In the last post, I discussed cultural awareness on behalf of the medical professional as a necessary step to better understanding the Latino culture and the impact it can have on in-clinic communication and health beliefs. I also proposed that it would be better to create a custom assessment rather than pulling one from the Internet, since it could be better geared towards purposeful self-reflection and tailored to the medical setting. Specifically, I recommended presenting three main groups of questions which are to be discussed one by one in small groups. The three categories of questions I suggested were: (1) assessing culture through past experiences, (2) assessing world views, (3) assessing the culture of healthcare. As these categories are rather general and do not convey much information about the content or mechanics of the questions, In this post, I will describe each one and offer examples of what an assessment of this type may look like.
The first section, assessing culture through past experiences, is partly a warm up but also an important phase that will help open the minds of the learner towards their own cultural biases. The goal is for the students to reflect on their past ––life growing up, traditions, visits to the hospital or health clinic, times they were ill, etc.–– in order to feel out some of their own cultural beliefs and see where their biases may originate. The questions related to life growing up will slowly reveal parts of their culture. Questions of this type include: where where you born, where did you grow up, what was your family like, what is your favorite family memory, did you travel as a child or have you traveled as an adult, discuss a time when you were ill and how your family responded to that illness, what do you value in yourself and in others. These questions may seem to be of a simply “getting to know you” style, but they target our basic assumptions of normality. After these intro questions, the questions can become a bit more specific around the healthcare setting: from your past experience, what do you expect to happen when you go to a medical clinic / hospital, how do you expect the doctor to interact with you, what would you consider normal / not normal. Before going into the next section, it is important to ask the class as a whole if they found any cultural values during their discussion.
This brings the group into the second section which starts to dive deeper, beyond past experience to looking at world views. As a whole, the United States culture tends to have a world view molded by an independent spirit, capitalism and, for some, religious ties to protestantism. However, it is important not to tell the students what Western world views tend to be but instead to encourage them to reflect on their own personal world view, which may be similar or divergent from the “norm”. How do they view money? Time? How much space do they need physically, emotionally, or in terms of pauses between speakers in a conversation to feel comfortable? How do they view honesty? Then, challenge them to discuss how they think others´ world views could differ from theirs. Do they think all cultures view time as they do? For example, if they state that they view time as money, do they believe that is common across all cultures? What is good about each belief? How do they believe these world views could be seen or imposed in the healthcare setting?
Finally, the third section picks up on some of the elements that have come out in the discussion thus far and synthesizes them to a more concrete setting: the medical field. The last two sections touched on aspects of the healthcare setting and the impact of a person´s beliefs and experiences, whereas in this section the students will focus specifically on their perception of the medical setting and how this can impact their manner of relating with the patient. Topics that probably should be touched on include: access to care (accessing the healthcare system is similar in most countries, it is fairly easy to access information on health programs that are offered, the US health system is fairly easy to navigate), the doctor-patient interaction (does not vary much between countries or cultures, family members in other cultures may play the same / different role in treatment decisions, etc.), perceptions on health, sickness and treatment (do views on health and sickness vary between cultures; on a continuum from biology based to folklore based, where do you feel the typical view in the United States falls, do you have expectations on what a patient would eat or drink given they have a certain illness, do you expect that to be the same for those from a different culture).
Do note that as instructors we need to be careful to not present the questions neither as an overwhelming list nor as an overly-cartoonish attempt to make it more “fun”. Rather, we need to aim for the middle: pleasant and motivating but not childish. Furthermore, there do not need to be many questions within each category. The goal is not an exhaustive reflection of the medical professional´s cultural beliefs, but instead an introduction to self-reflection and a realization of cultural bias and how it can play a role in clinic. To offer an example of what I mean, I have attached a few photos of a survey that I wrote. I am attaching photos rather than files since it is only meant as an example and is not edited and ready for classroom presentation. If anyone would like a copy in order to be able to see the activities better, let me know by email and I will pass one along to you.
Now that cultural beliefs held by the medical professional have been addressed, it is important not to ignore the possibility of bias on the part of the instructor against the medical professional. Next week, I will look at some common misconceptions of physicians that exist in the United States and the impact they could have on the way the instructor presents the course and interacts with his or her medical professional students.
American Speech-Language-Hearing Association (2010). Cultural Competence Checklist: Personal Reflection. URL: http://www.asha.org/uploadedFiles/Cultural-Competence-Checklist-Personal-Reflection.pdf
Central Vancouver Island Multicultural Society (–). Cultural Competence Self-assessment Checklist. URL: http://static.diversityteam.org/files/414/cultural-competence-self-assessment-checklist.pdf?1342126927
Comas- Díaz, Lillian (2012): “Multicultural care: A clinician´s guide to cultural competence. Psychologists in independent practice”. American Psychological Association 42:13-42.
Livermore, David (2013): “ Self-Assessment of Your CQ”. Cultural Intelligence Center. URL: http://www.culturalq.com/selfassessgo.html
Obermeyer, Marlene & Martha Sanchez (2006): Cultural Advantage: Cultural Competency in Practice. URL: http://www.culture-advantage.com/
Washington Workforce Training and Education Board (2002): “Assess Yourself 2: Cultural Awareness Self-Assessment Form”. URL: http://highered.mcgraw-hill.com/sites/dl/free/0072563974/87090/ch02.html