Breaking Down Professional and Cultural Barriers in the Classroom: Our Experience and Recommendations

Joyce Addo-Atuah, PhD
Interim Chair, SBA Department & Associate Professor
College of Pharmacy, Touro College
Course Co-Director, Introduction to Cultural Competency
Joyce.addo-atuah@touro.edu

 Jeffrey R. Gardere, PhD
Associate Professor
College of Osteopathic Medicine, Touro College
Course Co-Director, Introduction to Cultural Competency
Jeffrey.gardere@touro.edu

The Introduction to Cultural Competency course that we offer for first year medical (TouroCom) and pharmacy (TCOP) students on the Harlem campus is a unique offering. We recently learned from a national survey conducted by the Health Disparities and Cultural Competency Special Interest Group of the American Association of Colleges of Pharmacy (AACP) that our course is the only one taught at an interprofessional education (IPE) setting.  The World Health Organization (WHO) describes IPE as “when students from two or more professions learn about, from, and with each other to enable effective collaboration and improve health outcomes.”

With globalization resulting in patient populations of diverse backgrounds, IPE has become a buzz word and a required component of the training and educational experience of health professional students. We know that patient diversity means varying health-related cultural beliefs and practices, the lived experiences of disease in diverse backgrounds, and access to and use of healthcare services and interventions, all of which have implications for patient health outcomes and overall quality of life.  This patient diversity is compounded by the presentation of complex health conditions which frequently require culturally-competent multidisciplinary healthcare teams to provide the needed comprehensive care. Herein lies the importance of IPE and cultural competency training for health professions students.

The Challenges

When we started this Cultural Competency course in this IPE setting in the 2017 spring semester, we quickly learned that placing medical and pharmacy students together in the same classroom does not automatically translate into them learning “about, from and with each other.” The barriers we had to break down before effective learning could take place belonged to two categories, professional and cultural.  We all know the silo systems in which the typical healthcare professional student is trained; interprofessional rivalry and turf protectionism are nothing new both in school and in practice.  Added to this professional protectionism is the cultural divide which exists even between students in the same school. We therefore had to strategize to effectively break down these barriers and here we are happy to share our efforts so far which we believe are yielding tangible positive results.

Formation of IPE Teams

Students may or may not be familiar with working in teams within their individual schools. Even within the same school, we have had challenges with certain teams whose members simply cannot work together or with that single individual who seems to have problems with the other team members because of their negative perception of his/her contribution to team effort. So setting up teams of medical and pharmacy students would be expected to bring on an additional layer of complexity but we persevered to bring the needed changes.

In the first year of the course, we set up IPE teams of 7-8 students (usually 2-3 pharmacy students per team because there were less of them in the combined class) and electronically connected them through the course management system (Blackboard, now Canvas) to facilitate communication. Each team was charged to work together outside of class to complete the course project which consisted of planning a culturally-competent health educational campaign to reduce the vulnerability of their assigned population group to the latter’s most prevalent public health problem. The teams presented their campaigns in class based on the Health Belief Model, accompanied by culturally-sensitive flyers that they had designed to publicize their campaigns. This was our modest effort at addressing both the professional and cultural divide in the first course offering in 2017.

The Results  

A post-course anonymous student survey overwhelmingly called for more IPE in-class activities to foster a closer collaboration between students within and across the two schools and as course directors, we responded to address the students’ needs.   In the subsequent course offerings, we added a minimum of two in-class IPE group activities. One of the activities was designed to break down both the professional and cultural barriers as described below.

Experiencing Diversity in the Classroom Exercise

In this exercise, the IPE teams were required to work in class to experience their own diversity; an experience we believed would prepare them to work with patients of diverse backgrounds.  Each team was required to have a healthy and open discussion among their members using an outline provided to them. This included race/ethnicity, country of origin, mother tongue and other languages spoken, number and names of countries visited, having family and/or friends outside of own race/ethnicity, family use of complementary and alternative medicine (CAM) and interesting health/disease-related cultural beliefs, values and practices. Each team was required to present their findings in a tabular form, replacing student names with numbers in the table of responses and thereby effectively protecting their privacy and identity. The team’s submission also had to include a list of individual reflections of each team member regarding their experience with the exercise and its inherent value to them.  Before the end of the class, student representatives of the different teams shared some reflections on their experiences with the class.

Findings

It is important to celebrate the diversity in our colleges. In one class, nearly 80% of the students spoke 2-3 languages; 85% reported family use of CAM; over 80% had a history of global travel; and 10% had family members outside their race/ethnicity. All in all, this exercise has become the source of self-introspection and awareness of others because as one student succinctly put it, “when we decided to take the questions one at a time and allow each team member to open up and talk about self and become vulnerable before the team, we soon found out that although we had such a diverse background, we have more in common than what we originally thought; this has been a great eye opener.”

What Is the Take Home Message Here for Educators?

  1. Be sensitive to the environment and the people you teach.
  2. Use your classroom as a “lab” of the concepts you are trying to teach; you will be greatly surprised at the outcomes of such practical demonstrations.
  3. Do not be afraid to solicit student feedback on your course outside the official course evaluations.
  4. Let your students see that you value their input in the course by incorporating their feedback into the ongoing quality improvement of your course.

Summing It All Up 

Since we started the Introduction to Cultural Competency course in an IPE setting involving medical and pharmacy students in 2017, we have seen dramatic positive interactions between students, faculty, and staff across our two schools on the Harlem campus. Several extracurricular activities and events have been jointly organized and co-hosted by students of the two schools. Students-faculty, faculty-faculty and faculty-staff interactions across our schools have also become very evident. Finally we believe that the course and its exercises have assisted our students to address their implicit biases toward different students and cultures in the classroom and increased their cultural sensitivity and interprofessional skills to facilitate their transition into multidisciplinary, culturally-competent healthcare teams.  We employed the use of the Interprofessional Collaborative Cultural Competencies Attainment Survey (ICCCAS) in the 2019 course offering to confirm and quantify these attainments.

Acknowledgments

None of these efforts and outcomes would have been possible without the active collaboration of our deans, other administrators, the IT and administrative staff, and the student leaderships of the two colleges who always play their part very well to ensure the smooth running of the course throughout the semester in spite of scheduling difficulties at times. In the end, interprofessional collaboration and cultural sensitivity triumph for the benefit of us all.

Further Study:

Please register through the link below to participate in the upcoming webinar, scheduled for June 18, 2019 at 2.00-3.00pm when we will describe in detail how we have developed, implemented, and assessed this course.

https://connect.aacp.org/events/event-description?CalendarEventKey=57883d5b-dbf8-4486-bb35-dd34ea0a9f79&Home=%2fevents%2fcalenda

Further Readings

Institute of Medicine (IOM): Unequal Treatment: Confronting Racial & ethnic Disparities in Healthcare-Executive Summary. Available at: http://coe.stanford.edu/courses/ethmedreadings06/em0601garcia2.pdf     Accessed 1/14/2019

Cooper LA and Powe NR. Disparities in patient experiences, healthcare processes, and outcomes: The role of patient-provider racial, ethnic, and language concordance. Available at: http://www.commonwealthfund.org/programs/minority/cooper_raceconcordance_753.pdf.  Accessed 01/15/2019

Brigdes DR, Davison RA, Odegard PS, Maki IV, Tomkowiak J. Interprofessional collaboration: three best practice models of interprofessional education. Med Educ Online 2011:16. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3081249/  Accessed June 4, 2019

World Health Organization. Framework for Action on Interprofessional Education and Collaborative Practice, 2010. Available at: https://apps.who.int/iris/bitstream/handle/10665/70185/WHO_HRH_HPN_10.3_eng.pdf;jsessionid=8D7A9EB20EE3A9888858B1A9C38BAA43?sequence  Accessed June 3, 2019

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