Registrar pre teaching session worksheet
>click here for printable version<Please note: The structure of this module is slightly different to the other modules in this teaching series. This is because it was deemed that this structure was most the most appropriate way in which to learn this content.
This module deals with cultural awareness as it relates to general practice in your community. The focus is on local cultural contexts, how and why they exist, and how you might understand them and modify your practice to accommodate them.
The module does not address issues to do with Indigenous Cultural Awareness as this is dealt with specifically in the Registrar’s Block Release. A session on Refugee Health is included in the Block Release program and it would be useful to ask your Registrar if they have attended that session and discuss any issues.
This module is divided into three sections. Registrars and their supervisors can decide to do one or more sections of the module. The Registrar can undertake the learning activity then report back to the supervisor to discuss their response to each section.
It is important for the supervisor to read through the activities and give them some consideration prior to the teaching session.
Part A. Understanding culture
Key questions
- What is culture? What is a cultural group?
- What cultural group do you hail from?
- What is racism?
These key questions aim to increase Registrars’ and supervisors’ understanding of what culture is and why we try to understand culture.
Activity
We all have a set of beliefs, values and ways of living that are acquired over a lifetime of experiences. The term culture refers to a set of such beliefs, values, ways of living and communicating that is shared by groups of people. Concepts of health and illness (and subsequently whether people present, if they do then when and how people present, what they expect of health professionals, how they communicate, etc) are culturally determined. It is important that GPs are aware of the cultural differences that they might encounter with their patients. In order to identify the cultural differences it is important to be aware of your own culture and how it affects the way you work with your patients.
Reflect and write down your thoughts on the following regarding patients from your culture:
- Why do patients come to see their GP with a new problem? How do they identify that something is “wrong”?
- Why do patients present to see you on their own generally?
- What is so sacrosanct about patient confidentiality?
- What do you understand is the relationship between mental health and physical health? Is there a distinction? Why? Why not?
- If you give patients things to do as follow up, do they do them? Do they get their scripts filled? If they do get them filled, do they take the medications? Do they watch their diets? Do they exercise? Why? Why not?
- If they don’t do them then do they still turn up for the next appointment? Why? Why not?
There are many assumptions we make about the way our patients conduct themselves and the way we behave professionally. They do not always make sense but we accept them as given.
Recognising differences in how some cultures function does not imply that you discriminate against them; on the contrary the aim of understanding other cultures we encounter in our practice is to accommodate them in order to improve the care we provide.
According to the International Convention on the Elimination of All Forms of Racial Discrimination, the term "racial discrimination" means any distinction, exclusion, restriction or preference based on race, colour, descent, or national or ethnic origin which has the purpose or effect of nullifying or impairing the recognition, enjoyment or exercise, on an equal footing, of human rights and fundamental freedoms in the political, economic, social, cultural or any other field of public life.
Unpacking the features of some cultures as they relate to their health related behaviour allows us to work in a way that improves their access to and outcomes from, health services.
Bring your notes and reflections back to your supervisor for the next in-practice teaching session.
Part B. Cultures within your Practice
The patients seen within your practice will represent the different cultural and ethnic groups/profiles relevant to your practice. Different cultural and ethnic groups present a distinct set of beliefs, values and norms which have an impact in the primary care setting.
Activity
Reflect and write down your thoughts on the following:
How is a person’s culture different to their ethnicity?
What sort of cultures do you see in your patients in this practice? What sorts of ethnic groups are represented? What sort of overlap is there between different ethnic groups and different cultures?
Take one of the cultural groups that is different from yours, and identify what might be different about people from that group in terms of:
- Types of health problems they present with
- How they present them to you
- What they expect you to do
- How they expect you to behave as a doctor
- Their expectations of the health system
- Their understandings about their health and illness
What understandings do they have about mental health problems? How do they present?
What differences are there in non-verbal communication styles that people from this group use?
Are there gender differences?
Are there traditional/cultural healing practices that this group engages in?
What sorts of gender issues are there within this cultural group?
Are there doctor-patient gender issues with this cultural group? What are they? How can they be addressed?
What sorts of interpreter services are available in this practice? What are some of the issues with using interpreters?
Readings
You might be interested in a range of readings that are available via this link. http://www.racgp.org.au/cald
Bring your notes and reflections back to your Supervisor for the next in-practice teaching session.
Part C. The migration experience
Australia has experienced waves of people migrating here to live from various parts of the world. Apart from Indigenous Australians (who have been here 50,000 years and can probably claim to be non-migrants) we are all migrants or descendants of migrants. For the past 200 years there have been waves of migrants from northern and southern Europe, Asia, Oceania, South America, the Middle East and Africa. The conditions under which people leave their homelands impact on how they experience settling in to a new country: whether or not they have been involved in war or other traumatic experiences in their own country; how many of their family members they have left behind and whether or not they are safe; what the experience of migration has been like for them.
If there have been recent migration experiences, how might these impact on the patient’s physical and mental health?
Activity
This activity requires some research and reflection.
Find out which patients from diverse cultural backgrounds use your practice and choose one group who has recently migrated to Australia. If you have seen a patient from this background, you may want to focus your thinking around this patient. Or you could ask your Supervisor if there is a patient that he or she is aware of who could be used for a case discussion.
What political or societal circumstances have led people to leave their original country?
What are some of the ways that these circumstances continue to affect immigrants?
Why might this be relevant to you as their doctor?
Although these circumstances may be relevant to their health issues, it is sometimes very hard for patients to talk about their experiences. There are some crucial considerations to how you might bring up discussion of trauma. What do you think they might be?
What resources are there in your area for patients who have been tortured or traumatized?
What are some of the other services/resources that are available for recent migrants/refugees?
The following may be useful sources of background information.
Links
Multicultural Mental Health Australia
www.mmha.org.au
STTARS supporting survivors of torture and trauma
http://www.sttars.org.au/