cultural Competence for the Health
Care Team. Center for Health Sciences Interprofessional Educational
blog, Updated on July 16th, 2014 at 2:12 pm,
http://collaborate.uw.edu/blogs/main-blog/teaching-cultural-competence-for-the-health-care-team.html,
last retrieved March 7, 2015
http://collaborate.uw.edu/blogs/main-blog/teaching-cultural-competence-for-the-health-care-team.html
Cross, T. L., Bazron, B. J., Dennis, K. W., Isaacs, M. R. (1989).
Towards a culturally competent system of care: A monograph on
effective services for minority children who are severely
emotionally disturbed. Washington, D. C.: National Institute of
Mental Health, Child and Adolescent Service System Program.
Interprofessional Education Collaborative Expert Panel. (2011) Core
competencies for interprofessional collaborative practice: Report
of an expert panel. Washington, D.C.: Interprofessional Education
Collaborative.
https://ipecollaborative.org/uploads/IPEC-Core-Competencies.pdf,
last retrieved March 10, 2015
https://ipecollaborative.org/uploads/IPEC-Core-Competencies.pdf
Mitchell, P., Hall, L., & Gaines, M. (2012). A social compact
for advancing team-based high-value health care. Health Affairs
Blog. Retrieved from
http://healthaffairs.org/blog/2012/05/04/a-social-compact-for-
advancing-team-based-high-value-health-care/
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References Mitchell, P., Hall, L., & Gaines, M. (2012). A
social compact for advancing team-based high-value health care.
Health Affairs Blog. Retrieved from
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10,
2015http://healthaffairs.org/blog/2012/05/04/a-social-compact-for-
advancing-team-based-high-value-health-care/ Mitchell, P., Wynia,
M., Golden, R., McNellis, B., Okun, S., Webb, E., Von Kohorn, I.
(2012). Core principles & values of effective team-based health
care. Washington, D. C.: Institute of Medicine.
(http://iom.edu/Home/Global/Perspectives/2012/TeamBasedCare.aspx,
last retrieved March 10,
2015)http://iom.edu/Home/Global/Perspectives/2012/TeamBasedCare.aspx
National Center for Cultural Competence. (nd). Conceptual
frameworks/models, guiding values and principles. Retrieved from
http://nccc.georgetown.edu/foundations/frameworks.html#ccdefinition.
Last retrieved March 10,
2015http://nccc.georgetown.edu/foundations/frameworks.html#ccdefinition
Okun, S, Schoenbaum, SC, Andrews, D, Chidambaran, P, Chollette, V
et al (2014). Patients and health care teams forging effective
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