Designing a cultural competence curriculum is inherently complex. Many elements are needed, and multiple frameworks exist. We used a novel approach to identify and prioritize elements to include in a cultural competence curriculum to address disparities in cardiovascular disease. First, we used the Nominal Group Technique (NGT) to generate and prioritize a list of ideas to include in the curriculum. NGT is a structured small-group process that fosters creativity and equal participation of participants. We conducted four NGT sessions and elicited responses to the question “What sorts of things could be included in a curriculum that focuses on cultural competence training for physicians?” Participants in the NGT sessions were nine medical students, seven medicine residents, seven practicing physicians, and seven disparities researchers. To organize the ideas generated, we then asked 45 educators and researchers to group and rank the ideas based on their own perceptions of importance. Finally, to produce homogeneous groupings of elements based on the ideas grouped and ranked, we used multidimensional scaling (MDS) and hierarchical cluster analysis. The NGT sessions generated 61 ideas, 29 of which were selected by at least two participants. We observed five clusters of related issues within the multidimensional space (asterisks indicate the NGT groups’ top-rated ideas): (1) patients’ cultural background (provide information on cultures,* habits, customs, values), (2) impact on health care and health behavior (include factors influencing health services, folk remedies, diet), (3) differences in therapies and health disparities (provide pharmacological therapies, reasons for cardiovascular disparities), (4) awareness of approaches to multicultural care (increase awareness of own biases,* stereotype avoidance), and (5) resources to manage cultural diversity (provide resources for patients and their families to comprehend instructions,* provide questions to permit taking a cultural history,* language translation guide and available services, community resources). The MDS showed good fit of the dimensions (Stress = .074; R2 = .97). Our cognitive mapping approach allowed us to use input from various stakeholders and generate critical domains to guide the development of the new curriculum. This curriculum is composed of online cultural competence training modules. Users can learn effective cross-cultural approaches to care for African American patients with cardiovascular disease, especially hypertension. Videos with real patient scenarios and case-based modules increase learners’ awareness. This project has been completely funded by a grant from the National Institutes of Health (NIH) through the National Heart Lung and Blood Institute (NHLBI).
By using this resource, learners will be able to learn effective cross-cultural approaches to care for African-American patients with cardiovascular disease, especially hypertension.
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Estrada CA, Houston TK, Allison JJ, Shewchuk RM, Bigby J, Staton LJ. What should we include in a cultural competence curriculum?- A formative evaluation. 30th Society of General Internal Medicine National Meeting, Toronto, Canada, April 25-28, 2007 [Poster]. J Gen Intern Med. 2007;22(Supp 1):164.
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