University of Pittsburgh

Cultural Competence

Background

A patient’s sociocultural background informs her or his health beliefs and behaviors.  Physicians-in-training must be prepared to deal with an increasingly diverse patient population.  Exposure to the social contexts of patients of varying races and ethnicities, physical abilities, sexual orientations, religions, etc., coupled with the tools to gather information through patient interviews, can give physicians a framework within which to form more effective patient-doctor relationships.

Goal

The goal is to prepare physicians-in-training to be culturally sensitive health care providers to diverse populations.  

Implementation

Development of these skills, and the emotional intelligence to apply them, is introduced early and continued throughout the curriculum as a longitudinal theme. It begins with the School’s educational objectives, where the components of cultural competence are articulated in broad goals and specific objectives. Activities to help students achieve these objectives are woven throughout the curriculum.

The value and impact of diversity in the educational environment is addressed in three sessions during the first week orientation program. Students participate in large group sessions, small group discussions, and exercises that provide a vital forum for discussion and raising awareness of students’ pre-existing concepts and biases, and sets the stage for the curriculum that follows.

Introduction to Being a Physician

Within the Introduction to Being a Physician course, during the first full week of medical school classes, students spend a day in a Pittsburgh community that is challenged by economic decline and a host of accompanying issues. Through this immersive experience students gain perspective about the everyday challenges faced by many of the patients they will treat. This experience, which has been a vital start to the curriculum for nearly two decades, is consistently recognized by students as an eye-opening event for those individuals who have never faced these types of personal and family challenges.

Patient, Physician and Society Block

Continuing in the Patient, Physician and Society block, the Ethics, Law and Professionalism course includes sessions that address consent to treatment and treatment refusal, including raising student awareness of cultural and personal influences on the decision to accept or decline treatment.  The importance of viewing health matters from a patient perspective is in the forefront in sessions on law at the end of life, actively hastening death, abortion and assisted reproduction.

Behavioral Medicine

In the Behavioral Medicine course, during spring of the first year, students learn how behavioral and social factors can have determinative and interactive impacts in causation of the course of disease, in areas such as pain, substance abuse and motivation to change health behaviors. This course also includes specific sessions on behavior change across cultures.

Population Health

During the second year Population Health course, students learn about social determinants of health and participate in the poverty simulation exercise.  During this highly engaging simulation, small teams of students attempt to conduct activities of daily life as might be experienced by families in poverty. This simulation, which was introduced as part of this new course, was well-received by students.  Students who had never lived under these conditions gained new perspective about and heightened sensitivity to the profound challenges faced by individuals and families who do not have the same access to resources that more affluent families enjoy. This effectively heightened awareness of the complexity of patient-centered care at a point in the curriculum just before students begin clerkships.

Advanced Medical Interviewing

Also in second year, during the Advanced Medical Interviewing course, students work through the challenges associated with communicating with a patient from a different culture and who is not fluent in English. Students are assessed on their skill in communicating through a translator as part of one of the cases on the Clinical Competency Assessment, the fourth year standardized patient examination.

Clinical Clerkships

During the clinical clerkships, cultural competence is incorporated in didactic sessions and clinical experiences.  In the Family Medicine Clerkship, a small group session on culturally competent care is part of the day-long introductory curriculum. In the Combined Ambulatory Medicine and Pediatrics Clerkship, students may opt to rotate at the SALUD clinic which serves the Spanish-speaking community. Many students volunteer at SALUD and other clinics for underserved populations throughout the four years.

Mini-Elective Program

The mini-elective program provides additional opportunities for learning in this area, beyond the required curriculum. For example, basic and intermediate courses in medical Spanish have been extremely well received by students. Introductory Spanish instruction is offered during the summer between first and second year. More advanced courses on practical conversations in medical Spanish are offered to first and second year students during the academic year.

The success of the Spanish program inspired expansion to other languages and cultures. In January 2011, the first medical French workshop was conducted, to help students preparing for a Family Medicine-sponsored clinical experience in Haiti. Student interest in research and clinical rotations at the UPMC hospital in Palermo, Italy, has also increased significantly in recent years. Eight students are presently preparing for summer 2011 research experiences in Palermo. As part of preparation for those cultural immersions, an Italian language program has been developed. This program incorporates a combination of independent study using Rosetta Stone and in-class practice with an Italian language instructor and native speakers. It is tailored to fit within students’ busy academic calendars while providing a platform for more in-depth learning once they arrive in Palermo.

With all of this interest and growth in language and cross-cultural preparation for students planning experiences here and abroad, these programs have been organized to form the foundation of the new Passport to Care program. This program provides resources and organization to help students acquire language skills and cultural background to prepare them for special curricular experiences and everyday professional practice with diverse populations.