Creative Teaching Strategies: Applying Cultural Overlays to High-Fidelity Patient Simulations

Beth LaVelle, PhD, RN, CEN and Meghan B. LaVelle, BSN, RN; HealthEast Care Systems, St. Paul, MN
 

SUMMARY OF KEY POINTS

I. Defining “culture” 

Types of cultures

Framework: the Purcell Model for Cultural Competence

Person, Family, Community, Society
Core values, traditions
 

Health literacy

Impact of culture on patient safety (see Betancourt, 2003)
Recognition of symptoms
Thresholds for seeking care
Ability to communicate symptoms to a provider who understands their meaning
Clinical decision-making
Ability to understand prescribed management strategy
Expectations of care
Many more…
 
 

II. Simulation

Teaching strategy

           Education vs. evaluation vs. remediation

Types of simulation

Standardized patients
Computer-based tutorials, case studies, interactive media
Anatomic models
Screen-based partial task trainers
Manikin-based (low, moderate, high fidelity)

Emphasis on application and integration of knowledge, skills, & critical thinking

Safety and Simulation

Expose to common & uncommon clinical situations
Develop skill & practice without risk to patients
Allow mistakes à natural consequences
Communication… interpersonal relationships…teamwork
Mange resources
Examine moral, ethical, legal, and cultural aspects
Identify & resolve systems-based challenges
 
 

III. Culture & Simulation

Differentiating cultural concepts: Awareness, Sensitivity, Competence

Top 10 excuses for why culture isn’t consistently part of simulations

Error of omission
Complicates/muddles the lesson
They’re just learning a psychomotor skill
Most manikins look Caucasian. Its difficult & costly to change skin color/features
No money in budget or time to get appropriate clothing/props
Changing clothing/props between scenarios would take too much time
Faculty knowledge deficit – don’t want to offend participants
Cultures are addressed in other classes
So many cultures – wouldn’t know where to begin
Ostrich syndrome: I’m uncomfortable & I don’t want to look at how my own culture & biases affect the care I give
 

Using cultural overlays

Strategies
Primary vs. secondary intent
Whose culture are we addressing?
Props (wigs, clothing, makeup, artifacts)
Mix & match?
 
   
Examples
 

   Review/Lessons learned:

Helpful hints
Simple  à complex
Clear objectives
Props set the “stage”
Be respectful of all cultures
Knowledge doesn’t always = action. Be patient
It’s difficult to measure attitudes
Don’t underestimate the impact of self-reflection
Think outside of the “traditional” cultures
 
    
What doesn’t work
 
 

IV. Questions/Discussion
 
 
 

OUR FAVORITE REFERENCES

Top 5 articles

Beagan, B.L. (2003). Teaching social and cultural awareness to Medical students: “It’s all very nice to talk about it in theory, but ultimately it makes no difference.” Academic Medicine, 78(6), 605-614.

Betancourt, J. R. (2003). Cross-cultural Medical education: Conceptual approaches and frameworks for evaluation. Academic Medicine, 78(6), 560-569.

Eddey, G.E. & Robey, K. L. (2005). Considering the culture of disability in cultural competence education. Academic Medicine, 80(7), 706-712.

Green, A.R., Betancourt, J. R., & Carrillo, J.E (2002). Integrating social factors into cross-cultural medical education. Academic Medicine, 77(3), 193-197

Tervalon, M. (2003). Components of culture in health for medical students’ education. Academic Medicine, 78(6), 570-576.

Top 3 texts

Transcultural Health Care: a culturally competent approach, 2nd ed (2003). Purnell & Paulanka, FA Davis  ISBN 0-8036-1057-2

Caring for Women Cross-culturally (2003). St. Hill, Lipson, & Meleis, FA Davis. ISBN 0-8036-1004-1

Culture in Clinical Care (2002). Bonder, Martin, & Miracle. Slack, Inc. ISBN 1-55642-459-0

Top 5 web sites & organizations

Ethnomed  http://healthlinks.washington.edu/clinical/ethnomed

DiversityRx   www.DiversityRx.org

Cultural Competency in Medicine www.asma.org

Transcultural Nursing Society  www.tcns.org

AltaVists.com, then Babel Fish

Simulation:

Ideas for Case Studies: Thomson-Delmar series

      Clinically focused professional organizations: core curriculum, case studies

                  Journal articles

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