GY1 Faculty HRSA Grant Training

GY1 Faculty HRSA Grant Training (2005-2006)

Greetings,

The faculty development component of OUCOM’s HRSA Grant on Evidence Based Medicine (EBM), Patient Safety (PS), and Cultural Competence (CC) requires a development activity in all three areas in grant year 1 (GR1) and two activities for each area during in GR2 and GR3.

I have combined GR1 activity into a one-hour training packet with a one-page pre-test (2 min), followed by an activity in each area (30 min total) and finishing with a one-page post-test (10 min).

The objectives for this training are:

Evidence Based Medicine (EBM)

Define EMB.
Outline the five steps of EBM.
Increase your level of mastery of EBM by at least one-step on the scale of Novice, Advanced Beginner, Competent, Proficient, Expert, Master.

Cultural Competence (CC)

Define Cultural Competence
Construct a model of areas where you can improve your cultural competence.
Increase your level of mastery of CC by at least one step on the scale of Novice, Advanced Beginner, Competent, Proficient, Expert, Master.

Patient Safety (PS)

Define Patient Safety.
Describe the main terms of patient safety.
Increase your level of mastery of PS by at least one step on the scale of Novice, Advanced Beginner, Competent, Proficient, Expert, Master.

Your role is to take the pretest, work through the packet, take the posttest without referring to the packet materials (honor system), review the material to fill or correct the blank or incorrect answers, answer the post-training questions, and click the "Submit" button.

Subsequent EBM, CC, & PS training will follow in the next two years. Thank you for helping with our quest to move toward mastery EBM, CC, and PS!

Regards, ssd

Stephen S. Davis, Ph.D.

Director, Faculty Development

Pretest on Evidence Based Medicine (EBM), Cultural Competency (CC),
and Patient Safety (PS) training.

Evidence Based Medicine (EBM)

Define EBM in your own words:

Describe the logical 5 steps of EBM:

What do you consider to be your level of EBM?

Cultural Competency (CC)

Define CC in your own words:

Identify actions you can take in the physical environment, communications and your attitude to demonstrate cultural competency:
1. Physical environment:
2. Communications:
3. Attitude:

What do you consider to be your level of CC?

Patient Safety (PS)

Define PS in your own words:

Describe the meaning of the following terms:
1. Medical error:
2. Systems error:
3. Adverse event:

What do you consider to be your level of PS knowledge, skills, and attitude?

Evidence Based Medicine (EBM)

Definition of Evidence-Based Medicine (EBM)

The EBM subcommittee of the OU-COM Curriculum Advisory Committee (CAC) has adopted the definition of evidence-based medicine (EBM) developed by David Sackett, M.D., and colleagues (2000, p. 1):

"Evidence-based medicine (EBM) is the integration of best research evidence with clinical expertise and patient values…When these three elements are integrated, clinicians and patients form a diagnostic and therapeutic alliance which optimizes clinical outcomes and quality of life."

"By best research evidence we mean clinically relevant research, often from the basic sciences of medicine, but especially from patient-centered clinical research into the accuracy and precision of diagnostic tests (including the clinical examination), the power of prognostic markers, and the efficacy and safety of therapeutic, rehabilitative, and preventive regimens. New evidence from clinical research both invalidates previously accepted diagnostic tests and treatments and replaces them with new ones that are more powerful, more accurate, more efficacious, and safer."

"By clinical expertise we mean the ability to use our clinical skills and past experience to rapidly identify each patient's unique health state and diagnosis, their individual risks and benefits of potential interventions, and their personal values and expectations."

"By patient values we mean the unique preferences, concerns and expectations each patient brings to a clinical encounter and which must be integrated into clinical decisions if they are to serve the patient."

Furthermore, the EBM subcommittee is developing an outline of curricular learning objectives and activities organized around the five steps of practicing EBM that were articulated by Sackett and colleagues:

1. CONVERT the need for information into answerable questions.

2. TRACK DOWN the best evidence with which to answer the questions.

3. CRITICALLY APPRAISE the evidence for its validity, impact, and applicability.

4. INTEGRATE the critical appraisal with our clinical expertise and with our patient's unique biology, values, and circumstances.

5. EVALUATE our effectiveness and efficiency in executing steps 1-4 and seek ways to improve them both for next time.

Source: Sackett, D. L., Straus, S. E., Richardson, W. S., Rosenberg, W., & Haynes, R. B. (2000). Evidence-based medicine: How to practice and teach EBM (2nd ed.). Edinburgh: Churchill Livingstone.

The book is available in the OU-COM LRC and the OU Health Sciences Library. The book's website is the Center for Evidence-Based Medicine at the University of Toronto.

- More information on your FD Web Site: http://www.oucom.ohiou.edu/fd/evidence_based_medicine_resources.htm

Cultural Competency (CC)

Definition of Cultural Competency (CC)

Many definitions of cultural competence have been put forward, but probably the most widely accepted is the following: “Cultural and linguistic competence is a set of congruent behaviors, knowledge, attitudes, and policies that come together in a system, organization, or among professionals that enables effective work in cross-cultural situations. ‘Culture’ refers to integrated patterns of human behavior that include the language, thoughts, actions, customs, beliefs, and institutions of racial, ethnic, social, or religious groups. ‘Competence’ implies having the capacity to function effectively as an individual or an organization within the context of the cultural beliefs, practices, and needs presented by patients and their communities.

Cross, T L et al. Towards a Culturally Competent System of Care: A Monograph on Effective Services for Minority Children, National Center for Cultural Competence, Georgetown University, 1989.

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The Cultural Competence Health Practitioner Assessment (CCHPA) was developed by the National Center for Cultural Competence (NCCC) at the request of the Bureau of Primary Health Care, Health Resources and Services Administration, U.S. Department of Health and Human Services. The CCHPA is intended to enhance the delivery of high quality services to culturally and linguistically diverse individuals and underserved communities. It is also intended to promote cultural and linguistic competence as an essential approach for practitioners in the elimination of health disparities among racial and ethnic groups.

The CCHPA is based on three assumptions: (1) cultural competence is a developmental process at both the individual and organizational levels; (2) with appropriate support, individuals can enhance their cultural awareness, knowledge and skills over time; and (3) cultural strengths exist within organizations or networks of professionals but often go unnoticed and untapped (Mason, 1996). There are six subscales: Values and Belief Systems, Cultural Aspects of Epidemiology Clinical Decision-Making, Life Cycle Events, Cross-Cultural Communication and Empowerment/Health Management.

For this first training session I’m just using the first question in each area…subsequent sessions will address the others.

Subscale: Values and Belief Systems
The Values and Belief Systems concerns practitioners' knowledge of the values and belief systems of diverse cultural groups and their impact on health care access and utilization. The scale explores perspectives of health, illness, well-being, care-seeking behaviors, traditional health practices, spirituality, and family/community dynamics. Responses to these items range form 1 - "not at all" to 4 - "very well."

1. I know the following values and belief systems for culturally diverse groups in my service area related to: (Please respond to all items)

Not at All Barely Fairly Well Very Well

a. health

O O O O

b. illness

O O O O

c. well-being or wellness

O O O O

d. help-seeking behaviors

O O O O

e. cultural definitions of preventive health

O O O O

f. preference for traditional healers

O O O O

g. traditional healing practices

O O O O

Subscale: Cultural Aspects of Epidemiology
The Cultural Aspects of Epidemiology concerns practitioners' knowledge of cultural, environmental and related etiologic factors that contribute to disease. It probes health disparity and risk and protective factors for underserved groups and communities. Responses to these items range from 1 not at all to 4 very well.

1) I know the impact of the following indicators on the health and well-being of the communities I serve:

Not at All Barely Fairly Well Very Well

a. domestic violence

O O O O

b. community violence rates

O O O O

c. sexual abuse/trauma

O O O O

d. substance abuse

O O O O

e. mental health

O O O O

f. oral health

O O O O

g. infant mortality & morbidity

O O O O

h. teenage pregnancy

O O O O

i. poverty

O O O O

j. unemployment

O O O O

k. housing

O O O O

l. homelessness

O O O O

m. racism, discrimination & bias

O O O O

n. literacy

O O O O

o. limited English proficiency

O O O O

p. other environmental factors

O O O O

Subscale: Clinical Decision-Making
The Clinical Decision-Making concerns practitioners' knowledge of culturally-defined health beliefs and practices, and the ability to integrate this knowledge in approaches to health care delivery. It addresses intake, assessment/diagnosis, treatment/discharge planning, and use of community-based resources. The responses range from 1 never or not at all to 4 regularly or very well.

1) I integrate the following in diagnostic protocols:
(Only answer this question if you have prescribing authority)

Never Seldom Sometimes Regularly

a. knowledge of diverse values and belief systems to health and disease

O O O O

b. individuals' perception of what caused their disease/illness

O O O O

c. culturally relevant information from family members

O O O O

d. screening/diagnostic tests based on age

O O O O

e. screening/diagnostic tests based on race/ethnicity

O O O O

f. screening/diagnostic tests based on gender

O O O O

Subscale: Life Cycle Events
The Life Cycle Events concerns practitioners knowledge of the cultural implications of various life cycle events, and the ability to address them in approaches to health care delivery. Responses range from 1 not at all to 4 very often.

1) My health care delivery approaches accommodate cultural beliefs and practices related to the following life cycle events:

Not at all Sometimes Fairly often Very often

a. pregnancy and birth

O O O O

b. rites of passage

O O O O

c. puberty

O O O O

d. menopause

O O O O

e. marriage/divorce

O O O O

f. aging

O O O O

g. death and dying

O O O O

Subscale: Cross-Cultural Communication
The Cross Cultural Communication involves practitioners' knowledge and skills in communicating with culturally and linguistically diverse groups as it relates to health care access and utilization. The subscale explores capacity for cross-cultural communication, utilization of different modes of communication and the provision of interpretation/translation services. Responses range from 1 "never to 4 regularly.

21) I address the cross-cultural communication needs of individuals in my practice by:

Never Seldom Sometimes Regularly

a. ensuring that individuals are being served in their primary language including the written notices given to them

O O O O

b. using trained/certified medical interpreters when communicating with individuals when I do not speak their language

O O O O

c. having pre-interview meetings with interpreters to clarify roles, goals and expectations

O O O O

d. ensuring or advocating that individuals who do not speak English have access to trained/certified medical interpreters

O O O O

e. acknowledging and incorporating culturally appropriate non-verbal communication when interacting with culturally or linguistically diverse individuals

O O O O

f. modifying health education or related materials to meet the linguistic needs of individuals served

O O O O

g. modifying health education techniques to meet the unique needs or learning styles of culturally and linguistically diverse individuals and communities

O O O O

h. developing and reviewing treatment plans and treatment/discharge instructions in the mode of communication preferred by the individual

O O O O

i. modifying health education or related material to meet the literacy needs of individuals served

O O O O

Subscale: Empowerment/Health Management
The Empowerment and Health Management subscale consists of five items. This subscale involves the practitioners' role in providing information that enables individuals to intervene on their own behalf, advocate and build community capacity for improved health. Responses range from 1 never or not at all to 4 regularly or very well.

1) I use consent forms, health education materials, and other relevant information to accommodate:

Never Seldom Sometimes Regularly

a. cultural and linguistic needs of populations served

O O O O

b. literacy needs of populations served

O O O O

c. other alternative formats. (e.g., sign-language, picture boards, audio tapes etc.)

O O O O

Source: National Center for Cultural Competence, http://www11.georgetown.edu/research/gucchd/nccc/

QUICKLY REVIEW YOUR ANSWERS AND CHOOSE AN ITEM FOR IMPROVEMENT, MAKE A PLAN AND CARRY IT OUT. REPORT IN #7 BELOW.

Patient Safety (PS)

Definition of Patient Safety (PS)

The prevention of healthcare errors, and the elimination or mitigation of patient injury caused by healthcare errors. An unintended healthcare outcome caused by a defect in the delivery of care to a patient. Healthcare errors may be errors of commission (doing the wrong thing), omission (not doing the right thing), or execution (doing the right thing incorrectly). Errors may be made by any member of the healthcare team in any healthcare setting.

National Patient Safety Foundation, www.npsf.org (approved by the NPSF^® Board July 2003)

“To Err is Human,” a landmark study in 2000 reports that: “safety is defined as freedom from accidental injury.”

National Academy Press, http://darwin.nap.edu/books/0309068371/html, page 4.

The “Executive Summary” of that report is states:

“The knowledgeable health reporter for the Boston Globe, Betsy Lehman, died from an overdose during chemotherapy. Willie King had the wrong leg amputated. Ben Kolb was eight years old when he died during ''minor" surgery due to a drug mix-up.

These horrific cases that make the headlines are just the tip of the iceberg. Two large studies, one conducted in Colorado and Utah and the other in New York, found that adverse events occurred in 2.9 and 3.7 percent of hospitalizations, respectively. In Colorado and Utah hospitals, 6.6 percent of adverse events led to death, as compared with 13.6 percent in New York hospitals. In both of these studies, over half of these adverse events resulted from medical errors and could have been prevented.

When extrapolated to the over 33.6 million admissions to U.S. hospitals in 1997, the results of the study in Colorado and Utah imply that at least 44,000 Americans die each year as a result of medical errors. The results of the New York Study suggest the number may be as high as 98,000. Even when using the lower estimate, deaths due to medical errors exceed the number attributable to the 8th-leading cause of death. More people die in a given year as a result of medical errors than from motor vehicle accidents (43,458), breast cancer (42,297), or AIDS (16,516).

Total national costs (lost income, lost household production, disability and health care costs) of preventable adverse events (medical errors resulting in injury) are estimated to be between $17 billion and $29 billion, of which health care costs represent over one-half.`

National Academy Press, http://darwin.nap.edu/books/0309068371/html, pages 1 & 2.

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Terms:	Definitions:
Adverse event:	An injury that was caused by medical management and that results in measurable disability.
Error:	The failure of a planned action to be completed as intended or the use of a wrong plan to achieve an aim. Errors can include problems in practice, products, procedures, and systems.
Unpreventable adverse event:	An adverse event resulting from a complication that cannot be prevented given the current state of knowledge.
Medical error:	An adverse event or near miss that is preventable with the current state of medical knowledge.
Near miss:	An event or situation that could have resulted in an accident, injury or illness, but did not, either by chance or through timely intervention.
System:	A regularly interacting or interdependent group of items forming a unified whole.
Systems error:	An error that is not the result of an individual’s actions, but the predictable outcome of a series of actions and factors that comprise a diagnostic or treatment process.

Center for Quality Improvement and Patient Safety (CQuIPS), http://www.quic.gov/report/mederr8.htm

Posttest on Evidence Based Medicine (EBM), Cultural Competency (CC),
and Patient Safety (PS) training.

Evidence Based Medicine (EBM)

Define EBM in your own words:

Describe the logical 5 steps of EBM:

What do you consider to be your level of EBM?

Cultural Competency (CC)

Define CC in your own words:

Identify actions you can take in the physical environment, communications and your attitude to demonstrate cultural competency:
1. Physical environment:
2. Communications:
3. Attitude:

What do you consider to be your level of CC?

Patient Safety (PS)

Define PS in your own words:

Describe the meaning of the following terms:
1. Medical error:
2. Systems error:
3. Adverse event:

What do you consider to be your level of PS knowledge, skills, and attitude?

Name:

Title/Position:

Date:

HRSA Grant Faculty Development GY1 Follow Up Questions

1. Relook at objectives -- have we met them?

2. What did you learn about EBM?

3. What did you learn about CC?

4. What did you learn about PS?

5. What do you recommend that would be useful to you for future training sessions?

7. What do you plan to do after this training that you didn't or stopped doing before?

8. What other thoughts do you have about this training?

Last updated: 07/18/2007