Standardized Patient Cases for Skill Building in Patient-centered, Cross-cultural Interviewing (Stanford Gap Cases)

Publication ID Published Volume
9133 April 5, 2012 8

Abstract

This resource includes materials needed to run a 4-case standardized patient exercise in patient-centered, cross-cultural interviewing. The goal of the exercise is to enable participants to identify and bridge cultural gaps between patients and medical providers.

The Gap Cases exercise was developed as a formative component of the core clerkship in pediatrics at the Stanford School of Medicine.

Important features:

  • The program emphasizes a patient-centered, individualized approach to cross-cultural interactions.
  • In its original format, the exercise is run as a group session led by faculty facilitators, with students observing one another and giving feedback.
  • Cases and related materials are easily adapted to different settings and target audiences, (e.g. informal role-plays, small or large group discussion with students, residents, and/or faculty).
  • Cases are built from everyday experiences. Learning points can be readily practiced and reinforced in the context of routine clinical care.

The materials submitted expand the body of case-based educational resources available for skill building in cross-cultural interviewing.

Our program has been running continuously since 2006, with one group of 8 clerkship students participating each month. (~ 480 students over the past 5 years).

To date, we have relied on student surveys to evaluate the effectiveness of the program.

Students complete an anonymous, open-ended survey at the end of each Gap Cases session. (A copy of the questionnaire is included with the Session Tools set of resource files.) During the first year of the program we analyzed themes from 140 students’ responses to the survey questions about key learning points and reactions to observing peers and being observed.

Key learning points included:

  • Importance of eliciting patients’ perspectives (35%)
  • Ideas for general interviewing (22%)
  • Broader awareness of cultural issues (13%)
  • Importance of social context (9%)

Reactions to observing other students’ interviews were 91% positive and otherwise mixed.

Reactions to being observed by peers were 77% positive, 7% neutral or negative, and otherwise mixed. Students perceived peer feedback to be constructive and helpful in making them aware of blind spots.

(See the Instructor's Guide for sample narrative comments from the student questionnaire.)

Additional informal feedback from students indicates that having a faculty case facilitator – rather relying solely on standardized patients to provide feedback - is a valued feature of the program.

During the first year of the program, students also completed a retrospective pre-post version of the Health Beliefs Attitudes Survey (HBAS, Dobbie 2002) at the end of each clerkship rotation. The HBAS measures perceived importance of understanding patients’ perspectives on illness. We surveyed 52 students at the end of the clerkship during the initial year of the program; 85% completed surveys. Results showed small, but statistically significant attitudinal changes in the four domains measured by the instrument.

Since the first year of the program we have continued to use the end-of-session qualitative evaluation form, with similar themes arising in students’ responses.

Citation

Stuart E, Bereknyei S, Long M, Blankenburg R, Weak V, Garcia R. Standardized patient cases for skill building in patient-centered, cross-cultural interviewing (Stanford gap cases). MedEdPORTAL Publications. 2012;8:9133. http://doi.org/10.15766/mep_2374-8265.9133

Educational Objectives

  1. To outline theoretical frameworks for eliciting patients’ perspectives on illness.
  2. To demonstrate the use of questions to deliberately explore key dimensions of the illness experience (ideas, feelings, expectations, and impact of illness on function).
  3. To reflect on and articulate the medical provider’s perspective in a series of clinical situations.
  4. To discuss potential benefits of applying frameworks for cross-cultural interviewing to all patient encounters.

Keywords

  • Interpreter Use, Traditional Remedies, Interviewing, Health Equity Research

References

Related presentations:

  1. Hooper K, Basaviah P, Braddock C, Stuart E, Joshi S, Bryant M, Vega C, Teaching cultural competence and reducing health disparities across the trainee continuum: A multi-institutional perspective AAMC Western Group on Educational Affairs annual meeting, panel presentation, Stanford, May 2011.
  2. Woodhead J, Smith S, Martinez S, Fall L, Stuart E, Mihalic A, Strategies and Tools to Teach About the Medical Home: Professionalism, Culture, and Communication, Council on Medical Student Education in Pediatrics annual meeting, educational workshop, Albuquerque, NM, March 2010.
  3. Stuart E, Bereknyei S, Long M, Blankenburg R, Evaluation of a Standardized Patient Exercise in Patient-centered, Cross-cultural Interviewing, Research in Medical Education (RIME) platform presentation, Association of American Medical Colleges Annual Meeting, San Antonio, TX, November 2008.
  4. Stuart E, Bereknyei S, Long M, Blankenburg R, Javier J, Evaluation of a Standardized Patient Exercise in Patient-centered, Cross-cultural Interviewing, Pediatric Academic Societies annual meeting, poster presentation, Honolulu, HI, May 2008
  5. Allard K, Stuart E, Social Work Participation in a Standardized Patient Exercise - Or, Getting Them While They're Young, Society for Social Work Leadership in Healthcare annual conference, Pediatrics Pre-Conference Intensive, Montreal, Canada, April 2008.
  6. Stuart E, Bereknyei S, Long M, Blankenburg R , Mind the Gap: Developing Case-based materials for training in cross-cultural communication, Council on Medical Student Education in Pediatrics annual meeting, educational workshop, Atlanta, GA, April 2008.
  7. Stuart E, Bereknyei S, Long M, Blankenburg R, The Pediatrics SPEx: Evaluation of a Standardized-Patient Exercise in Patient-centered, Cross-cultural Interviewing, Council on Medical Student Education in Pediatrics annual meeting, platform presentation, Atlanta, GA, April 2008.
  8. Bereknyei S, Stuart AE, Garcia RD, Long M, Blankenburg R, Mind the Gap: Medical Student Reactions to a Pediatric Standardized Patient Exercise Society for Applied Anthropology Annual Meeting, panel presentation, Memphis, TN, March 2008.
  9. Stuart E, Long M, Blankenburg R, Javier J, Mind the Gap: Developing Case-based materials for training in cross-cultural communication, University of Southern California Keck School of Medicine, Innovations in Medical Education conference, educational workshop, Pasadena, CA, March 2008.
  10. Stuart E, Bereknyei S, Long M, Blankenburg R, The Pediatrics SPEx: Evaluation of a Standardized-Patient Exercise in Patient-centered, Cross-cultural Interviewing, University of Southern California Keck School of Medicine, Innovations in Medical Education conference, oral abstract presentation, Pasadena, CA, March 2008.

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ISSN 2374-8265