Innovations in clinical training for cultural competence

High-fidelity patient simulation is a teaching/evaluation strategy used to facilitate the application of knowledge, psychomotor/communication skills, and critical thinking without endangering real patients. Healthcare professionals live and work in an increasingly diverse world. So, why do the creators of simulation scenarios often ignore key factors that impact the communication and interactions critical to our patients such as culture, socioeconomics, literacy, gender, and personality. Why are the majority of manikins white males - and left that way?

It is easily within our grasp to use simulation to accommodate diversity and provide the best care/best experience for our communities. Purnell’s 2003 Model for Cultural Competence and Betancourt's (2003) conceptual approach to cultural awareness, sensitivity, and competency provide the frameworks for the cultural “overlays” that have enriched our scenarios, stimulated discussion of the potential impact of culture on effectiveness of communication and therapies, and provided a means to enhance skills needed for culturally competent practice. The overlays may be the primary focus of the scenario (learning about health-care practices/risk factors of a particular culture i.e. a Latino woman experiencing post-partum bleeding) or secondary (a particular patient condition  i.e. a woman with post-partum hemorrhage “happens” to be Latino).

Cultural, legal, and ethical overlays for high-fidelity simulation scenarios have been successfully applied to a wide variety of courses such as ACLS, Code Team, Rapid Response Teams, orientation (critical/progressive care, new grad, emergency care, medical air transport, labor and delivery), and skills days for both inpatient and ambulatory care staff. Key components of using cultural overlays include: 1) have clear objectives; 2) progress from simple to complex; 3) set the stage with clothing, make-up, wigs, props, and spoken language; 4) be respectful of all cultures, and 5) recognize that some health care providers avoid self-reflection and that knowledge doesn’t always result in action. Practical suggestions for creating cultural overlays for simulation scenarios, samples of scenarios, ideas for tools/props, and favorite resources will be readily shared during this session.