Cultural Competence: National Hispanic Medical Association
Congressional Briefing
Elena Rios, MD, MSPH
President & CEO
July 14, 2005
NHMA Established: 1994
Mission: to improve the health of Hispanics and other underserved.
Major activities: Advocacy, National Conference, Leadership Fellowship for physicians, CC
project
National Hispanic Health Foundation for policy research ( affiliated with Wagner Graduate
School of Public Service, NYU)
36,000 Hispanic physicians; now working with 12 medical societies across the nation
Dr. Rios works at OWH
First
Project: Linking Women’s Health Curriculum Development to Minority Women –
became the Cultural Competence Conference of 1995
Met with AAMC – not interested (did their own meeting the following spring)
Met with Faculty for ideas – Women faculty enthusiastic, few minority faculty was the issue
Met with the OMH – very interested, became co-sponsor
Planning Committee – curriculum change focus
Curriculum Collection, Faculty network, linkages create new synergy
DHHS Networking with Academia
Response Panel:
Accreditation Bodies (AMA rep for ACGME)
Licensing Bodies
USMLE – the national board exam for doctors
Medical Schools and Residency Programs
Federal Govt – Acting ASH, Dr. Jo Ivey Boufford presents on Federal Leadership
Outcomes of the Meeting
Review of the LCME - 1996
Review of the USMLE – 1998
Journal Article
Minority Women’s Health Conference
MWH Panel of Experts
OWH supports the first Quality for Diverse Populations Conference
Provides a session at the Conference and at the APHA conference of 1998
NHMA & Cultural Competence
Library collection – 1999
NHMA Leadership Fellowship Policy Projects
NHMA Annual Conferences Sessions
Curriculum collection, faculty resource list
Panel of Experts in 2000 - HCOEs
Paper – History, Stress, Diet, Language
Resident Curriculum in NYC 2001-2005
Advocacy
Regional Approach of Change
Purpose: to expand teaching & research for GME in the community
Case Studies
Focus Group with Community Leaders
Focus Group with Faculty
Focus Group with Medical Residents
Meetings with the power structure in NYC
Leadership Issues
State develops program to increase funding of cultural competence training to hospitals, not
residency programs
Hospitals must offer plan, then implementation to train 80% residents to gain funds
Impact evaluation not a focus
Meetings with legislators, Chair Health Com.
Faculty and residents generally unaware
CME State Legislation
New Jersey – passed legislation
Cultural Competence CME course mandate for physician licensure
California – legislation in committee
Cultural Competence to be integrated in all CME Courses for physician licensure
NHMA - Evaluation of Cultural Competence Meeting, 2004
Joint Commission on the Accreditation of Hospitals
Hospitals, Language and Culture Project survey of 60 hospitals how they address culture and
collection of data on best CLAS standards
Patient Safety link for cultural competence
Liaison Committee on Medical Education
2000 – adopted 2 standards:
The faculty and students must demonstrate an understanding of the manner in which people of
diverse cultures and belief systems preceive health and illness and respond to various symptoms,
disease, and treatments.
Medical students must learn to recognize and appropriately address gender and cultural biases
in themselves and others, and in the process of health care delivery.
AAMC
Curriculum Management Information Database (CurrMIT) – database of curriculum
Graduate Education Questionnaire – 2004 survey found 80-90% cultural competence
curriculum was inadequate
AAMC
Tool for the Assessment of Cultural Competence Training (TACCT)
Cultural competence context, definition
Key aspects – epidemiology, pt-centered care, institutional culture, cultural history of pt.
Understanding steretyping
Health disparities
Cultural clinical skills
USMLE
Recently the exam places emphasis on the population that the patient originates from for the
student to determine its implication in terms of basic/clinical science, interpersonal skills and
communication skills.
Testing can be changed to patient centered suggesting that cultural competence can be put into
the exam
ECFMG
Certifies more Hispanic physicians than the U.S. system trains (1000 physicians)
NCQA
Assessment programs: Managed care motivation program; doctors in diabetes and heart and
stroke care
Recognition program for physician office systems
Standards – cultural – quality care, diversity of Medicaid program members by race, ethnicity,
language
Research on CLAS and managed care orgs
National Quality Forum
Developed a report based on a Study Group on need for race/ethnicity data in health plans for
health disparities.
No cultural competence focus in quality improvement work.
National Hispanic Health Leadership Summit
NHMA and Congressional Hispanic Caucus
US DHHS, RWJ Foundation
California Endowment
PhRMA, Amgen, Aventis
NCLR, National Puerto Rican Coalition, MALDEF, Aspira, other partners
175 experts nominated, working meeting
www.nhmamd.org
Hispanic Leadership Summit & Cultural Competence
Promote the HHS OMH CLAS standards
Mandate and reimburse cultural competency services as well as language access services
Develop measures for performance, outcome evaluation
Develop a database of experts and model programs
Support research on cultural competence and health knowledge development about Hispanics
Mandate
cultural competence training and CME in health professions education
Policy Recommendations
1. Faculty Development Grants – Title VII
Develop a lecture series
Makes series available on the website
Training modules for residency programs
Community networks, speakers, training
Expand Faculty Development to more than fellowships; in-service training for all faculty
development
Policy Recommendations
2. Quality Demonstrations in Medicare MMA
-Expand to quality care training with cultural competence standards and models of training from
OWH, HRSA, OMH – to providers
-Policy Issue: link training for physicians to quality of care delivery and patient safety
3. Office On Women’s Health Training
-Expand the WH Centers of Excellence; work with State offices and Regional offices,
and International Leaders on women’s health quality measures and cultural competence
Federal Programs need to focus on cultural competence
REACH 2010, CDC
Community Clinics and HCAP, HRSA
HIV AIDS programs, HRSA
Research Grants, NIH, AHRQ, CDC
Health Provider Training – OWH, OMH, HRSA
Medicare, Medicaid, SCHIP policy - CMS
US-Mexico Binational Health Insurance – NEW
Women’s Health Leadership Training – OWH
Offices on Minority Health & Health Disparities