USING MEDICAL SIMULATIONS TO TEACH MULTICULTURAL DIVERSITY Developments In Business Simulation & Experiential Learning, Volume 24, 1997 USING MEDICAL SIMULATIONS TO TEACH MULTICULTURAL DIVERSITY Anthony M. Errichetti, Philadelphia College of Osteopathic Medicine ABSTRACT Medical students at Philadelphia College of Osteopathic Medicine receive training m multicultural diversity through simulated medical encounters with Standardized Patients. The goal is clinical and multi-cultural competence, i.e. the ability to examine, treat and relate to a culturally diverse patient population. The students participate in a series of simulated medical encounters with SPs who are actual medical patients hired from the community and trained to evaluate clinical and inter-personal skills with the students following the encounters. The result is a meaningful encounter between student and patient in which both learn to appreciate the value systems of the other. INTRODUCTION Philadelphia is a multi-ethnic “city of neighborhoods.” Approximately 45% of the population is African-American, there is a fast growing Asian and Hispanic population and neighborhoods are often separated by economic class and ethnic and racial identity. The main mission of Philadelphia College of Osteopathic Medicine (PCOM) is to train primary care physicians who can work with a medically and culturally diverse patient population. Although the student body of PCOM is approximately 95% Caucasian from the middle class, the patients they encounter during clinical rotations in their third and fourth years are predominately African- American, Hispanic-American and Caucasians from the lower economic class. To better prepare these students for their clinical rotations, and for their work as primary care physicians, all students are required to practice their clinical skills during their first and second years by “treating" culturally diverse Standardized Patients (SPs) several times per year during simulated medical encounters. SPs are either healthy individuals trained to simulate an illness or actual patients trained to portray their own illness in a standardized way (Barrows, 1993). The Standardized Patient Program at PCOM uses actual patients with chronic conditions in order to make the medical simulations as realistic as possible. Approximately 80% of the SPs are African-American or Hispanic. SCREENING, RECRUITING AND TRAINING SPs SPs are recruited directly from community health care clinics where PCOM’s students will eventually perform their clinical rotations. These clinics are located in economically disadvantaged and medically undeserved neighborhoods. The SPs recruited have chronic conditions commonly treated in primary care, e.g. cardiovascular and cardiopulmonary conditions, diabetes, obesity, hypertension, musculoskeletal problems, etc. Job requirements for SPs include basic literacy and absence of health conditions that would make regular part-time employment an impossibility. Following recruitment SPs are screened and evaluated by SP trainers using a structured interview instrument developed at PCOM called the Health illness Lifestyle Survey (HILS). The survey asks questions about the SPs health problems, illness and health-seeking behaviors, experience with health care professionals, work experience and level of perceived self-efficacy. The HILS is also given in a self-administered form to SPs on a monthly basis and serves to get SPs to self-monitor their health. The rationale for using an instrument such as HILS is to determine if SPs suffer ill effects from the medical simulation process. To date, no SPs have reported problems participating in the program. Training for the medical simulations takes place in 4-6 hours. The medical cases arid simulations are 37 Developments In Business Simulation & Experiential Learning, Volume 24, 1997 constructed around the SPs actual health conditions. The SPs’ names are changed, and selected aspects of their condition are amplified or deleted depending upon the training goal. SPs are prepared for the simulated medical encounters through role-play with SP trainers and clinical faculty members. SPs also receive training in medical and inter-personal communication skills and attend a seminar entitled “Ethnic and Cultural Considerations in Health Care.” The seminar provides a basis upon which SPs can reflect on the communication skills and multicultural competence of the medical students they will encounter. SIMULATED MEDICAL ENCOUNTERS Following training SPs begin working with students. During a typical SP exercise, a student examines the chief complaint, takes a medical history, performs a physical examination and then advises the SP. Following the examination the student receives feedback from the SP regarding his or her clinical performance and interpersonal skills. The feedback centers around ethnic and cultural factors, noted by McGoldrick, Giordano and Pearce (1982), that structure health-seeking and health-providing behaviors. These factors include the patients’ experience and expression of pain, communication about pain and symptoms, health beliefs, attitudes towards doctors and helpers, and what treatment patients desire or expect. The examination and feedback session is videotaped for later review by student and faculty. CONCLUSIONS An analysis of the videotapes reveals that both students and SPs often make erroneous assumptions about the others’ knowledge, attitude and behaviors, assumptions based on a lack of personal or professional experience and contact with their counterpart. Confronting these assumptions during the medical simulations and feedback sessions counteract a problem often associated with training in multicultural competence, i.e. patient stereotyping, assumptive bias and the confounding of ethnicity with class and socioeconomic status (Shapiro & Lenahan, 1996). The simulated medical encounters have proven to be a meaningful experience for both student and SP. Students report the encounters increase their medical knowledge, clinical skill level and confidence while SPs report an increase in their sense of self-efficacy and self-confidence in dealing with their own doctors. REFERENCES Barrows, H. (1993) An overview of the uses of standardized patients for teaching and evaluating clinical skills. Academic Medicine, 68, 443-454 McGoldrick., M., Giordano, J. & Pearce, J.K. (1982). Ethnicity and Family Therapy. New York: Guilford Press. Shapiro J &, Lenahan P. (1996) Family medicine: a culturally diverse world: a solution-oriented approach to common cross-cultural problems m medical encounters. Family Medicine Apr; 28 (4): 249-55. 38 Table of Contents Volume 24, 1997 Incorporating Computer Telephony into the MIS Course A Learner Oriented Infrastructure for videoconferencing Based Distance Education Courses The Identification of Temporally Related Structural Elements of the Experiential Component of Electronic Spreadsheet Tasks Does Involvement Influence Learning from Simulation Participation? Some Relationships with Helpfulness and Performance Outcomes Musings on Business Garne Performance Evaluation Performance on a TE Simulation: What does it represent? The Business Policy Game: An International Simulation - An Assessment Tool Students in Free Enterprise as Experiential Learning The Role of Computer Models in Wargames: A Practitioner's view Using Focus Groups as a Tool to Research Learning: A Demonstration and a Discussion Using Medical Simulations to Teach Multi-Cultural Diversity Using the World Game to Internationalize International Exchange Game Community Services Needs Assessment: An Innovative Approach Introducing Students to Potential Total Quality Management Ethical Dilemmas Privacy in the Workplace: A Situational Analysis Antecedents of Learning in Simulations Demonstrating the Learning Effectiveness of Simulation: Where we are and Where we need to go The Use of Computer Simulations as a Pedagogical Aid in Teaching Management Information Systems Evaluating Simulation Learning in a Distant Learning Instructional Model Financial Engineering of Global Investments The Labor History Game: Playing with the Past Perks Participation Assessing Negotiator's Proficiency with a Negotiation role-play The Art of Negotiating Enhancing Learning and Employee Development through the Assessment of Learning Pedagogy Preferences across selected Dimensions of Culture: A Preliminary Investigation Cooperative Learning: What are we Learning? Effective Use of Mastery Based Experiential learning in a Project Course to improve skills in system analysis and Design Simulations and Learning: Can we prove a relationship? (Seminar) Predicting and Reviewing NYSE Stock Prices by use of Basic Statistical Analysis and Logic Toy Car Depreciation Exercise ABSEL as Home Community: An Interactive Exploration Service Learning: Linking Academic Study to Community Development and Business Enhancement Ability of Efficient Evaluation of Knowledge-Based Management Strategies Corporate Ethics Training Programs Modeling Attributes in Demand Functions of Computerized Business Simulations: An Extension of Teach's Gravity Flow Algorithm Expert Systems Combined with Neutral Networks: Tools to Benefit the Marketing Researcher Computer Game Design: New Directions for Intercultural Simulation Game Designers Consistency in Simulation Performance over Time and Across Simulation Games The Impact of an Artificial Market Leader on Simulation Competitor's Strategies Business Plans, Case Studies, and Total Enterprise Simulations: A Natural Co-existence An Exploration into the Non-Use of Business Simulations The Market Game: Interactive Learning Through Market Simulation Plotting Brand Trajectories with the COMPLETE PPM package: A Market Segmentation Analysis and Positioning Tool Me and Mine Inc: An Exercise in Management Theory Learning to Differentiate Leadership from Managerial Position Business Ethics Survey: A Perspective from the Retail Industry Experiential Learning in Demand Analysis for an Agricultural Commodity Marketing on the Internet: A Pedagogical Exercise College Students Need Simple Computer Simulations, Especially for International Business Courses An Analysis of Student Attitudes, Performance, and Strategies in a Simulation Competition Based on a Controlled Product-Market-Entry Game Structure The Crystal Enterprise: Application of a Non-Computerized Simulation Model in a Process of Organizational Change Threshold: A Windows-Based Behaviorally Oriented Total Enterprise Simulation Coaching Business Game Teams Using a Decision Variable Optimizer Rock and Roll is here to Stay: Enhancing Experiential Pedagogy with Musical Exercises An Example of Business Process Analysis Simulation for Customer Software Support The Use of Business Gaming in Hong Kong Academic Institutions Using the Integrative International Simulation INTOPIA Mark 2000 in a Concentrated MBA Curriculum A Group Experience as an Integrated Part of the Core Management Course Empowered Learning in the Classroom The Inter-Group Interaction: An Innovative Approach to Cooperative Learning Courses that Utilize Student Team: An Approach to enhancing their Effectiveness Thoughts about the Measurement of Learning: The Case for Guided Learning and Associated Measurement Issues Measuring Student Learning Using Business Simulations: A Theory Based Perspective On the Use of PC Fingame in an Undergraduate Finance Course How Managers get Things Done: A Virtual Soundbite Internet Experiential learning in the Principals of Marketing Classroom: A Pedagogical Approach Current Student Perceptions Relative to Business Simulations Beyond Capitalism: Designing Business Policy and Social Justice The Use of Boards of Directors to Evaluate Reports and Presentations in an Undergraduate Business Policy Course Beacon Lumber: An Experiential Introduction to Financial Accounting The Application of Organizational Motivation Principles: The Experiential Business Simulation Motus Manufacturing Avoiding a Bogey: Grading Case Discussions Scientifically Communicating Consumer Behavior II: A Modified Exercise Using Personal Consumption Journals in Condensed Courses Designing Instruments for Assessing the Effectiveness of Simulations, (Seminar) 360º Performance Feedback: Appraisal vs. Assessment The Cafeteria Approach to Managing an Academic Career: Remaining Non-Perishable while Doing Your Own Thing An Experiential Exercise Related to Person-Organization Fit and it's Consequences For Today's Dynamic and Changing World, Business Simulations need to be expanded to encompass Much Greater Complexity: A Demonstration The Incident Process: A Case in Reverse Contextually-Anchored Business Simulations The Energy Factor: Building Motivation in the Simulation Gaming Environment The Design of an Internet Game