Promoting Physicians' Cultural Competence Through Reflective Practice

描述(由申请人提供)： 大量研究记录了心血管和肺部疾病的差异，尽管总体国民健康有了重大改善。为了减少差异，教育管理机构呼吁采取干预措施，改善对具有不同价值观、信仰和行为的患者的文化适当护理。虽然存在许多创新来培养文化能力，但很少有数据来指导将这些创新纳入整个医学教育体系，或评估其有效性。此外，促进文化能力的许多努力由于范围不大或缺乏指导性概念框架而受到限制。在这个项目中，我们将使用“反思性实践”的框架来指导贝勒文化能力综合课程的实施，并帮助确保制度环境加强学生获得知识、技能和态度。反思性实践代表了在人际交往之前、期间和之后对自己行为的基础和影响的认识。在文化能力教育中，反思性实践尤其重要，因为许多隐含的态度驱动着行为。为了让医生改变他们的行为，他们需要了解自己的基线态度，有能力倾听和理解患者的观点，并能够在制定行为时权衡自己行为的影响。我们的项目团队由一个多文化、多学科的调查小组、国际公认的“专家教练”和一个国家顾问小组组成，所有这些都致力于在我们的项目倡议的执行过程中模拟反思性实践。我们的第一个目标是使贝勒的课程内容达到AAMC最近发布的文化能力课程标准，并通过 始终如一地关注跨文化反思实践。通过与课程负责人建立伙伴关系，我们的团队将确定课程差距，并采取和/或设计干预措施来弥补这些差距。我们的第二个目标是在我们先前工作的基础上，实施有效的工具来评估学习者的文化能力成就。这些评估的一个主要目的是提供建设性的反馈，以告知和引导学习者的自我反思。我们的第三个目标是衡量和积极影响“隐性课程”。隐性课程指的是非正式制度环境对教授文化能力的支持，如果忽视，甚至可能破坏最有效的正规教学活动。本着反思性实践的承诺，我们将继续使用评估数据来完善赠款活动。我们将积极传播经验教训，包括评估工具等创新产品。我们将与贝勒的领导人、国家顾问小组成员和德克萨斯医学会合作，以确保广泛传播。(摘要结束)

DESCRIPTION (provided by applicant): A large body of research documents disparities in cardiovascular and pulmonary diseases, despite major improvements in the overall national health. In an attempt to reduce disparities, educational governing bodies have called for interventions to improve culturally appropriate care for patients with diverse values, beliefs, and behaviors. While many innovations exist to foster cultural competence, there is very little data to guide incorporation of such innovations across the continuum of medical education, or to evaluate their effectiveness. Further, many efforts to promote cultural competence have been limited by modest scope or a lack of a guiding conceptual framework. In this project, we will use the framework of 'reflective practice' to guide implementation of an integrated curriculum in cultural competence at Baylor and to help ensure the institutional environment reinforces students' acquisition of knowledge, skills, and attitudes. Reflective practice represents an awareness of the basis for and impact of ones' actions before, during, and after interpersonal encounters. In educating for cultural competence, reflective practice is particularly important, because of the many implicit attitudes that drive behaviors. In order for a physician to alter their behaviors, they need to have an understanding of their own baseline attitudes, an ability to hear and understand the patient's perspective, and be able to weigh the effects of their own behaviors as they are enacting them. Our project team consists of a multicultural, multidisciplinary group of investigators, internationally recognized 'expert coaches,' and a national advisory panel, all committed to modeling reflective practice in the execution of our project initiatives. Our first aim is to bring the content of Baylor's curriculum up to the standard for cultural competence curricula recently published by the AAMC, and to strengthen this curriculum with a consistent focus on cross-cultural reflective practice. By building partnerships with curriculum leaders, our team will, identify curricular gaps and adopt and/or design interventions to address those gaps. Our second aim is to build on our prior work to implement valid tools to assess learners' achievement of cultural competence. A primary purpose of these assessments will be to provide constructive feedback to inform and guide learners' self-reflections. Our third aim is to measure and positively influence the 'hidden curriculum.' The hidden curriculum refers to the supportiveness of the informal institutional environment with respect to teaching cultural competence, and, if ignored, may undermine even the most effective formal teaching activities. Consistent with a commitment to reflective practice, we will continually use evaluation data to refine grant activities. We will actively disseminate lessons learned, including innovative products such as assessment tools. We will partner with leaders at Baylor, national advisory panel members, and the Texas Medical Association to assure widespread dissemination. (End of Abstract)