LEARN Model Handout

Open Handout

 


 

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 limited-English proficient patients
  4. Learn different methods of effective communication and interaction
  5. Learn and demonstrate how to effectively communicate with patients through interpreters

Models of Effective Cross-Cultural Communication and Negotiation

There are many mnemonics that can be used for clinical interviewing and communication beyond the standard SOAP format you’ve learned. These models each provide an easily remembered framework for a patient encounter and can help you to improve your skills in cross-cultural, patient-centered care. You may have heard of some of these models: LEARN, ETHNIC(S), BELIEF, BATHE, ESFT, etc. For this assignment, you will practice using the modified LEARN model to help you elicit your patient’s history:

L=Listen

  • Identify and greet family or friends of the patient
  • Ideally, provide an interpreter when interacting with limited-English proficiency (Note: we recognize that not all sites have interpreters available)
  • Start with open-ended questions and avoid interruption for the first 30 seconds that a patient speaks, e.g.:
    • Could you please tell me your reason for the visit today?
    • How can I help you today?
  • Listen with sympathy & understanding to the patient’s perception of the problem

E = Elicit

  • Elicit the patient’s health beliefs as they relate to the reason for the visit as well as his/her health behaviors. The following questions may help in the process:
    • What do you think has caused your problem/illness?
    • Why do you think it started when it did?
    • What do you think your sickness does to you?
    • How severe is your sickness? Will it have a long or short course?
    • What kind of treatment do you think you should receive?
    • What are the most important results you hope to receive from this treatment?
    • What are the chief problems your sickness has caused for you?
    • What do you fear most about your sickness?
    • How can I be of most help to you?

(These questions are adapted from the work of Arthur Kleinman. See the attached paper, Culture, Illness, and Care. Clinical Lessons from Anthropologic and Cross-Cultural Research. It is a worthwhile read.)

A = Assess

  • Assess potential attributes and problems in a person’s life that may have an impact on his/her health and health behaviors. Medicine in this country may be totally foreign to someone. Also, in some cultures, families make decisions together as a unit, or individuals may turn to an elder for health advice. Lastly, people may be too shy to discuss their needs out of respect for the physician. Here are some examples of questions you can ask (we provide some of these in the assignment):
    • I’d like to get to know you more today. Could you tell me about yourself? With whom you live? Where you work?
    • What brought you here to this country? How does medical care differ here?
    • Do you have family and friends who help you with decisions or who give you advice?
    • Do you have coverage for your medications?
    • Are there times that are bad for you for appointments? Is transportation a problem for you?
    • Do you have any trouble reading medicine bottles or appointment cards?

R = Recommend

  • Recommend a plan of action with an explanation of your rationale using language that the patient is able to understand. Physicians underestimate the amount of information that patients want and often provide the information using medical jargon that is unintelligible to the patient. Patients often are too embarrassed to admit this. You can check how well you taught the patient, by using the following questions:
    • To make sure that we understand one another, can you tell me what it is that I just told you?
    • Is there any part that you don’t understand?

N = Negotiate

  • Negotiate a plan of action with your patient after you have made your recommendations. You can use these questions:
    • Now that we understand each other, let’s come up with a plan that works for you.
    • What do you think should be the next steps?

(Adapted from: Cultural Competency in Medical Education: A Guidebook for Schools. Published by HRSA,September 2004.)