Teaching Cultural Competency in Medical School: Engaging the Community Classroom

Transcription

1 Teaching Cultural Competency in Medical School: Engaging the Community Classroom Martina Kamaka, MD University of Hawaiʻi John A. Burns School of Medicine

2 Objectives 1. Describe a cultural competency training initiative at the John A. Burns School of Medicine 2. Review analyses of student reflection papers 3. Share key findings, lessons learned in using community classrooms

3 Background 2004-Formation of the Department of Native Hawaiian Health at the University of Hawaii John A. Burns School of Medicine (JABSOM) Address NH health disparities (20% of homeland population, highest health disparities) Research Medical Education Clinical Practice Community input

4 Background DNHH C3 (Cultural Competency Curriculum ) team Multidisciplinary Curricular building blocks Look to culture Multiple teaching methodologies required - experiential `A`ohe pau ka ike i ka halau ho`okahi Not all knowledge is taught in the same school Maka hana ka ʻike In the doing, one learns

5 Native Hawaiian Health: Past Native Hawaiian Worldview: Wellness MACRO LEVEL MICRO LEVEL Akua, Nā Aumākua (God, Higher Powers) ʻUhane (Spirit) Lokahi/Pono (Unity, Harmony, Balance) Lokahi/Pono (Unity, Harmony, Balance) Kanaka (Mankind, Family, Community) Aina, Moana, Lani (Nature or Environment) Manaʻo, Naʻau (Mind) Kino (Body) Hawaiian Worldview Source: RKPaglinawan

6 Cultural Competency in the JABSOM Medical Student Curriculum UNIT UNIT UNIT UNIT 1 st year Native Hawaiian Community Health elective Native Hawaiian Community Health elective Native Hawaiian Community Health elective Native Hawaiian Health Community elective Introduction to Hawaiian health Interaction of Medicine & Culture I PBL Interaction of Medicine & Culture II Cultural immersion PBL Cultural Standardised patient Interaction of Medicine & Culture III 2 nd Year PBL Simulation Case NHH colloquium (optional) 3 rd Year NHH: Aliʻi Trusts 4 th year Native Hawaiian Health clinical elective Native Hawaiian Health clinical elective Native Hawaiian Health clinical elective Native Hawaiian Health clinical elective

7 Native Hawaiian Health: Past, Present, Future Strengths based Community resources-the community as classroom Service Learning Offered throughout year 1, 4 hours a week Course Objectives: Native Hawaiian history and culture role of traditional Native Hawaiian healing and cultural practices (precontact and present day). status of Native Hawaiian health and causes of health disparities. Utilizing a holistic approach toward Native Hawaiian health. service learning projects. Painting Herb Kane

8 NH Health: Comprehensive List of Community Partners Community Health Centers WCCHC KKV/Hooulu Aina POL Nonprofit Hawaiian organizations Papahana Kuaola Paepae Heeia Kanehunamoku Wahiawa Hawaiian Civic Club Koolaupoko Hawaiian Civic Club Cultural practitioners Traditional healers Cultural consultants-pohaku stone Taro farmers-ohana Bishop Canoe paddlers-waianuenue Canoe Club Hui Maoli ola University of Hawaii Hawaiian studies-kanewai lo I HIMB Windward Community College Other Kamehameha Schools Ke Kula of Samuel M. Kamakau Papakolea Community Government Board of Water Supply US Army-Makua valley

9 NH Health Past & Present Self awareness exercises Sense of place Genealogy Native Hawaiian History Cultural trauma Native Hawaiian relationship to land Spiritual connection Āina-that which feeds Ahupua a land division Shared resources Resource management Top image: Bottom image:

10 Native Hawaiian Health: Past Traditional Healing Practices Lomilomi (massage) La au lapa au (herbal) Utilize our healing garden Ho oponopono (conflict resolution)

11 Classrooms in community: Storied and Sacred places Service learning sites

12 Community classroom: Ma Uka and Wai

13 Community Partners: Papahana Kuaola and Hoʻoulu Āina Land, sustainable agriculture Service learning sites

14 Community Partners: Hawaiians as scientists-ma Kai Classroom site Service learning site

15 Community Partners: various cultural practitioners

16 Native Hawaiian Health: Future Service Learning site Community classroom

17 Assessing Course Impact Analyses of end of year student reflection papers Objectives Determine consistency of reflections with course objectives Determine student s understanding of Native Hawaiian health at course conclusion Demographics 27 students (2 not included-submitted alternative project) 14 females, 13 male 63% local and 15% from continental US, 22% international 22% were Native Hawaiian, 78% were other ethnicities Methodology Retrospective analysis (N=25) from Constant comparative analysis with consensus on major themes and subthemes

18 Results Major themes Relationship of culture to health 76% discussed the relationship between culture and health Holistic approach to NH health 52% discussed the value of a holistic approach to NH health Connection of ʻĀina to health 60% discussed understanding the connection between ʻāina and health Impact on future practice 56% discussed the impact of what they learned for their future practice I learned how Native Hawaiian health and culture are completely integrated..care of the whole person (and family)-mind, body and spirit central tenant Native Hawaiian health is man s integral relation with the land. Spiritual connection also vital was surprised to discover how the land can be used as a place to heal and restore the mind and body

19 Shared mana o, thoughts...the lessons from all of our classes will be important in the next three years. What will prove to be some of the most important things we learned, I think, are the ones we learned through our community health class Until I took the course, I didn t realize the importance of participating in and preserving Hawaiian culture-didn t understand the need to maintain Hawaiian presence in modern day living.

20 Key Findings/Lessons Learned Invest in building relationships and trust with community members Honor their time Example of WCCHC Being creative with limited resources and funding Complex Logistics and Planning Working with community requires flexibility Working outdoors requires flexibility Medical students prefer structure and set syllabi Long term evaluation and impact needed

21 Ike Hawai i Hoʻailona, signs Community partners have been supportive Appreciate the students growing interest in Hawaiian culture/health, and in deepening their own sense of identity Love having an impact on student training

22 Mahalo, thanks DNHH C3 team Faculty & staff of NHCOE Department of Native Hawaiian Health JABSOM office of medical education Our community partners Our students This course is funded through the Native Hawaiian Center of Excellence which is supported by Grant No. D34HP16044 from the Health Resources and Services Administrations Bureau of Health Professions, US Department of Health and Human Services. Photos courtesy of M. Kamaka and L. Yap unless otherwise indicated I will be forever thankful that I signed up for this elective..