This training has been developed for the purpose of providing community context to counseling patients who have a history of migration. The materials integrate community input with materials on forming therapeutic alliances with patients and action planning. Building from a collection of first-hand interviews and focus groups with members of a transnational community from Oaxaca, Mexico, who reside in California but maintain strong ties with their community of origin, the authors created a series of vignettes that delve into some of the perspectives that reflect many of the challenges facing providers who care for patients with strong transnational ties. The content contributes to skill building for improved health communication, focusing on clinical planning and therapeutic alliance formation with immigrant patients who may have close ties with their home countries and with the models of care common in their community of origin. The training was piloted with more than 50 resident and medical student trainees who work with transnational communities similar to those that informed the training content. The feedback highlights valuable discussion stimulated by the personal vignettes shared in this training. When this training was previously implemented, residents and medical students were given a short evaluation at the end of the session and were asked to rate the training using a 1-5 scale, with 5 being “Excellent.” The training received ratings in the 4-5 range. One training with 25 family medicine residents of all three years rated the training an average of 4.5. An internal medicine residency program director observed the training and commented, “The curriculum presented was extremely valuable in providing our residents with a context for their patients’ migration histories as well as concrete communication skills to improve the care provided to patients who have moved here from all over the world.” Based on these prior experiences with implementation, this training can be adapted to a wide variety of settings with clinical trainees from broad backgrounds and various levels of training.
- Define the concepts of transnational competence and cultural humility for clinical trainees practicing among increasingly diverse patient populations.
- Examine their patterns of communication and behavior as clinicians during reflective exercises based on patient perspectives.
- Enhance their awareness of transnational community context by examining quotations and narratives based on first-hand patient experiences.
- Elicit relevant migration history as well as patients’ values and goals during the medical interview.
- Integrate action planning into patient-centered counseling strategies.
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DeFries T, Rivera M, Ghorob A, Handley M. Aligning clinician and community perspectives to improve health communication with transnational communities from Mexico – development of a pilot training program. Oral presentation at: Jack Rodnick Memorial Colloquium on Innovations in Family Medicine, UCSF; March 2012; San Francisco, CA.
DeFries T, Rivera M, Ghorob M, Handley M. Aligning clinician and community perspectives to improve health communication with transnational communities from Mexico – eevelopment of a pilot training program. Poster presented at: UCSF Health Disparities Research Symposium; October 2010; San Francisco, CA.
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