Table 1.
Organization of 29 Ideas Generated by Participants in Four Independent Nominal Group Technique (NGT) Sessions *, †
| Elements of cognitive map |
The NGT sessions: ideas generated, participants, ratings of ideas |
||||
|---|---|---|---|---|---|
| Neighborhood | Cognitive map number for the idea | Ideas listed by family | Participant type | Rating | Sumof ratings; (overall sum of ratings) |
| Patient’s background | |||||
|
Cultural background (religion, customs, moral values) | |||||
| 3 | Identify conflicts between major world religious beliefs and principles of Western medicine (I) | MS4 | 3,2 | 5 | |
| 7 | Include examples of customs that are commonly encountered in different cultures (I) | Res | 3,2 | 5 | |
| 24 | Include content regarding values held by different cultures (F) | Res | 2,2 | 4 | |
| 16 | Provide content describing the cultural differences regarding views of marriage, sexuality, and abortions (I) | Comm | 2,1 | 3 | |
|
Culture and health (religion and cultural impact, behavior and adherence) | |||||
| 15 | Provide information on religious principles of particular cultures and how these might influence medical care (I) | Comm | 2,1 | 3 | |
| 10 | Include practical examples of cultural differences that have the potential to influence medical care (I) | Res | 3,1 | 4 | |
| 13 | Describe habits that are unique to the culture and how these habitsmay relate to non-compliance/ adherence (i.e. dietary behaviors) (I) | Comm | 3,2,2 | 7 | |
| 27 | Include modules indicating cultural variability concerning the nature of the different culture’s views about approaching medicine (F) | Comm | 2,1,1 | 4 | |
|
Social background (health patterns, CAM, geographic) | |||||
| 14 | Develop social science content, reflective of different cultures views of the roles of patients, caregivers, and physicians (I) | Comm | 3,3 | 6 | |
| 12 | Present objective data on the cultures of various patient population groups, including different health patterns and the factors that influence the use of health services (I) | Comm | 3,3,1 | 7 | |
| 25 | Provide information on herbal and folk remedies popular in different cultures (F) | Comm | 2,2 | 4 | |
| 26 | Include information that addresses regional differences in cultures and ethnicity (F) | Comm | 3,1 | 4 (56) | |
| Provider/health care system | |||||
|
Clinical skills (own bias self-awareness, patient-centered, professionalism) | |||||
| 17 | Include content to help learners become aware of own biases and attitudes and how these influence patient care (I) | CER | 3,2,2,2 | 9 | |
| 23 | Address issues fundamental to baseline professionalism (F) | MS4 | 3,2 | 5 | |
| 20 | Include basic content emphasizing patient-centered care (I) | CER | 3,1 | 4 | |
|
Communication skills (history, stereotype avoidance) | |||||
| 1 | Identify critical questions that would permit taking cultural history (i.e. focusing on having physicians develop greater patient-centeredness) (I) | MS4 | 3,1,1 | 17 | |
| 21 | Include exercises to help “stereotype avoidance” without teaching about stereotypes (I) | CER | 2, 1 | 3 | |
|
Health disparities epidemiology (prevalence, causes, medications) | |||||
| 4 | Provide epidemiological data regarding disease prevalence of different race/ethnic groups (I) | MS4 | 2,2 | 4 | |
| 19 | Provide info re: disparities that exist in CV care --reasons for these disparities (I) | CER | 3,3 | 6 | |
| 2 | Identify content showing how pharmacological treatments might be tailored to specific ethnic groups(I) | MS4 | 3,2,1,1 | 7 (55) | |
| Cross-culture | |||||
|
Cross-cultural communication (idioms, barriers, examples) | |||||
| 28 | Provide information regarding variability in indigenous vernacular, colloquiums, and idioms across ethnicities (F) | Comm | 2,1 | 3 | |
| 9 | Present information that addresses common barriers that prevent patients from following doctor’s recommendations (I) | Res | 2,2,1 | 5 | |
| 18 | Present real life examples as case vignettes in the form of interactive video (I) | CER | 3,3 | 6 | |
|
Cross-cultural resources | |||||
| 29 | Include resources/info about where physicians can go to get information regarding broad issues of cultural competencein medicine (F) | CER | 3,2,2,1 | 8 | |
| 11 | Provide links to resources that have information regarding the characteristics of different cultures (I) | Res | 2,1 | 3 (25) | |
| Resources | Translator guides, instructions | ||||
| 5 | Develop language translation guides for use in practice (I) | MS4 | 2,1 | 3 | |
| 8 | Provide a list of available translator services (I) | Res | 3,2 | 5 | |
| 6 | Provide access to resources to ensure that patients and their families comprehend physician and medical instructions (I) | Res | 3,3 | 6 | |
|
Community resources | |||||
| 22 | Develop a list of community resources relevant to culturally diverse patients (F) | MS4 | 3,3,2,1 | 9 (23) | |
Ideas were generated by 30 medical students, residents, and physicians in response to the question: “What sorts of things could be included in a curriculum that focuses on cultural competence training for physicians?” The 29 ideas shown in the table were selected by at least two of 45 educators and researchers. Multidimensional scaling (MDS) and hierarchical cluster analysis produced homogeneous groupings of related concepts and generated a cognitive map. The table presents the ten small groups, or families, of cognitively most-similar ideas, each within four larger groups, or neighborhoods, of cognitive similarity. Ratings indicate the most (3), next-to-most (2), and least (1) important ideas. The higher the sum of the ratings, the greater the idea’s perceived importance. Most of the feasible ideas were not considered the most important ideas, and vice versa. The ideas are listed by the same cognitive map numbers in both this table and Figure 2.
I = important, F = feasible, CAM = complimentary and alternative medicine, CER = clinician educators and researchers, Comm = community physicians, Res = internal medicine residents, MS4 = fourth-year medical students.