Cultural Competency in Osteopathic Medicine. Prof. Reza Nassiri Director, Institute of International Health Michigan State University

Cultural Competency in Osteopathic Medicine Prof. Reza Nassiri Director, Institute of International Health Michigan State University

Cultural Competency in Medicine Presentation goal: To promote an active and integrated approach to multicultural issues When practicing osteopathic medicine Throughout osteopathic medical colleges

Cultural Competency in Medicine Most peer reviewed articles on cultural competency in medicine focus on English-speaking countries, where there are diverse communities of immigrants and war refugees: United States United Kingdom Australia New Zealand

Cultural Competency in Healthcare Cultural competence in medicine is now considered to be a federal standard of care and is among educational objectives for various accreditation bodies in medical education. Academic Medicine, Vol. 80, No 6/June 2005

Cultural Competency in Healthcare The quality of evidence from interventions to improve cultural competence of health professionals is generally poor! Academic Medicine, Vol. 80, No 6/June 2005

Cultural Competency in Healthcare LCME (Liaison Committee for Medical Education) and ACGME (Accreditation Council for Graduate Med. Ed.) Emphasize the need for training in cultural competence in medical schools and post-graduate programs. J Gen Intern Med 2006; 21: 1116-1120

Cultural Competency in Healthcare National Center for Cultural Competence (NCCC) Mission: To increase the capacity of health and mental health programs to design, implement, and evaluate culturally and linguistically competent service delivery systems.

United States Has long been culturally diverse. Is becoming more responsive to the needs of people from diverse backgrounds. Therefore, it is critically important that healthcare professionals are educated specifically to address issues of culture in an effective manner.

U. S. and Immigration More than 50 million people in the U.S. will be ethnically diverse by 2020. In 1940, 70% of immigrants were from Europe. By 2000, the pool of immigrants had changed so that 18% came from Europe, 44% came from Asia and 38% came from Latin America and the Caribbean.

U. S. and Immigration The U.S. attracts two thirds of the world's immigration. Primary care physicians can expect more than 40% of their patients to be from minority cultures.

Healthcare and Cultural Diversity The health industry is starting to realize the importance of cultural sensitivity. Michigan Physicians Mutual Liability company underwrites malpractice policies so that doctors receive a 2-5% premium reduction if they take a seminar on cultural diversity. The Pennsylvania Health Law Project (PHLP) has been pushing for stronger linguistic and cultural standards in federally funded health programs.

Legislation Cultural Diversity New Jersey Requires Physician Cultural Competency Training as a Condition of Licensure Senate Bill 144, signed into law March 23, 2005 California Continuing Medical Education on Cultural Competency AB 1195 Chapter 514, effective July 1, 2006

Legislation Cultural Diversity Washington State Requiring Multicultural Education for Health Professionals 2006 Senate Bill 6194S, signed into law March 27, 2006

United States Bodies recognizing the importance of cultural diversity in medicine AOA The DO, Vol. 49, No. 5, May 2008: Building Trust: DOs examine cultural competency in medicine AMA National Academy of Sciences Institute of Medicine

Cultural Competence What is culture? Refers to integrated patterns of human behavior that include: Language Thoughts Communications Actions Customs Beliefs Values Institutions of racial, ethnic, religious, or social groups

Cultural Competence What is competence? Implies having the capacity to function effectively as an individual and an organization within the context of the Cultural beliefs Cultural behaviors Needs presented by consumers and their communities

What is Cultural Competence? Knowledge information and data from and about groups INTO Clinical Standards Clinical Skills Service Approaches Techniques Marketing Programs Integrated and transformed that match the individual's culture and increase both the quality and appropriateness of health care and health outcomes.

Cultural Considerations: Primary and Secondary Dimensions of Diversity Primary dimensions influence who an individual is. Secondary dimensions influence an individual s participation. Income Parental Status Class Economics Political Context Education Employment Community Networks Sexual Orientation Gender Age Literacy Spiritual Beliefs Geographic Location Family/Extended Family Race Immigration Ethnicity Status Language Marital Status Cultural + Historical Country of Origin Knowledge/Experience Perceptions of Physical Qualities Physical Abilities Military Experience English Language Proficiency (adapted from Rasmussen, 1996)

Culturally Competent Health System Acknowledges the benefits that culturally diverse group bring to the U.S. Assists healthcare providers and consumers to achieve the best, most practical care and services. Holds health organizations/regulators for meeting the needs of all members of the community they serve.

Cultural Competency in Medicine Benefits for health professional Can improve Knowledge Attitude Skills Can affect patient s health outcome and satisfaction

Cultural Competency in Medicine Kleinman s tool to elicit health beliefs in clinical encounters What do you think caused your problem? What do you call your problem? Why do you think it started when it did? What does your sickness do to you? How severe is it? Will it have a short or long course?

Cultural Competency in Medicine Kleinman s tool to elicit health beliefs in clinical encounters (continued); What do you fear most about your disorder? What are the chief problems that your sickness has? Caused for you? What kind of treatment do you think you should receive? What are the most important results you hope?

Cultural Competency in Medicine LEARN Model Listen with sympathy and understanding Explain your perceptions Acknowledge differences Recommend treatment Negotiate agreement

Cultural Competency in Medicine Importance of teaching cultural competence Illness and disease may vary by culture Diverse belief systems exist on health, healing and wellness Cultural attitudes affect relationship with physicians and other providers Patients seek complementary and alternative health services There is a shortage of minority or culturallydiverse physicians

Cultural Competence Training in US Medical Schools JAMA. 2004; 291:2142 Medical Schools 2 broad strategies: Cultural immersion programs Cultural competence curricula Cultural immersion programs Typically include either a clinical rotation in another country, or a more local experience with native communities. In 2002, 38% of US medical students participated in international electives, compared with 6% in 1982.

Cultural Competence Training in US Medical Schools JAMA. 2004; 291:2142 Cultural competence curricula Use case-based, small-group formats to explore: The core cultural issues and health beliefs of various ethnic groups Complementary and alternative medicine Language barriers Substance abuse Racism Cross-cultural interview skills

Cultural Competence Training in US Medical Schools JAMA. 2004; 291:2142 As of 2000 87% of US medical schools addressed cultural competence in 3 or fewer lectures during the preclinical years. 8% of schools offered separate course on the topic of cultural competency in medicine.

Cultural Competence Training in US Medical Schools JAMA. 2004; 291:2142 Medical students who participated in crosscultural exchange, particularly international rotations in medicine and public health, reported that they had gained: Improved cultural sensitivity Communications skills Appreciation for public health Respect for cultural differences

Cultural Competency in Medicine Academic Medicine, 2008, 83(1): 106-111 Physicians, Know Thyself: The Professional Culture of Medicine as a Framework for Teaching Cultural Competence The greatest challenges: When attempting to convey the importance of cultural competence to allopathic medical students who view it as a soft science. Avoiding the perpetuation of stereotype and labeling groups as others in the process of teaching cultural competence Few cultural competence curricula are designed to foster an awareness of the student s own cultural background.

Cultural Competence in Osteopathic Medicine

Cultural Competence in Osteopathic Medicine For many Nations.... Health is viewed as a HOLISTIC relationship between the following components: Mental Spiritual Emotional Physical Social

Cultural Competence in Osteopathic Medicine Treatment of an illness should include consideration of the whole person A historical opportunity for osteopathic profession to be in forefront of culturally holistic approach to the patient s care and need. Culturally competent patient-centered outcome.

Cultural Competence in Osteopathic Medicine Logic: Osteopathic Medicine is a growing field of healthcare delivery Responds well to demographic changes. Improves the quality of health services and outcome through the concept of holistic approach. Gains competitive edge through its philosophy and practice.

Model: Interplay of Dimensions Cultural Competency in Osteopathic Medicine Knowledge Conviction Capacity for action (Healthcare) System (AOA) Organization (DO) Profession (Osteopathic Physicians) Individual The system supports the organization The organization and profession support the individual The individual informs the organization, profession and the system by applying his/her knowledge, conviction and capacity for action

Cultural Competence in Osteopathic Medicine ARTICLE: DOs Examine Cultural Competency in Medicine The DO, May Issue, 2008 Article written by Carolyn Schierborn, Senior Editorial Project Manager in the AOA Department of Publications.

The DO, Vol. 49, No. 5, May 2008 ARTICLE: DOs Examine Cultural Competency in Medicine Contributors: Barbara Ross-Lee, DO David V. Condoluci, DO Hector Lopez, DO Margaret Aguwa, DO, MPH Kathleen M. Farrell, DO Larry D. Purnell, Ph.D. Judith A. Lightfood, DO Thomas A. Vavalieri, DO Maria I. Brown, DO Elizabeth A. Shandor, DO Kathleen A. Spreen, DO Karen j. Nichols, DO - Riginald W. Stewart, DO - Dr. Garza - Lewin Wyatt Jr, DO - William T. Betz, DO - Timothy J. Barreirro, DO - John T. Pham, DO - Sonia Rivera-Martinez, DO - James M. Lally, DO - Bruce Dubin, DO - Anthony Dekker, DO - Karen I. Hanscom, Ph.D. - Prof. Nassiri

The DO, Vol. 49, No. 5, May 2008 DOs Examine Cultural Competency in Medicine Dr. Ross-Lee It s important for physicians and other healthcare professionals to appreciate the impact of culture on health outcomes

The DO, Vol. 49, No. 5, May 2008 DOs Examine Cultural Competency in Medicine Dr. Condoluci Consulting on HIV, safe sex, and a newly married woman. Wife: I am very religious. I know God will protect me.

The DO, Vol. 49, No. 5, May 2008 DOs Examine Cultural Competency in Medicine Dr. Aguwa Cultural competency in medicine means understanding the differences that exist among diverse patient populations that can affect how individual patients care for themselves, interpret health and disease, and use healthcare services.

The DO, Vol. 49, No. 5, May 2008 DOs Examine Cultural Competency in Medicine Dr. Farrell Cultural competency in medicine means accepting people for who they are.

The DO, Vol. 49, No. 5, May 2008 DOs Examine Cultural Competency in Medicine Prof. Reza Nassiri Cultural competency describes the ability of healthcare professionals, organizations, institutions, such as osteopathic medicine, to deliver patient-centered holistic care in people of diverse cultures.

The DO, Vol. 49, No. 5, May 2008 DOs Examine Cultural Competency in Medicine Prof. Reza Nassiri Why cultural competency become a buzz phrase? - Demographic change - Greater attention to disparities in health outcomes - Demand for higher quality health care overall - Globalization of healthcare

The DO, Vol. 49, No. 5, May 2008 DOs Examine Cultural Competency in Medicine Dr. Lightfoot Contributing factors in health disparities: - Poverty - Employment discrimination - Lower educational attainment - Lack of access to high-paying jobs - Inconsistent relationship with healthcare professionals due to an insufficient number of physicians in minority communities.

The DO, Vol. 49, No. 5, May 2008 DOs Examine Cultural Competency in Medicine Dr. Stewart (African-American) African-American patients should get screened earlier for disease to which they are particularly susceptible. I speak to my patients from the context of risk-profiling

The DO, Vol. 49, No. 5, May 2008 DOs Examine Cultural Competency in Medicine Dr. Wyatt Jr. The key to ending minority health disparities is to recruit more minorities into medical schools. Minorities tend to practice in the communities they come from.

The DO, Vol. 49, No. 5, May 2008 DOs Examine Cultural Competency in Medicine Dr. Betz Only 7% of the students in PNWU-COM s inaugural class this fall will be Hispanic, even though Yakima is a 43% Hispanic, and only one student is known to be Native American.

The DO, Vol. 49, No. 5, May 2008 DOs Examine Cultural Competency in Medicine Dr. Pham My Vietnamese patients feel so at ease talking with me because I not only speak their language but also understand their culture

The DO, Vol. 49, No. 5, May 2008 DOs Examine Cultural Competency in Medicine Dr. Sonia Rivera-Martinez Finds that her fluency in Spanish gives her an edge in communicating with the man Hispanic patients who seek care at Medisys East New York, a federally qualified clinic in Brooklyn.

The DO, Vol. 49, No. 5, May 2008 DOs Examine Cultural Competency in Medicine Dr. Brown Once you graduate from medical school, you are no longer a member of the proletariat, it is important to avoid medical jargon when communicating with patients.

The DO, Vol. 49, No. 5, May 2008 DOs Examine Cultural Competency in Medicine Dr. Dubins When patients feel they have your respect, they are more likely to trust you and comply with treatment. Physicians need to be aware of the ways culture influences points of view.

The DO, Vol. 49, No. 5, May 2008 DOs Examine Cultural Competency in Medicine Dr. Shandor When I practiced in Immolalee, FL, I treated a number of Haitian patients. If people lose weight quickly, they are thought to have AIDS. Because they are afraid of the stigma associated with AIDS, it s difficult to persuade overweight Haitian patients with diabetes to lose weight.

The DO, Vol. 49, No. 5, May 2008 DOs Examine Cultural Competency in Medicine Dr. Dekker You need to get to know the leaders and others in the tribe [American Indians]. Find out which healthcare issues are important to community. Don t make assumption. They believe the physical and spiritual world is intense.

The DO, Vol. 49, No. 5, May 2008 DOs Examine Cultural Competency in Medicine Dr. Nichols You need to approach patients as individuals, there can be as much variations within cultural groups as there is between them.

The DO, Vol. 49, No. 5, May 2008 DOs Examine Cultural Competency in Medicine Dr. Nichols Suggests asking patients general, open-ended questions to learn about their cultural identity, such as: - How do you honor your heritage? - What are your concerns about your health? - What concerns must we consider in creating your treatment plan?

The DO, Vol. 49, No. 5, May 2008 DOs Examine Cultural Competency in Medicine Dr. Purnell When interviewing a recent emigrant from Mexico, for example, he contends that it is better for a physician to ask, Have you been to a yerbero versus simply asking, Have you seen anyone else about your condition?

The DO, Vol. 49, No. 5, May 2008 DOs Examine Cultural Competency in Medicine Dr. Cavalieri UMDNJ-SOM is partnering with the New Jersey Association of Osteopathic Physicians and Surgeons to conduct cultural competency CME seminars.

Cultural Competence in Osteopathic Medicine Cultural competency is now an essential skill for the practice of compassionate, humanistic care of patients. Linda Boyd, DO, Director Physician s Core Course UMDNJ

Promotion of Cultural Competence in Osteopathic Colleges Improvement in curriculum Establishing the COM s Culturally Competent Care Education Committee (CCCEC) Mission To foster the development of faculty and curriculum to prepare student with knowledge, skills, and attitudes to practice culturally competent osteopathic medicine, thereby diminishing health care disparities.

CONCLUSION Published research suggest Cultural Competence may: Improve physician-patient communication and collaboration Increase patient satisfaction Enhance adherence Teaching cultural competency in medicine reduces health disparities.

CONCLUSION Achieving culturally competent health care, should be the priority of the osteopathic profession, primarily due the uniqueness such as holistic approach and humanistic training that graduates receive during their education. Osteopathic medicine in the United States has a historical opportunity to deliver culturally sensitive and competent care.

Thank you for your attention! Reza.Nassiri@hc.msu.edu