Exploring gender differences across cultures: A teaching and learning module in family medicine

1. Exploring gender differences across cultures: A teaching and learning module in family medicine Group 4 Teachers’ course Kranjska Gora 2004

2. Group 4

3. Klaric Zdenko – Bosnia Colin Chilvers – New Zealand Reka Vernes – Hungary Smiljka Radic – Serbia Alberto de Carvalho – Portugal Fusun Yaris – Turkey David Manning – UK Andrej Kravos – Slovenia Nevenka Secer-Dolenc – Slovenia Darinka Klacar – Slovenia Marko Kocian – Slovenia Yonah Yaphe - Israel Group 4 members

4. Gender and Culture • In all cultures the differences between men and women are obvious and important. • They are important but not obvious in the practice of medicine in a cross-cultural setting. • This course is designed to meet this learning need in family medicine.

5. Objectives • At the end of this course the learner will: • Know key gender differences in different ethnic groups • Know how to apply this knowledge in practice. • Value its importance.

6. Course modules • Sexual orientation • Health and disease prevalence • Taboos • Specific cultural health practices • Medicolegal problems • Venus and Mars • Expression of symptoms and emotions • Patients’ expectations • Health beliefs

7. Module 1: Culture, patient expectations and sexual orientation Background • We are surrounded by diversity but medical training traditionally focusses on the dominant culture. • This module will train doctors to work with diverse populations

8. Module 1: Culture, patient expectations and sexual orientation -Objectives At the end of this course participants will: • Know how to deal with people from different cultures, genders and sexual orientation from their own. • Be able to recognize the different needs in performing examinations on people from different cultures, genders and sexual orientation. • Identify when to have a chaperone.

9. M1: Methods • Workshops, group work, role play • Example: Doctor’s request for urine sample and patient’s confusion. • Video presentation of cases for discussion • Presentation of the learner’s own cases

10. M1: Assessment • Knowledge: Oral and written examination • Skills: OSCE • Attitudes: Pre- and post-course test • Example: • 1. I am comfortable performing an internal examination on a patient of a different gender from a different culture without a chaperone. 12345 • 2. This course will change (has changed) my practice. 12345 • 3. I will apply what I will learn (have learned). 12345

11. Module 2: Culture, gender, health and illness prevalence • Background: Epidemiology is a basic medical science. • It is important that the student understand the importance of the use of epidemiology in medical care of different ethnic communities.

12. Module 2: Objectives • By the end of the module the learner will be able to: • Knowledge: identify major epidemiological features of ethnic groups within the country. • Skill: interpret relevant health data including simple analysis of statistics of prevalence and incidence of disease in different cultures by gender • Attitude: the student will demonstrate an awareness of cultural influences on the utilization of health care

13. M2: Methods • Knowledge: Public health data from official sources, health books, published data (NIVEL) • Skills: Problem Based Learning e.g. case study method. A new ethnic group joins your practice. How will you modify your screening procedures? • Attitudes: Case studies in facilitated group discussion

14. M2: PBL Case • In 1991 400,000 Kurdish refugees came from Northern Iraq to Turkey. • 300,000 were young adult females. • The rest mainly children and the elderly. • 60% of the women were pregnant. • You are a public health officer responsible for women and children. • How would you manage this situation?

15. M2: Assessment • Knowledge: MCQ on ethnicity and disease prevalence in the community. • Skills: OSCE – Encounter with a patient of a different gender and ethnicity who is offered a screening or therapeutic procedure. • Attitudes: Direct observation, questionnaires with Likert scales pre- and post-course.

16. Module 3: Taboos, health beliefs and gender • Background: Ignorance of taboos and health beliefs may be a source of disagreement and conflict in the consultation.

17. M3: Objectives • At the end of the module the learner will • Be aware of differences in acceptance of taboos and health beliefs according to gender across cultures • Be sensitive to patients’ messages about taboos or health beliefs • Will demonstrate sensitivity about differences in expression of emotions across cultures and genders. • Establish rapport to be able to learn about taboos.

18. M3: Methods • Structure: 4 hour course • Introductory lecture on cross cultural differences (20 minutes) and communication models- patient centred care (20 minutes) • “Thought shower and popcorn session”– report of experiences with taboos in different ethnic groups in the learners’ practices. (20 minutes) • Role play and debriefing: Doctor coping with interview with fatigued woman from a culture where husband will not allow doctor to interview patient alone. (60 minutes) Repeat role play for assessment.

19. M3: Assessment • Feedback sheet to assess what learners gained from program and changes in attitude and understanding and approach and the influence on daily practice. Open questions: • What was good about today’s exercise? • What would I do differently? • What would I like more of in this exercise? • What could we use less of?

20. M3: Assessment Closed questions: • I learned new things today: 12345 • I was able to participate actively.12345 • The atmosphere was positive • I was able to express myself freely. • The group leader led the group effectively. • I would participate in a workshop like this again.

21. Module 4: Specific health practices - Background • Understanding specific cultural health practices can help the doctor to better understand the reactions of the patient to different health conditions. • This understanding can improve adherence to treatment and outcomes.

22. M4: Objectives At the end of the course the learner will: • Know the background of different cultural behaviours in relation to health practices. • Know how to communicate effectively and non-judgementally with patients from different cultures to learn about unique health practices. • Show an acceptance of diversity in health practices and avoid conflict with patients.

23. M4: Methods • Knowledge: Home visits, patient interviews, medical anthropology texts. Invite representative of ethnic group to speak to learners. • Skills: Observation of skilled interviewers, practice interviews with feedback

24. M4: Assessment • Knowledge: Observation of learners, knowledge tests, feedback from patients • Skills: Observation • Asessment: Observation, patient satisfaction

25. Conclusion • This course helps to bring medicine up to date with new content and new methods with regard to culture and gender.