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Understanding the Role of Diversity in Faculty Development. Joan Y. Reede, MD, MPH, MS Harvard Medical School Office for Faculty Development and Diversity December 4, 1999. A Time of Change. Understanding the Role of Diversity in Faculty Develoment. The Diversity Imperative.

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Understanding the role of diversity in faculty development l.jpg

Understanding the Role of Diversity in Faculty Development

Joan Y. Reede, MD, MPH, MS

Harvard Medical School

Office for Faculty Development and Diversity

December 4, 1999




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Projected “Minority” Percentage

By Year 2056, whites will probably by a “non-dominating” group.


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Facts… % of Population Foreign-Born


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Hypotheses to Explain this Variation health care services individuals receive.

  • Physiologic differences including variations in the natural history of disease.

  • Failure to account for externalities such as availability of services.

  • Patient preferences for procedures varies by sub-population

  • Physicians are biased toward certain groups.

  • Poor doctor-patient communication


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Cultural Variation – Biological health care services individuals receive.

  • Risk of genetically inherited disorders such as thalassemia

  • Biologic variations such as lactose tolerance

  • Physiologic or metabolic differences that may affect the administration of medications

  • Mortality and morbidity rates which may vary


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Cultural Variation – Attitudes & Values health care services individuals receive.

  • Importance of individual or community

  • Roles for women, men, and children

  • Preferred family structure – nuclear, extended, one generation, multigenerational

  • Importance of folk wisdom

  • How time is used and valued

  • Role of religious life, spirituality, and secular life

  • Body language


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Culture health care services individuals receive.

  • “Culture refers to the dominant set of symbolic codes (linguistic, moral, aesthetic) and material practices (dietary/behavioral) that characterize a group.”Pierce, Earls, Kleinman, 1999

  • Culture is a body of beliefs and customs that define a group of people as being connected and that determines their identity.


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Health Care is a Cultural Construct health care services individuals receive.

  • Culture of the Biomedical Model

  • Culture of Individual Professions – allopathic & osteopathic medicine, nursing, social work…

  • Culture of Individual Discipline – pediatrics, internal medicine, surgery, cardiac surgery…

  • Culture of Academic Medical Center

  • Culture of Community Health Center

  • Culture of Managed Care Organization

  • Patient’s Culture


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Perceptions of Disease and Illness health care services individuals receive.

  • Invasion of microorganism

  • Deterioration of body due to age, accident

  • Body imbalance

  • Punishment by God

  • Result of offending ancestors


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Perceptions of Healing and Curing health care services individuals receive.

  • Fighting an intruder

  • Putting the body back in balance

  • Making atonement to God for wrongdoing

  • Making peace with ancestors


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Healer health care services individuals receive.

Expert/miracle worker

God’s worker

Shaman

Pill dispenser

Confidant or friend of family

Authority figure

Last resort for healing

Someone who inflicts pain

Perceptions of Doctors


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Impact of Culture on Physician-Patient Relationships health care services individuals receive.

  • Patient

    • Level of comfort with physician

    • Understanding of the health care system

    • Fear of rejection of personal health beliefs

    • Expectation of physician and health providers

  • Physician

    • Socialized in Western bio-medical context

    • Disclosure

    • Authority

    • Communication


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    Communication Barriers health care services individuals receive.

    Patient-Related Barriers

    Physician-Related Barriers

    Communication Barriers in Providing Quality Health Care

    Insurer-Related Barriers

    Institutional Barriers


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    What is Cultural Competence? health care services individuals receive.

    • “Cultural competence is the ability to deliver effective medical care to people from different cultures. By understanding, valuing, and incorporating the cultural differences of America’s diverse population and examining one’s own health-related values and beliefs, health providers deliver more effective and cost-efficient care.”

      HRSA 1998


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    Cultural Competency health care services individuals receive.

    An integration and Interaction of…

    Health-related beliefs and cultural values

    Disease-incidence and prevalence

    Treatment efficacy


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    Improve quality of care health care services individuals receive.

    Improve health outcomes

    Increase customer satisfaction

    Improve acceptance, salience, and efficacy of interventions

    Social justice

    Reduce potential liability

    Satisfy accreditation standards

    Gain and maintain market share

    Gain community support

    Satisfy payor demands

    Increase productivity

    Improve recruitment

    Increase commitment

    Decrease turnover

    Increase creativity in problem solving

    Case for Cultural Competence


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    Understanding the Role of Diversity in Faculty Development health care services individuals receive.

    Academic Medicine’s Response


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    The Challenge health care services individuals receive.


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    Philosophy health care services individuals receive.

    • Most physicians are committed to providing culturally competent, high quality care.

    • Cultural competency encompasses more than race and gender.

    • Prejudice, fears, and stereotyping are learned behavior that can interfere with communication and trust.

    • Cultural competency workshops and electives alone will not change long-held attitudes.

    • Cultural competency and diversity should be seen as part of a continuous learning process


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    Underrepresented Minority Participation in Medical Education health care services individuals receive.


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    Recruitment Issues? health care services individuals receive.

    • Location defense

    • Pipeline defense

    • Budgetary defense

    • Market forces

    • No raid policy

    • Turnover problem


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    Diversity “Taxes” health care services individuals receive.

    • Assumptions and stereotyping

    • Chilly climate

    • Excessive student/resident demands

    • Excessive committee assignments

    • Undervaluing scholarship on minority issues

    • “Token Hire” misconception

    • Cumulative professional disadvantage


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    Retention Steps health care services individuals receive.

    • Make commitment to diversity explicit

    • Prepare department for change

    • Establish a mentoring process

    • Involve senior faculty

      • Networks

      • Collaboration

  • Chair/division chief assume responsibility for protection from committee assignments

  • Provide orientation before and after hire


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    Where? health care services individuals receive.

    Rewards and Recognition

    Research

    Clinical care

    Teaching

    Public service

    Administration


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    Diversity and Promotion health care services individuals receive.

    • Clinical Service

      • Marketing, Time constraints

  • Research

    • Definition of merit

  • Administration

    • Service burden, “Typecasting syndrome”

  • Teaching

    • Non-traditional courses

  • Collegiality

    • Subjectivity, “Hairsplitting concept”


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    3P’s – Pro-active, Persistent, Positive health care services individuals receive.

    • A Time of Change

      • Training extending into diverse communities with diverse populations

    • Cultural competence training integrated into

      • Faculty development training programs

      • Continuing education

      • Student and resident education and training

    • Increasing representation of faculty of color

      • Recruitment

      • Retention

      • Promotion


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