Hispanic Curriculum for NYC GME

The National Hispanic Medical Association & The New York City Health and Hospitals Corporation
Meeting on Hispanic Cultural Competence for Graduate Medical Education, Friday, May 30th, 2003
NHMA and the Greater New York City Hospital Association, Monday, June 3, 2003

Hispanic Curriculum Program Project Final Report

NHMA Hispanic Cultural Curriculum New York City Graduate Medical Education

NHMA has convened focus groups of community leaders from Mexican, Dominican and Puerto Rican neighborhoods as well as faculty from GME programs in NYC to discuss the curriculum needs and research challenges in the area of Hispanic health. The Robert F. Wagner Graduate School of Public Service, New York University and the Office of Minority Health U.S. DHHS are supporting the project. This endeavor will provide an assessment of community-based information and linkages with community-based organizations and leaders that could be utilized in the development of cultural competence curriculum focused on the Hispanic populations of New York City for graduate medical education programs that could be replicated across the nation.

The literature has demonstrated that culture impacts outcome of clinical care, quality of health care delivery and patient satisfaction in the health care arena. In addition, the U.S. Department of Health and Human Services has recognized the importance of the bias of physicians based on the "culture of medicine" that has been shown by recent studies to impact the quality of care provided to minority patients. The DHHS Elimination of Ethnic/Racial Disparities in Health warrants a discussion of cultural impact on access to health care as well as the cultural competence of the physicians and other providers who play key roles in health care delivery.

Physician sensitivity to culture should begin in the formative years of medical education. This project meets the challenge of developing knowledge based on what is currently being taught in medical education to physicians - in medical schools and in primary care based residency programs. It was decided to limit the project to primary care, since most encounters with patients are by these physicians, and the continuity of care with families occurs most often with primary care medicine - which includes Internal Medicine, Family Practice, and Pediatrics.

Cultural competence is defined by Flores as the recognition and appropriate response to key cultural features affecting clinical care. Physician training in cultural competence should result in the gaining awareness; knowledge and skills that would enhance the clinical care targeted for persons from different cultural backgrounds, in this case, Hispanics. Therefore, the quality of care and patient satisfaction should be increased for persons who face cultural barriers from the mainstream in the U.S. health system. The ultimate outcome is to increase the quality of the U.S. health care system. During the past decade there has been a critical recognition of the importance of the lack of knowledge of physicians regarding their practice patterns targeted at patients from various minority and ethnic cultural backgrounds. One major trend brought forth in medical education that would increase this knowledge is the development of community-based training. In order to assist primary care residency programs to improve their curricula for delivering quality medical care delivery to minorities, there is a need to develop an assessment of the community based approach in the current curriculum for educating residents about minority patients.

In 2000, the population of New York City included 27 percent Hispanics, 35 percent White Non-Hispanic and 38 percent African American, Native American and other races. Hispanics make up the largest group in NYC. The demographic profile of NYC Hispanics demonstrate that there are neighborhoods with large numbers of Hispanics - Puerto Ricans, Dominicans, Mexicans with low income, low education, young populations, and low amount of health insurance of health access problems. We are interested in building linkages with those health care facilities and community based organizations that serve the Hispanic populations in various neighborhoods in New York City, such as the Bronx, Washington Heights, and East Harlem. The linkages with the providers will enhance the understanding of the important role of the community support in the health delivery patterns for Hispanics.

We have been focusing the discussion on the following topics that are important in the development of curriculum to train physicians about culture and their patients with community linkages:

1. The relationship between mind and body (biology of belief).
2. The physiology of the healing system in the body.
3. The relationship between nutrition and health, with a focus on the typical Hispanic diet.
4. The current health seeking behavior of Hispanics with a focus on traditional healing and conventional medicine.
5. The importance of family dynamics and health promotion and treatment information among Hispanics.
6. Traditional healing practices.
7. Hispanic history in the Northeast with a focus on developing an understanding of the unique transfer of information from the health provider to different generations in the Puerto Rican, Dominican, and Mexican American family.

In summary, the assessment of cultural competence curriculum in primary care residency programs is an important project that meets the challenge of the U.S. Department of Health and Human Services to determine how to develop mechanisms, in this case, curriculum that can decrease the disparities in medical care by increasing awareness, knowledge and skills of physicians in treating minority patients.

The meetings have been essential to building consensus on future strategies that do not duplicate work that has been accomplished in New York City with the Hispanic communities. It has been important to include the members of the communities in these efforts to gain their partnership with the NHMA. The NHMA received support from our New York Advisory Committee members to involve residency program faculty and resident networks with the meetings.

Case Studies are being developed to gain an understanding of the issues faced by Hispanics in New York City in accessing health care services and providers. A focus will be on the perspective of the community as to what are key elements for cultural competent services and providers. In addition, the case studies will be used in the meetings as a basis for discussions on lessons learned for outreach, management and information dissemination.

Currently, NHMA is in its third year of a four-year project with a focus on Cultural Competence Curriculum Evaluation. A presentation was made by GME faculty at the NHMA 8th Annual Conference and a meeting of accreditation and board examiners will be convened in September 2005. NHMA assembled three focus groups of community leaders from Mexican, Dominican and Puerto Rican neighborhoods, faculty from GME programs in NYC, and residents from GME programs in NYC to discuss the curriculum needs and research challenges in the area of Hispanic health.