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 i s 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 i s 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 i s 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.
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