Bridging the gap: a curriculum to teach residents cultural humility.

BACKGROUND AND OBJECTIVES: Family physicians are expected to provide culturally sensitive care. However, teaching about cultural diversity and measuring educational outcomes can be challenging. We describe a diversity curriculum based on the concept of cultural humility, which includes participatory didactic and structured learning activities. METHODS: Two classes of second-year family medicine residents participated in a yearlong diversity curriculum. Self-assessment and observational data were collected before and after the curriculum. RESULTS: Observational data showed that residents increased patient involvement during office visits. Ratings by announced and unannounced simulated patients indicated that residents were attentive to the patient's perspective and social context. Resident ratings indicated high satisfaction with the learning activities. Self-assessment data did not show significant changes in residents' perception of their ability to work with particular patients. CONCLUSIONS: Participatory learning activities that focus on cultural humility are a promising approach for diversity education.

Scholarly Activities of Family Medicine Faculty: Results of a National Survey.

BACKGROUND AND OBJECTIVES: This survey examined how family medicine residency programs define scholarly activity, the productivity of programs, and perceived barriers to scholarly work. Five types of residency programs are compared: university-based, community-based (unaffiliated, university-affiliated, university-administered), and military. METHODS: A 13 item web-based questionnaire was sent to all 455 U. S. family medicine residency programs. The survey solicited demographic information as well as program expectations of faculty, presence of a research coordinator/director, activities considered scholarly, productivity, and perceived barriers. RESULTS: A total of 177 surveys were completed for a response rate of 38%, similar to response rates of web-based surveys in the literature. 67.6% of programs encouraged, but did not require scholarly activity, and 44.5% indicated their program had no research coordinator/ director. University-based programs had the highest levels of productivity compared to other program types. Primary barriers to scholarly activity noted were lack of time (73/138, 53%) and lack of supportive infrastructure (37/138, 27%). CONCLUSIONS: While interpretations are limited by the response rate of the survey, results provide an increased understanding of how programs define scholarly activity as well as reference points for faculty productivity. This information can help program directors when setting criteria for scholarly work.

Push and pull: resolving differences of opinion during meetings.

Consider the results of a recent study that looks at how to handle differences of opinions among physicians and other health care staff, including the ways that "push" and "pull" statements affect the outcomes of meetings.

Relationship-centered administration: transferring effective communication skills from the exam room to the conference room.

Medical researchers have shown that relationship-centered healthcare increases patient satisfaction and improves health outcomes. The components of relationship-centered healthcare--listening, sharing decision making, and respecting others--improve patient motivation and commitment to a plan of action. Currently, no data are available on the extent to which medical administrative settings adhere to relationship-centered principles. To begin to answer this question, we observed a convenience sample of 45 meetings in healthcare settings to assess the frequency and types of relationship-centered behaviors shown by group leaders. Our results provide preliminary data that leaders, especially female leaders, praised the value of group member efforts and encouraged members to provide input. Less frequently employed relationship-centered behaviors included providing a verbal summary of a discussion, responding to feelings expressed by members, and setting explicit agendas. Finally, we found some provocative associations. Female leaders received higher satisfaction ratings, and male leaders were more verbally dominant. Similar to physician-patient interaction, new topics for discussion are less likely to arise spontaneously late in a meeting if early agenda setting is utilized. To our knowledge, this is the first such study in a medical setting. Our findings encourage those who chair meetings to reflect on the extent to which they use a collaborative approach and offer specific content areas on which to focus. Further research on the concept and outcomes of relationship-centered administrative approach is warranted.

Interviewing when family members are present.

The presence of family members at an office visit creates unique opportunities and challenges for the physician while interviewing the patient. The physician must address issues of confidentiality, privacy, and agency. Special skills are required to respectfully and efficiently involve family members, while keeping the patient at the center of the visit. A core set of interviewing skills exists for office visit interviews with family members present. These skills include building rapport with each participant by identifying their individual issues and perspectives, and encouraging participation by listening to and addressing the concerns of all persons. Physicians should also avoid triangulation, maintain confidentiality, and verify agreement with the plan. It may be necessary to use more advanced family interviewing skills, including providing direction despite problematic communications; managing conflict; negotiating common ground; and referring members to family therapy.