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Educating for Cultural Awareness. Workshop A. A Faculty Development Program for Teachers of Internationally Educated Health Care Professionals. International Medical Graduates. FACT: In 2002, 23% of physicians practicing in Canada obtained their medical degrees outside of Canada (AIPSO, 2004)
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Educating for Cultural Awareness Workshop A A Faculty Development Program for Teachers of Internationally Educated Health Care Professionals
International Medical Graduates • FACT: In 2002, 23% of physicians practicing in Canada obtained their medical degrees outside of Canada (AIPSO, 2004) • FACT: In 2001/2002, 2039 of the 8684 residents training in Canada held MD degrees earned outside of Canada (Association of Canadian Medical Schools, 2003)
3. Exercise: Establishing Group Norms BRAINSTORM: What type of environment enhances your ability to learn? DISCUSS PROPOSAL: All in agreement?
4. Educating for Cultural Awareness Involves: • Helping teachers develop an understanding of their own ethno-cultural backgrounds, beliefs, attitudes and values (self-awareness) • Fostering acquisition of a greater understanding of and empathy for the cultural backgrounds and life experiences of IEHCPs (cultural diversity awareness) • Promoting the development and integration of self-awareness and cultural diversity awareness into the teacher’s activities (skill development)
4. Educating for Cultural Awareness Involves (Cont’d): • Framing cultural competence as a process of life-long learning for educators and health professionals alike • Developing cultural awareness and responsiveness involves developing qualities and approaches as opposed to a concrete set of tasks or expert knowledge
4. Rationale “Learning to think, act, lead and work productively in partnership with people of different cultures, styles, abilities, classes, nationalities, races, sexual orientations and genders goes beyond acquiring new skills and attitudes…It requires that the individual give up familiar ways of thinking, expectations, roles, and operating patterns which they have come to assume are routine for all.” Salmond, 2000
5. Internationally Educated Health Care Professionals (IEHCPs) • Canadian citizens who pursued their training outside of Canada • Citizens of other countries with international health professions degrees in Canada on work visas • Immigrants to Canada who have health professions degrees from institutions outside of Canada who are hoping to practice
5. Integrating IEHCPs Into the Canadian Health Care System BRAINSTORM: What skills and experiences do IEHCPs bring to Canadian health care systems? What challenges might they face in their integration to Canadian health care?
5. Skills and Experiences of IEHCPs • Knowledge of other countries, cultures, and health care systems • Clinical expertise, often specialized • May be older with more life experiences • Knowledge of diseases less common in Canada • Diagnostic and treatment knowledge less reliant on technology
5. Potential Challenges to Practice for IEHCPs • A number of entry routes to licensure and practice • Adjustment to new cultures, health beliefs and health care systems • Language issues even for those fluent in English • Personal adjustment issues: loss of self-identity, extended family support, and/or self-esteem problems
5. Potential Challenges to Practice for IEHCPs (Cont’d) • Discrimination and racism • Lack of training in cross-cultural communication strategies, certain bodies of medical knowledge, or clinical skills • Familiarity with different educational styles • Economic challenges • Lack of institutional support for cultural or religious needs
5. Potential Challenges to Practice for IEHCPs (Cont’d) BRAINSTORM:What have you learned by working with IEHCPs?
5. Challenges for Teachers of IEHCPs • A lack of knowledge of cross-cultural educational strategies • Working with learners who do not speak English as a first language • A lack of cultural awareness and sensitivity to the backgrounds, cultural patterns and needs of their internationally educated learners • A lack of institutional support for the teacher or the IEHCP
Workshop Component 1: Developing Cultural and Self-Awareness
1. Weaving and Key Characteristics of Culture • It is learned, not innate • It is transmissible, through language and symbols • It is dynamic, changing to respond to need • It is selective, creating boundaries, limits • It is ethnocentric (centred on itself) • It has interrelated facets – it is a complex system where change in one area affects other areas
BRAINSTORM: What other than culture influences our beliefs and behaviours? 1. Weaving and Key Characteristics of Culture (Cont’d)
2. What Other Than Culture Influences Our Beliefs and Behaviours? • Personalities • Self-awareness • Past experiences • Economic status • Education • Physical environments
2. What Other Than Culture Influences Our Beliefs and Behaviours? (Cont’d) • Our identities are more complex than our cultural associations; we are neither solely influenced by one culture nor completely a product of our cultures
3. Exercise: Cultural Awareness BRAINSTORM: How would you describe cultural awareness and responsiveness? In what ways can a teacher demonstrate cultural awareness?
3. Cultural Awareness Defined “An appreciation and consciousness of differences among groups with simultaneous acknowledgment of the uniqueness of each individual.” Salmond, 2000
3. Cultural Awareness Guiding Principles “Maintenance of a broad, objective, and open attitude toward individuals and their cultures” and avoiding “seeing all individuals as alike” This requires willingness “of individuals and institutions to unearth, examine and shed light on their underlying assumptions about people whose cultures differ from their own” Wells, 2000
3. Cultural Awareness (Cont’d) BRAINSTORM: What are potential barriers to teaching in culturally aware and responsive ways?
3. Cultural Awareness? (Cont’d) • Are there any problems with this comment? • How much, and how quickly, can we expect those from other countries to change?
4. What are Our Cultures? How do they affect us?
4. Discovering Cultural Values Through Proverbs • Examples: • Cleanliness is next to godliness • A stitch in time saves nine • Waste not, want not • Others? • Values in the proverb?
5. Thinking About How We Think • What: Note what word was triggered. Try not to censor yourself • Where: Try to identify where you think the message came from • Significance: Did you make any judgment about the message – Was it good? Bad? Happy? Sad? Beautiful? Ugly? Etc…
6. Our Cultures • We all belong to multiple cultures and sub-cultures • Our cultures, as well as our personality, socio-economic status, education and physical environments, shape our perspective, or vantage
6. The Blind Ones and The Matter of the Elephant • What does this story say to you? • Can you think of examples in your personal or professional life where these multiple versions of the experience exist?
6. Our Cultural Vantage Point “ ‘Vantage’: any observing mind has a specific point of view, and that point of view has physical, psychological, and cultural dimension that restrict how much can be observed at any moment” Bonder, Martin & Miracle, 2001
6. Culture & Bias • “Bias”: preferences, instinctive orientations or beliefs that shape our responses to each situation, some of which are rooted in heritage (LaMountain & Abramms, 1993) • Being aware of our biases helps us to manage them better, making us more effective when working with people from less familiar cultural backgrounds
7. Exercise: Reaching Consensus • Groups of 3-4 • Read worksheet individually. Write “A” if you agree with the statement as is, or “D” if you disagree • Once all have completed the list, review as a group • On points of discrepancy among group members, discuss concerns and re-write the sentence in a way that all can agree
7. Exercise: Reaching Consensus (Cont’d) • Large group discussion: Each small group offers one sentence they altered, with an explanation of why the change was necessary • Do you think this exercise would be different in more of a diverse group?
8. Exploring Medical Culture “Biomedicine is characterized as both a part of the larger culture, reflecting its mainstream norms, values, and beliefs, and as a culture in itself, based on the classical scientific model, with its own language, structure, norms, values, and beliefs.” Loustaunau & Sobo, 1997
8. Exploring Health Care Culture Natal Culture Specialty Culture Health Care Culture Kagawa-Singer & Kassim-Lakha, 2003 Others?
Workshop Component 2: Cultural Diversity Awareness and Sensitivity
1. Exposure to Various Cultures • Individual exercise • With a partner, discuss which groups were easiest, and which were more challenging to answer, reflecting on why this was the case • Larger group: Insights? Questions?
2. Ethnocentrism and Stereotypes • How we each experience cross-cultural interactions is shaped, in part, by our ability to challenge ethnocentrism and stereotypes
3. Ethnocentrism “Ethnocentrism involves using one’s own standards, values, and beliefs to make judgments about someone else. The standards against which others are measured are understood to be superior, true, or morally correct.” Loustaunau & Sobo, 1997
3. Ethnocentrism (Cont’d) “The tendency to use one’s own culture as the yardstick against which other cultural practices are measured and judged. This ethnocentric tendency is likely to result in cultural imposition.” Wells, 2000, citing Campinha-Bacote & Ferguson, 1991
3. Is Ethnocentrism an Issue in Health Care? (Cont’d) • What is the physician assuming in this statement? • What are the problems with this assumption? • Is it possible that health care professionals drop their cultural backgrounds when they walk into the clinic, the hospital, or the school?
3. Is Ethnocentrism an Issue in Health Care? (Cont’d) • Transfers into medicine via the basic tenets of science, where scientific knowledge is understood as ‘correct’ or ‘true’ • Assumes that medical knowledge is outside of cultural considerations. Medical knowledge is considered the correct way to explain illness phenomenon (Loustaunau & Sobo, 1997) • Health care professionals are assumed to be homogenous (Beagan, 2000)
