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Bringing Education & Service Together (BEST) Developing a Cross-Cultural Communications Curriculum for Primary Care Residency Programs Johanna Shapiro, Ph.D., Elizabeth M. Morrison, M.D., M.S.Ed., Judy Hollingshead, Ph.D., M.N. Training guidelines for primary care residencies emphasize the importance of cultural efficacy for all physicians. Despite a proliferation of pertinent educational initiatives, however, methods for teaching cross-cultural efficacy remains a controversial issue. One way to refine the question is to focus on the cross-cultural communication problems and possibilities that exist between doctors and patients. Since interaction is an indispensable element in the care of all patients, attention to this domain from a cross-cultural perspective may be a valuable starting point in the development of educational interventions that have utility and relevance for physicians on a daily basis. This project was a three-stage effort undertaken at the University of California, Irvine College of Medicine, under the overall leadership of Elizabeth Morrison, M.D., M.S.Ed. Year One was directed toward implementing a series of focus groups to assess the perceptions of stakeholders, including residents, faculty, and patients, regarding issues in culturally competent communication. A needs assessment survey of family medicine, general internal medicine, and pediatric residents was also conducted. The information gained from these investigations1,2 , was used to plan a curriculum in cross-cultural communication incorporating attitudinal, knowledge, and skill dimensions. Year Two involved development of a pilot project curriculum with 10 family medicine residents. Important findings from the studies cited above were that residents were skeptical about pedagogical efforts to teach cultural sensitivity, and expressed more trust in participating in such educational experiences when they were facilitated by trusted clinicians. Further, they tended to place blame on patients for perceived cross-cultural communication problems. In light of these findings, we developed a two-prong approach, consisting of two three-hour individual sessions using videotape and personalized debriefing and six group discussions facilitated by family physician faculty with particular interest and expertise in cross-cultural issues. Discussion topics included interviewing with limited Spanish, and working with nonprofessional interpreters; the initial interview with a Spanish-speaking patient; poverty medicine; adapting communication skills to a culturally different patient population; culturally influenced health beliefs common in our community; and overcoming difficulties in culturally discordant doctor-patient encounters. In Year Three, this curriculum was revised. Refinements were made in the individual sessions, and two additional group sessions were added (creative writing about difficult cross-cultural situations; using literature to facilitate understanding of different cultures). The target group was expanded to include the entire family medicine training program of 32 residents. We concluded from this project that a genuine interest in improving communication with patients from different cultural and socioeconomic backgrounds exists, but training must occur in psychologically safe environments.
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