APPENDIX 2

Kleinmans Explanatory Model of Illness

Kleinman and associates (1978) in their seminal paper further discuss the importance of the explanatory model: Eliciting the patients (explanatory) model gives the physician knowledge of the beliefs the patient holds about his illness, the personal and social meaning he attaches to his disorder, his expectations about what will happen to him and what the doctor will do, and his own therapeutic goals. Comparison of patient model with the doctors model enables the clinician to identify major discrepancies that may cause problems for clinical management. Such comparisons also help the clinician know which aspects of his explanatory model need clearer exposition to patients (and families), and what sort of patient education is most appropriate. And they clarify conicts not related to different levels of knowledge but different values and interests. Part of the clinical process involves negotiations between these explanatory models, once they have been made explicit. Eliciting the Patients Explanatory Model of illness through a set of targeted questions shown below is an important tool for facilitating cross-cultural communication, ensuring patient understanding, and identifying areas of conict that will need to be negotiated. The wording and number of questions used will vary depending on the characteristics of the patient, the problem, and the setting. r What do you think has caused your problem? r Why do you think it started when it did? r What do you think your sickness does to you? How does it work? r How severe is your sickness? Will it have a short or long course? r What kind of treatment do you think you should receive?

Achieving Cultural Competency: A Case-Based Approach to Training Health Professionals Edited by L. Hark, H. DeLisser 2009 Blackwell Publishing Ltd. ISBN: 978-1-405-18072-6

217

218

Appendix 2

r What are the most important results you hope to receive from this r What are the chief problems your sickness has caused for you? r What do you fear most about your sickness?
Adapted from, Kleinman A., Eisenberg L., Good B. Culture, illness, and care: clinical lessons from anthropological and cross-cultural research. Ann Intern Med 1978;88:25188. treatment?

Introduction

Case 5: Jon Lee

Case 2: Carl Jones

Appendix 3:

Case 13: Mae Ling

Case 9: Mary Jones

Case 20: Sulip Guha

Case 11: Carlos Cruz

Case 14: Earl Collins

Case 15: Irma Matos

Case 16: Eileen Clark

Case 18: Juana Caban

Case 1: Ruth Franklin

Case 3: Maria Morales

Case 12: Denise Smith

Case 8: George Dennis

Case 7: Isabel Delgado

Case 19: Alice Gregory

Case 25: Bobby Napier

Case 24: Naomi Fulton

Case 22: Alika Nkuutu

Case 23: Miguel Cortez

Case 17: Leslie OMalley

Case 6: Nadia Rosenberg

Case 4: Maya Mohammad

Case 21: Pepper Hawthorne

Case 10: Priya Krishnamurthy

Tools For Assessing Cultural Competency Training

Available at http://www.med-ed-online.org

D = Domain K = Knowledge S = Skill A = Attitude

= Cronbachs for Domain, for 42-item TACCT=0.905

K1. Dene race, ethnicity and culture

X X

K2. Identify patterns of national data

K3. Describe patterns of health disparities

Domain 1: Health Disparities

X X X X X

X X

K4. Identify key areas of disparities

K5. Discuss barriers to eliminating health disparities S1. Concretize epidemiology of disparities

S2. Gather and use data 2010

X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X

X X X X X X X X X

S3. Critically appraise lit. on disparities

A1. Recognize disparities amenable to intervention A2. Value eliminating disparities

K-1. Describe challenges in cross-cultural community K-2. Understand population health variability

K-3. Describe community-based elements

K-4. Identify community beliefs and health practices S-1. Collaborate with communities

Domain 2: Community Strategies

S2. Describe methods to identify community leaders S3. Propose a community-based health intervention A1. Value and address social health determinants

K1. Identify how race and culture relate to health

K2. Identify physician bias and stereotyping

S1. Demonstrate strategies to address/reduce bias

28. DA. Lie, J Boker, S Crandall, CN DeGannes, D Elliott, MD, P Henderson, C Kodjo, and L Seng. Revising the Tool for Assessing Cultural Competence Training (TACCT) for curriculum evaluation: Findings derived from seven US schools and expert consensus. Med Educ Online. 2008;13:11.

S2. Describe strategies to reduce physician bias

Domain 3: Bias/Stereotyping

X X

X X X X X X X X

S3. Show strategies to reduce bias in others

A1. Value historical impact of racism

S4. Elicit information in family-centered context

to Cross-Culture Communication

Domain 4: Communication Skills Specic

X X X X

X X X X X X X

X X X X

X X

X X

X X

X X X

X X X X

X X X X X X X X X X

X X X X X X X X X X X X

X X X X

X X X X X X X X

S5. Use negotiating and problem-solving skills

S6. Assess and enhance adherence

A1. Respect patients cultural beliefs

A2. Nonjudgmental listening to health beliefs

K1. Describe functions of an interpreter

K2. List effective ways of working with interpreter S1. Identify and collaborate with an interpreter

Domain 5: Use of

Interpreters

K1. Describe the physician-patient power imbalance S1. Recognize institutional cultural issues

Medicine

S2. Engage in reection about own beliefs

Domain 6: Self-reection, Culture of

S3. Use reective practices in patient care

A1. Value the need to address personal bias

219

Achieving Cultural Competency: A Case-Based Approach to Training Health Professionals

Duration: Maximum of 25 hours, each case should take 1 hour Credit: Up to 25 AMA PRA Category 1 CreditsTM , each case is awarded 1 AMA PRA Category 1 CreditTM Original Release Date: June 1, 2009 Last Review Date: January 5, 2009 Expiration: May 31, 2012 Completion Instructions r To receive CME credit for each case that you complete from this book, please visit the University of Pennsylvania Ofce of Continuing Medical Education website at: http://www.med.upenn.edu/ cme/culture/ r Once on the site, you will be presented with the option to choose from two topics. The topic for this book is called Achieving Cultural Competency Book Cases (Wiley-Blackwell 2009). After choosing this topic, you will be presented with a complete list of cases from this book. Select the case(s) for which you would like to receive CME credit. r In order to access any of these cases, you must have an account on the CME Website (complementary). r If you do not have an account, sign-up (click on member sign-up at the top of the page). r If you have an account, log into the site with your e-mail address and password (click on log-in at the top of the page). r Next, register for a particular activity (case) by using the link in the Course Materials box on the right. When prompted for an access code, enter: culturebook (Note: the access code is case-sensitive). r Click on the Get CME link in the Course Materials box. r You now need to complete the Post-Test. r After successfully completing the Post-Test, with a score of 75% or higher, you will be directed to the Evaluation. r After completing the Evaluation, you will be able to view, print, or save a CME certicate verifying your credit for this activity.