Cultural Competency at UF COM

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Cultural Competency at UF COM
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What is cultural competency?

• Cultural competency is "a set of academic and
  personal skills that allow us to increase our
  understanding and appreciation of cultural
  differences between groups.1

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Why do we need culturally sensitive doctors?

• Well documented disparities in health care based
  on race
• Physicians attitudes towards certain racial
  groups impact how they deliver health care
• Mistrust within certain racial/ethnic groups of
  Western health care system prevents them from
  receiving appropriate care

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Evidence of Racial Disparity in Health Care

• Compared to whites, blacks with cancer have an
  overall excess risk of death (HR, 1.16 95CI,
  1.12-1.20)1
• Blacks less likely than white patients to receive
  thrombolytic therapy at the time of arrival
  (32.4 vs. 48.2 P
• Among patients with diabetes, high blood
  pressure, or heart disease, Latinos and Asian
  Americans least likely to receive clinical
  services that are important for monitoring and
  controlling these chronic conditions13

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Medicare Observational Study

• Blacks less likely than whites to receive breast
  cancer screening (62.9 vs 70.9 P
• Blacks with diabetes less likely to receive eye
  examinations (43.6 vs 50.4 P .02)9
• Blacks less likely to receive beta-blocker
  medication after myocardial infarction (64.1 vs
  73.8 P
• Blacks less likely to have follow-up after
  hospitalization for mental illness (33.2 vs
  54.0 P

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• The mortality rate for African Americans is
  approx 1.6 times higher than that for white
  peoplea ratio that is identical to the
  blackwhite mortality ratio in 1950.13

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Approach to the Problem

• Health systems
• Address access issues
• Societal concerns
• Improve awareness of problem
• Provider issues
• Cultural competency

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Provider Issues

• Minority representation as health care providers
• Training of all health care providers in cultural
  sensitivity
• Implementing cultural competency goals early in
  training

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Racism Workshops

• One piece of a larger effort to train culturally
  competent physicians
• Conceived and sustained by medical students
• Students-teaching-students
• Open discussion format

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How it began

• A group of medical students from the class of
  2004 lead by Leila Sabet decided to enhance the
  cultural competency curriculum of UF COM. They
  were concerned that most medical students were
  not being exposed to issues of race and how these
  issues affect patient care.

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Goals Objectives

• Medical students should begin to feel comfortable
  discussing racial issues openly and candidly with
  people from other racial backgrounds.
• Students should become aware that racism still
  exists for many people, and begin to discover how
  this affects their patients lives.
• Students should begin to explore how they can
  apply awareness of racism to their practice and
  daily lives. They may also begin to develop ways
  to cope with racism as they witness or experience
  it.

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Video Discussion

• Two hour session
• Included in preceptorship orientation and 3rd
  year Family Practice clerkship
• Students watch video
• Break up into groups for discussion
• Groups facilitated by other medical students

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Primary goal of facilitator

• What do we do to alter the underlying
  unconsciousness that we have been indoctrinated
  with and completely free ourselves from social
  prejudices and racist inclinations?
• How will we use this to improve our interactions
  with patients and colleagues?

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Did you find this experience enlightening?
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Do you think this should be part of the
Preceptorship Orientation next year?
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Do you think discussion of racism should be
incorporated into EPC?
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Sample of Comments

• The discussion was very enlightening. I felt I
  got to know my classmates and their viewpoints
  and backgrounds.
• If this was part of EPC it could prepare us for
  difficult racial situations that we may
  encounter.
• This should be given to the Admissions Committee,
  as they are the ones having difficulty getting
  African Americans accepted in our class.

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More Comments

• The general nature of this program did not really
  assist me in preparing for the preceptorship. One
  cant help think that it might be better suited
  for freshmen orientation in August.
• More emphasis should be placed on sexism/racism
  in a health care setting.
• I also think sexuality should be addressed.

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Future Plans

• Continue to improve preclinical and clinical
  programs
• Train facilitators to place discussion in context
  of treating patients
• Involve more students as facilitators once they
  have participated in the workshops
• Continue to develop cultural competency
  especially by collaborating with EPC course
  directors

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The battles that count aren't the ones for gold
medals. The struggles within yourselfthe
invisible, inevitable battles inside all of
usthat's where it's at.Jesse Owens
(1913-1980)Blackthink (1970)
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