Instructor Guide

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PGY-1: Refugee and Immigrant Patients

Cross-cultural Communication: Interacting Effectively with Patients from Diverse Backgrounds

 


 

Goals:

There are two main goals and accompanying “parts” of the workshop. They can be presented together or separately.

  1. A PGY1 resident will understand the meaning of culture and the components and skills defining cultural competency.

Specific Objectives:

  1. Define culture and cultural competence
  2. Learn how to effectively collaborate and care for patients whose cultural experiences and beliefs differ from those of “mainstream” US medical culture
  3. Identify laws and standards related to caring for LEP patients
  4. Learn different methods of effective communication
  1. A PGY1 resident will be able to communicate effectively with patients from different cultural and linguistic backgrounds, including use of interpreters.

Specific Objectives:

  1. Learn different methods of effective communication and interaction.
  2. Learn how to effectively communicate through interpreters.

ACGME Core Competencies:

Patient Care

  • Demonstrate the ability to conduct culturally competent interviews and establish rapport across cultural differences

Medical Knowledge

  • Develop an understanding of how being a refugee impacts upon physical and emotional health and health care
  • Develop an understanding of the history, traditions, values, belief system, acculturation and/or migration patterns of an individual refugee

Practice-Based Learning and Improvement

  • Gain competence in working with an interpreter

Interpersonal and Communication Skills

  • Demonstrate the ability to perform a cultural beliefs/explanatory model interview based on Kleinman
  • Gain competence in working with an interpreter

Professionalism

  • Demonstrate awareness of his or her own personal attitudes, beliefs, biases and behaviors and how these may impact clinical care

Systems-Based Practice

  • Identify laws and policies that apply to patients with limited-English proficiency as well as language services available to patients at UVA

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Session Guide


Time Needed:

Part 1: 2 hours

Part 2: 1 hour

Equipment Needed:

  • Computer with DVD-ROM drive and LCD projector (PowerPoint is on a DVD)

Personnel Needed: Refugee with limited English proficiency and professional interpreter. You also may consider asking a small number of patients to participate (one at each workshop).

Suggested Reading:

Kleinman A, Eisenberg L, Good B. Culture, illness and care: Clinical lessons from anthropologic and cross-cultural research. Annals Intern Med 1978;88:251-8.

Instructor Script and Notes

Part 1 – 2 hours

    1. Introduction to Interpreter Skills
      1. Introduce the objectives of the session as outlined in the PowerPoint presentation.
      2. PowerPoint presentation – “Cross-Cultural Communication: Interacting Effectively with Patients from Diverse Backgrounds
        1. Review the meaning of culture and components of culture slides.
        2. Slide #9: Ask the residents to reflect, and then discuss the following. There is time for 2-4 residents to share their stories (can include more and encourage others to participate).
          1. Think about your own culture, especially your beliefs and values.
          2. Describe your cultural “profile” keeping in mind the preceding components.
          3. How do your beliefs and values influence your attitudes and experiences with health and health care? (You may need to think about the time before you entered medical school)
        3. The next several slides provide an overview of the components of medical culture. For each one there is a “blank slide” where the residents are asked to identify aspects of medical culture that fit into that component. The components are:
          1. Environment
          2. Economy
          3. Technology
          4. Religion/world view
          5. Language
          6. Social structure
          7. Beliefs and values
            • Each blank slide is followed by a “filled in” slide providing some of the answers.
        4. Review the next set of slides with the residents:
          1. Definition and Importance of Cultural Competence
          2. The LEARN Model: One Model to Help Facilitate the Understanding of Culturally Competent Communication Techniques
          3. Slide #28: Ask the residents to provide some examples of questions they can ask to elicit the patient’s health beliefs and practices)
          4. Laws and Standards that Apply to the Use of Interpreters and Other Aspects of Culturally Competent Care at the Health System Level
        5. The next series of slides focuses on interpreting. The barriers to interpreting can be a more interactive piece – ask the residents their thoughts on the barriers from the patients’, doctors’ and interpreters’ perspectives. Ask the residents about what skills are used in with an interpreter before reviewing the slides that provide these hints.

Part 2 – 60 minutes

  1. Interview of Patient with Interpreter
    1. Introduction
      1. Patient and interpreter will arrive to the classroom.
      2. Introduce the patient and interpreter.
      3. Explain the purpose of the “interview.”
    2. Interview
      1. 2-3 of the residents will have an opportunity to interview the patient directly (one at a time). They will introduce themselves to the patient and interpreter. The purpose is NOT to take a usual medical history but to get a feel for the patient, her/his experiences as a refugee, what it is like to get healthcare in the US/at UVA, compared with their birth country or second country, what are some of the cultural traditions of the patient’s cultural group; what have been the challenges of communicating in their native language, experience with interpreters, family and social history. Each resident will interview the patient for 5-10 minutes, and usually there is a break when the resident stops, or exhausts questions. If not, the instructor should stop them when appropriate, then ask for feedback from the resident and others. Then, repeat with the next 1-2 residents. After that, open up questions to the group to ask of the patient or the interpreter. The instructor needs to be thinking of feedback and suggestions during this time.
      2. At the end of the hour, thank the guests for coming and make sure they know how to find their way.