Quality Enhancement Plan for Georgia Health Sciences University

Quality Enhancement Plan for Q f G Georgia a Health h Scien nces Un niversitty Prepared by P y the Quality Enhanc cement Pla an Committtees fo or Reaffirm mation by SACSCOC S M March 29-31, 2011

Healthy Perspectives: Better Health Care through Better Understanding Georgia Health Sciences University

President: Ricardo Azziz, MD, MPH, MBA SACS Liaison: Roman M. Cibirka, DDS, MS QEP Director: Shelley C. Mishoe, PhD SACS Commissioner: G. Jack Allen, PhD

Table of Contents I. II.

III. IV.

V.

VI.

VII.

VIII. IX.

X.

Executive Summary Process to Develop the Quality Enhancement Plan Table 1: Executive Committee Table 2: Development Committee Table 3: Summary of Stakeholder Involvement Institutional Mission and Strategic Themes Development Committee and Work Groups Identification of the Topic Desired Student Learning Outcomes Figure 1: Healthy Perspectives Roadmap Faculty Survey Patient Advisor Focus Groups Selection of Student Learning Outcomes Literature Review and Best Practices Cultural Competence – Rationale for its Importance Cultural Competence – Definitions Technology-infused Learning Environment – Rationale Interprofessional Education – Rationale for Interprofessional Competence Implementation Enterprise Reintegration Patient- and Family-Centered Care Culturally and Linguistically Appropriate Services (CLAS) Joint Commission Standards – Patient-Centered Communication Enhancing Students’ Cultural Competency Integration into Existing Curricula across Disciplines Figure 2: Education Model for Cultural Competency Figure 3: Educational Delivery Model Figure 4: Student Progression Flowchart Healthy Perspectives Content Outlines Tables 4.1-4.6: Healthy Perspectives Content Outlines Professional Development of Faculty and Staff Timeline Table 5: Five-Year Implementation and Assessment Chart Incorporating Cultural Competency into GHSU Curricula Table 6: Incorporating Cultural Competency into the Curricula Organizational Structure Figure 5: QEP Organizational Structure and Position Descriptions Resources: Budget and Space Table 7: Budget and Space Allocations (FY 2012-2016) Table 8: Preliminary Space Requirements Development of the Assessment Plan for the QEP

Page 1 2 2 3 5 7 8 8 9 10 10 10 11 12 12 13 14 15 16 16 17 18 18 18 19 20 21 22 23 23 31 31 32 37 38 43 44 45 48 49 49

Table of Contents

XI. XII.

Rubrics for Assessing Cultural Competence Tables 9.1-9.6: Assessment Rubrics Assessment Instruments Selection of Pre- and Post-test Assessment Instruments Table 10: Summary of Cultural Competence Surveys References Appendices A. Gantt Chart for QEP Development B. QEP Communications/Marketing Plan C. Quality Enhancement Plan Survey for the QEP Topic D. Formal Request for Quality Enhancement Plan Project Proposals E. Theories and Positionality of Learning F. Rubric for Project Proposal Evaluations G. Survey of Faculty on Core Competencies

Page 50 50 60 60 61 62 66 67 72 76 81 86 87 89

Abbreviations Used in This Document

Abbreviation AACN AAMC

ACGME

ARC-PA

ACOTE

AHRQ

AMSA APTA CAI CLAS

CODA EAC ESP GHSU HPS ISED

Definition American Association of Colleges of Nursing The Association of American Medical Colleges The Accreditation Council on Graduate Medical Education Accreditation Review Commission on Education for the Physician Assistant Accreditation Council of Occupational Therapy Education Agency for Healthcare Research and Quality

Abbreviation IT

Definition Information Technology

LCME

Liaison Committee on Medical Education

MCG

Medical College of Georgia

MCGHI

MCG Health, Inc.

MCGHS

MCG Health System, Inc.

NLNAC

American Medical Student Association American Physical Therapy Association Computer Aided Instruction Culturally and Linguistically Appropriate Services Commission on Dental Accreditation Employee Advisory Council Enterprise-Wide Strategic Planning Georgia Health Sciences University Human Patient Simulation Instructional Support and Educational Design

PFCC (CPFCC)

National League for Nursing Accreditation Commission (Center for) Patient- and Family-Centered Care Physicians Practice Group

PPG QEP

SOD

Quality Enhancement Plan Southern Association of Colleges and SchoolsCommission on Colleges School of Allied Health Sciences School of Dentistry

SOM

School of Medicine

SON

School of Nursing

UGA

University of Georgia

VP

Virtual Patients

SACSCOC

SAHS

Georgia Health Sciences University I.

Executive Summary

The goals of the Quality Enhancement Plan (QEP) for the Georgia Health Sciences University (GHSU) are to provide students, faculty, and staff with the knowledge, attitudes, and skills necessary to develop as culturally competent health professionals. As a result, GHSU will graduate culturally competent health care professionals who will be better prepared to provide patient- and family-centered, culturally appropriate care to diverse populations.

An Institute of Medicine Report (2002) noted that sources of health disparities “include failures in the health care system, cultural and linguistic barriers, and a subtle mix of bias and prejudice during the clinical encounter.” The conceptual model for Georgia Health Sciences University’s QEP – titled Healthy Perspectives: Better health care through better understanding – is based on two assumptions: that cultural competence is broadly defined and that health care professionals are neither culturally nor ethnically neutral. The QEP evolved through a recursive process of analysis, investigation, research, communication, and collaboration involving a comprehensive representation of the academic institution. The main findings of three Advisory Work Groups, which helped to lay the foundation for the QEP, were that our institution must (1) educate the next generation of health care professionals to understand the global context in which health problems occur and (2) acknowledge and value the cultural influences that impact the choices and perspectives of the populations we serve. Selection of the QEP topic was accomplished through broad campus involvement over several months using forums, surveys, and proposals submitted by faculty and staff. Once the topic of cultural competency was selected, a broad-based iterative process was used to develop the project. The QEP Development Committee was charged to develop the QEP Project to enhance student learning of cultural competency by incorporating advanced technology.

The Georgia Health Sciences University QEP is designed to infuse cultural competence education throughout the educational continuum, beginning with online modules, followed by practice in simulated environments, and culminating with practice in real clinical settings.

Analysis of accreditation standards from health care accreditation organizations yielded 34 cultural competency outcomes in the domains of attitude, knowledge, and skills. These outcomes were prioritized by faculty and patient advisors to identify the six student learning outcomes for the QEP. Content outlines are being used to develop the online modules, Avatars, and clinical experiences which will enhance the attitudes, knowledge, and skills of our students and prepare them to be culturally competent health professionals.

A QEP assessment workgroup, which included a biostatistician, an assessment expert, and cultural competency experts, used Curran’s Guide for Rubric Development to define the cultural competencies for each of the six learning outcomes. The assessment plan includes a pre-test to assess students’ baseline level of cultural competence and proceed with cultural competency interventions and assessments as they are phased into the curricula. The assessment tool selected is The Cultural Competence Education Resource Toolkit (CCERT), consisting of three different instruments for academic settings, health care institutions, and professional associations. The QEP assessments include the CCERT for health care institutions, the assessment rubrics, learning activity evaluations, faculty instructional observations, professional development surveys, and Healthy Perspectives satisfaction surveys. The QEP framework, outcomes and assessment strategies are comprehensively aligned to support a continuous improvement approach to evaluating QEP effectiveness and making any needed adjustments.

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Georgia Health Sciences University II.

Process to Develop the Quality Enhancement Plan

The Georgia Health Sciences University (GHSU),1 the only public academic health center in the state of Georgia, first opened its doors to a handful of medical students in 1828, and now educates students in the fields of allied health sciences, biomedical sciences, dentistry, medicine, and nursing. Just as the institution has evolved from a medical college to a university, the GHSU Quality Enhancement Plan (QEP) has evolved through a recursive process of analysis, investigation, research, communication, and collaboration involving a broad representation of the academic institution.

The Provost designated associate provost, Dr. Shelley Mishoe, a professor of Graduate Studies and Respiratory Therapy, as the Director of the Quality Enhancement Plan. Among Dr. Mishoe’s areas of expertise are patient- and family-centered care and the use of outcomes to improve student learning. She, in turn, established an executive committee and then a development committee of a broad and diverse membership of faculty, staff, and students to formally begin the process in July 2009. Membership in these committees is shown in Tables 1 and 2.

Table 1: QEP Executive Committee Name Shelley Mishoe, Chair

Department Office of the Provost

Andria Thomas, Vice Chair Beth Brigdon

Medical College of Georgia Finance/ITSS

Roman Cibirka

Academic Affairs and Enrollment Management

Barbara Kiernan Dawnyetta Marable

College of Nursing President of Student Government Association Medical College of Georgia President, Employee Advisory Council Past President, Employee Advisory Council Assessment and Improvement College of Allied Health Sciences

Rachel Mathis Dayna Seymore Lisa Wheatley Mickey Williford Pam Witter

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Title/Role Associate Provost and Director of the QEP Associate Dean Vice President/CIO, Associate Provost Vice President and Associate Provost, Chair of COC Steering Committee Department Chair Student, College of Dental Medicine Student Assistant Grant Development Specialist Licensed Practical Nurse Director Strategic Planning

On February 1, 2011, the university changed its name to Georgia Health Sciences University, and the name Medical College of Georgia was returned to the college that awards degrees in medicine (formally, the School of Medicine). These changes have been applied to this document. However, some appendices that provide historical evidence may retain former naming conventions. For additional guidance on the new naming, please refer to the University Overview or contact the university for clarification.

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Georgia Health Sciences University Table 2: QEP Development Committee Name Shelley Mishoe, Chair Lisa Daitch* Kathy Davies Cheryl Dickson

Ranita Donald* Ruth Marie Fincher Kent Guion Kimberly Halbur Philip Hanes Stephen Hsu Cheedy Jaja David Scott Lind* Stephen Looney Lori Schumacher Lourdes Cabrera Michael Cormican Jessica De Jarnette Reed Halterman Sandra Inglett Jayne Kelly Christina Kozycki Himanshu Kumawat Lydia Luangruangrong Ben Popple Ronnie Zeidan Bernie Sikes Wood Hallie Stevenson Robin Wallace Sarah Wells

Department

Title/Role

College of Allied Health Sciences Greenblatt Library Medical College of Georgia (Athens)

Assistant Professor

Medical College of Georgia Medical College of Georgia College of Allied Health Sciences/Graduate Studies Medical College of Georgia College of Dental Medicine/Graduate Studies College of Dental Medicine/Graduate Studies College of Nursing Medical College of Georgia College of Dental Medicine/ Graduate Studies College of Nursing/Graduate Studies College of Nursing (Puerto Rico Campus) Medical College of Georgia Medical College of Georgia College of Nursing College of Nursing College of Dental Medicine Medical College of Georgia College of Allied Health Sciences Medical College of Georgia College of Dental Medicine Medical College of Georgia Medical College of Georgia College of Allied Health Sciences College of Allied Health Sciences College of Nursing (Athens)

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Librarian Associate Professor Campus Associate Dean of Student and Multi-Cultural Affairs Assistant Professor Vice Dean for Academic Affairs Interim Dean and QEP Implementation as of 2/1/11 Associate Dean for Diversity Affairs Assistant Dean for Academic Affairs Associate Professor Assistant Professor Section Chief Surgery/Oncology Professor Assistant Professor Student, Class of 2011 Student, Class of 2011 Student, Class of 2012 Student, Class of 2011 Student, Class of 2011 Student, Class of 2012 Student, Class of 2011 Student, Class of 2011 Student, Class of 2012 Student, Class of 2013 Student, Class of 2013 Student, Class of 2013 Student, Class of 2011 Student, Class of 2011 Student, Class of 2013

Georgia Health Sciences University Name Michael Casdorph* John Cooper Christine Deriso Nadine Odo* Christine O’Meara Mary Anne Park

Department Information Technology and Support Services Strategic Support Strategic Support Medical College of Georgia Center for Patient- and Family-Centered Care Medical College of Georgia

Brenda Rosson* Pam Witter

Title/Role Director of Instructional Support and Educational Design Coordinator for Academic Assessment Editorial Manager Public Information Specialist Program Development Coordinator Director of Surgical Research Services Nurse Clinician Strategic Planning Advisor

Medical College of Georgia College of Allied Health Sciences * These individuals were involved in the submission of QEP proposals that were ultimately chosen for consideration in the selection of the topic.

The Chair and Executive Committee reviewed their charge and developed a strategy with key components and milestones to be accomplished. The Executive Committee served as the overall approval body for recommendations from the QEP development committee. The Executive Committee developed an aggressive timeline to ensure the project’s completion (Appendix A, Gantt chart). The Committee had three initial goals: 1) Achieve broad-based participation from all constituent groups of the institution; 2) Identify a topic befitting the institutional mission to address a key issue that had emerged from review of institutional data and assessment activities; and 3) Focus on enhancing student learning outcomes.

The QEP Executive Committee began meeting with the campus community—the colleges, Employee Advisory Council, Faculty Senate, Student Government Association, invited forums and various committees—to explain the importance of the QEP in the institution’s reaffirmation of accreditation, describe the unique and exciting opportunity for educational innovation, and invite participation. The QEP Executive Committee continued to meet in person once per month for 60-90 minutes throughout the development of the project. Committee meeting agendas and minutes were sent in advance of each meeting, as well as materials for discussion.

Dr. Marilyn Greer, Director of the Office of Institutional Research at The University of Texas M. D. Anderson Cancer Center provided consultative services to the Assessment Workgroup to help cover a gap created when the coordinator for academic assessment resigned and departed the institution in the summer of 2010. Dr. Greer participated in the Assessment Workgroup Meetings and assisted the work group with the development of assessment rubrics, selection of cultural competency instruments and identification of the components of the assessment plan.

Program Directors, course directors and faculty from each college developed rubrics that will be used to evaluate the success of integrating cultural competence into the education of professional students (see QEP Rubrics, Tables 9.1 – 9.6).

Throughout the process, stakeholders participated in defining cultural competence as it relates to the strategic plan of GHSU’s patient- and family-centered approach toward health professions education as summarized in Table 3. The campus survey to faculty, staff, and students in the fall of 2009 began the initiative for selection of the topic. The faculty survey conducted online by

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Georgia Health Sciences University the Development Committee in the summer of 2010 helped to determine the six cultural competency priorities. The next area of involvement utilized patient advisor focus groups. After development of the rubrics, faculty and students were given the opportunity to review the rubrics and the associated scoring prior to finalizing the rubrics and beginning the design of the online modules (Section 1), the simulations or Avatars (Section 2), and the clinical experiences (Section 3). Faculty, students and staff were involved throughout the process by committees, workgroups and additional activities summarized in Table 3.

Table 3: Summary of Additional Stakeholder Involvement Project Survey of Faculty, Staff and Students on QEP Topic Selection Purpose: Assess the perceptions of the campus as to what is needed to enhance student learning Student and Faculty Campus Forums Purpose: Involve faculty, staff, and students in evaluation of rubrics that will be used to evaluate student cultural competency Request for Project Proposals Purpose: Obtain proposals that identify and provide basic justification for the selection of a project for the five-year GHSU QEP Survey of Faculty on Core Cultural Competencies Purpose: Assess top five cultural competency priorities in areas of attitude, knowledge, and skills Patient Advisor Focus Groups Purpose: Obtain patient/family-centered perspective to provide advice about cultural competency (knowledge, skills & attitudes) that they consider critical for GHSU health professions students

Stakeholders Faculty

Count 334

Staff

477

Students Faculty

354 26

Students

14

Staff Faculty

47 20

Staff

7

Students Faculty

4 244/739

Patients/families

22

5

Timeline September 2009 – October 2009

December 2009

December 2009 – January 2010

June 2010 – July 2010

July 2010

Georgia Health Sciences University Project Presentation for the Employee Advisory Council Purpose: Inform the EAC about the QEP Meeting with the President’s Cabinet Purpose: Obtain feedback and update the campus leadership on the QEP Meetings with the Deans of each College Purpose: Obtain feedback and update leadership on the QEP

Stakeholders Staff

Count 20

Timeline August 25, 2010

Faculty/Staff

26

September 20, 2010 February 14, 2011

Faculty

5

August 12, 2010

Additional meetings with the Program Directors of each College Purpose: Obtain feedback and update leadership on the QEP

Faculty

22

Presentation for the Student Government Association Purpose: Inform the student leaders about the QEP Student and Faculty Focus Groups Purpose: Obtain feedback and suggestions on the rubrics created by the Assessment Workgroup for the QEP QEP Campus-wide Luncheon Purpose: Inform the campus about the QEP

Students

30-40

February 2, 2011 August 11, 2010 (Nursing and Allied Health Sciences) August 12, 2010 (Medicine) August 16, 2010 (Dentistry) October 26, 2010 (Dentistry) October 27, 2010 (Nursing) October 27, 2010 (Medicine) October 29, 2010 (Allied Health Sciences) September 13, 2010

Faculty

11

November 2010

Students

18

Faculty/Staff/ Students

350+

September 2010 November 4, 2010

6

December 9, 2010

Georgia Health Sciences University Project QEP Celebration for Committees and Workgroups

Stakeholders Faculty

Count TBD

Timeline February 25, 2011

Staff In Progress

In Progress

February-March, 2011

Faculty

TBD

March 16, 2011

Students

Campus Forums to Discuss the Implementation of the QEP Campus Cookout to Promote the QEP

Students Staff Institutional Mission and Strategic Themes The next step in the process was a review of the institution’s strategic themes to guide the development of the QEP. The Georgia Health Sciences University is committed to serving the people of Georgia, the nation, and the world by: • Preparing the health professional workforce of the future; • Conducting research through programs that create, disseminate, and apply new knowledge relevant to human health; • Providing exceptional, innovative, patient-centered health care services; • Contributing to the economic development and well being of the State of Georgia through integrated programs in education, research, and clinical care.

As a publicly supported academic health center, strategic themes that were of particular relevance in sharpening the focus of the QEP were identified: • Expanding the capacity and reach of our educational assets; • Educating a workforce committed to improving health in an increasingly diverse state and nation; • Delivering a highly integrated, technology-infused curriculum that reflects and responds to our students’ evolving learning styles; • Conducting research in areas of greatest impact on the people we serve and translate that research into improved population health and community benefits; • Improving the quality and availability of clinical services.

The findings of three Advisory Work Groups (2008-2009) also helped to lay the foundation for the QEP. The Work Groups were charged with identifying best practices and community perspectives; conducting a gap analysis; providing findings and recommendations; and developing recommended plans of action on topics selected by the President and Cabinet (diversity, global health, and technology-infused curriculum). The Work Groups reviewed the literature, performed comparative analyses of peer institutions, examined existing GHSU documents, and sought additional insights into past and present GHSU global health initiatives through preliminary quantitative and qualitative research. The main findings of the Work Groups were that, as the state’s health sciences university, our institution must (1) educate the next generation of health care professionals to understand the global context in which health problems occur and (2) acknowledge and value the cultural influences that impact the choices and perspectives of the populations we serve (MCG Work Group on Global Health 2009).

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Georgia Health Sciences University Selection of the QEP topic of cultural competency as accomplished through broad campus involvement over several months using forums, surveys, requests for proposals, proposal reviews, selection of the top three proposals, and discussion of these proposals. The details of this important process are elaborated further in the next section. The QEP Development Committee was established in August 2009 and charged by the Provost to use a broad-based iterative process to develop the QEP Project to enhance student learning of cultural competency, incorporating advanced technology.

Development Committee and Work Groups The Development Committee developed the QEP with dedicated participation from across the entire campus. Individuals with knowledge and expertise in diversity, cultural competency, assessment, patient- and family-centered care as well as authors of the three final proposals accepted invitations to participate in the QEP Development Committee. To enhance the committee’s ability to develop and execute cultural competency educational modules in an interprofessional manner, a deliberate attempt was made to ensure diversity within the committee. Faculty, staff, and students were recruited from the colleges of allied health sciences, dentistry, medicine, nursing, the GHSU/UGA Medical Partnership (Athens), and the Puerto Rico and Athens campuses for nursing. The off-site committee members participated via telephone or video conferencing. The GHSU Center for Patient- and Family-Centered Care coordinator served on the committee to ensure that the patients’ perspective was brought into our discussions and to coordinate activities to obtain direct input from the family faculty and patient advisors. The committee used the timeline for development of the QEP, as shown in Appendix A, to keep the project on track.

Development Committee members worked in subgroups to address various aspects of the plan, including project tools, strategies, design and implementation. Additional workgroups were created that included membership from the development committee as well as from across the campus to address marketing and communications, assessment, professional development, and resources/budgeting. The marketing and communications plan is included in Appendix B. The QEP development committee worked on the educational components of the QEP, beginning with the operational definitions and criteria for student involvement, and continuing with student learning outcomes, educational delivery models, descriptions of actions to be implemented, and a timeline. Basecamp, a Web-based project-management tool that has to-do list, milestone management, file-sharing, time-tracking, and messaging-system capabilities was used for file sharing, communication, and collaboration. The QEP Development committee met every month, with committee members working in subgroups and reporting back at each meeting. Minutes were approved and published to Basecamp for every committee meeting, subgroup meeting, and workgroup meeting to enhance communications and consensus building among the various committees and workgroups. Throughout the process, the QEP director and committee members met with faculty, staff, and students through a variety of campus, school, and departmental venues to facilitate ongoing communications and document sharing. A Web site (www.georgiahealth.edu/sacs/qep) was established to reinforce information sharing and community participation in the QEP process.

III.

Identification of the Topic

During 2008-2009, the GHSU Work Groups laid the ground work for the QEP Executive Committee to further examine thematic areas of institutional need. These were diversity, global health, and technology-infused curriculum. The QEP Executive Committee surveyed the campus community (students, faculty, and staff) on what students should learn within each of

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Georgia Health Sciences University the thematic areas (Appendix C, Quality Enhancement Plan Survey for the QEP Topic). The survey participants were also asked to rank-order the thematic areas based on their relevancy to GHSU’s mission of educating tomorrow’s health care workforce. The committee received 1,165 survey responses, 334 from faculty, 354 from students, and 477 from staff. The QEP Executive Committee reviewed and analyzed the survey responses and determined that technology-infused curriculum and cultural competency were important to the campus community and should be considered further as QEP topics.

In December 2009, nine campus-wide open forums were hosted to engage the campus community in a discussion to further shape the QEP project. At each forum, participants were encouraged to view the QEP process as an opportunity for educational innovation and to suggest ways in which GHSU could enhance student learning to complement the institution’s mission. Enthusiasm grew as faculty, staff, and students contributed ideas for projects based on shared interests and interprofessional approaches. The QEP Executive Committee synthesized the feedback to create a formal request for proposals.

On December 22, 2009, a formal Request for Quality Enhancement Plan Project Proposals (Appendix D) was sent electronically to the campus community to solicit project proposals, and an incentive of $1,500 was offered for the top three proposals selected by the QEP Executive Committee. Criteria for further consideration and development were established. Six proposals were received and a Review Sub-Committee that included faculty, staff, and students not already involved in the QEP Executive Committee used a rubric to evaluate to what extent each proposal met the established criteria (Appendix F, Rubric for Project Proposal Evaluation). The subcommittee selected and ranked the six proposals for further assessment by the Executive Committee. After review and discussion, it was decided that three of the proposals were either too narrow or out of context. The remaining three proposals were submitted to the President for further consideration: • • •

A Multi-disciplinary Quality Enhancement Plan to Introduce Virtual Scenarios to Teach and Assess Cultural Competency and Spiritual Concerns in the Medical College of Georgia Health Profession Curricula Gaining Cultural Competence through Collaborative Patient Interactions with Students from Other Medical Institutions Using Distance Learning Technologies Innovations in Health Sciences Instructional Technology

The President, with input from the Deans, noted that all three proposals had merit and a combination of the three should be considered in the development of the QEP project on the topic of cultural competency.

A contest was launched to determine a title and tagline for the project. Suggestions were gathered from the GHSU Communications Department and QEP Development Committee. The QEP Executive and Development committees selected the top three choices, which were presented to the campus community for voting. By popular vote, the campus chose Healthy Perspectives: Better health care through better understanding.

IV.

Desired Student Learning Outcomes

A multi-pronged approach was taken to solicit GHSU community-wide input on student learning outcomes. A literature review yielded samples of cultural competency accreditation standards from health care organizations such as the American Physical Therapy Association, the Liaison Committee on Medical Education (LCME), and the American Association of Colleges of

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Georg gia Health Sciencces University Nursing. Thirty-four cultural competency outcomes o w were identifie ed in the th hree domain ns of attitude, knowledge, and skills. The resulting crosswa alk of cultura al competen ncies formed d the basis of a faculty su urvey and was incorpora ated into pa atient advisor focus grou up sessions. The quantitative and qua alitative data a from thesse sources was w triangulated by the e assessme ent to develop our o QEP roa admap and select s the student learning outcomes for the QE EP. Figure e 1: Healthy y Perspectiv ves Roadma ap

Faculty Survey S Strategicc Support’s Office O of Asssessment an nd Improvem ment develop ped an onlin ne faculty su urvey, entitled Survey of Faculty on Core Cultu ural Compe etencies, ad dministered through Su urvey Monkey from f June 29 to July 19, 2010 (Appe endix G). Respondents R s ranked theiir top five cu ultural competency priorities s in the area as of attitude e, knowledge, and skillss from highesst importancce (1) undred fortyy-four facultyy responded d, for a resp ponse rate of o 33 to least importance (5). Two hu percent.

Patient Advisor A Foc cus Groups s Our institution is com mmitted to the t inclusion n of patient advisors in all facets off the health care system, including po construction olicies and procedures, p n/renovationss, hiring pra actices, rese earch, education, and the QEP Q develop pment proce ess. Congru uent with ourr belief abou ut the importtance of input from f patientts and their families, we e conducted three two-h hour focus group sessio ons to gain the patient’s/fam mily’s perspe ective in ord der to inform the QEP prrocess. The interactive focus f group se essions reprresented collaboration between b the GHSU Cen nter for Patient- and Fa amilyCentered d Care (CPFCC) and d the MCG G Health, Inc. Deparrtment of Family F Serrvices Developm ment, and the t MCG Health, H Inc. Culturally and a Linguisstically Apprropriate Serrvices (CLAS) office. o We re ecruited volu unteer patien nt/family advvisors by tele ephone and email to ach hieve an ethniccally and culturally diversse sample.

The 22 participants (16 female es and 6 males), m ranging in age from 51-70 years, inclluded African-A American, Ca aucasian, an nd Native Am merican patient advisorss and a Latina staff mem mber.

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Georgia Health Sciences University All participants had at least a high school education and several had post-secondary degrees.

Four participants had been health professionals.

The groups were charged with providing advice and recommendations about the cultural competency knowledge, skills, and attitudes that they consider most important for GHSU students and faculty to demonstrate. Through large group discussions, small group work, information sharing, voting, and consensus building, patient advisors identified and prioritized cultural competencies needed to help prepare health professions students and faculty to interact optimally with a culturally diverse patient population. After reviewing the list of cultural competency skills compiled by the Development Committee from the various programmatic accreditation standards, the patient advisors identified their top five cultural competency educational priorities for each domain (attitudes, knowledge, and skills) using a combination of voting and discussion. Scores from the three focus groups were combined to yield the advisors’ top five priorities from the total list of options.

Selection of Student Learning Outcomes: Two cultural competencies were selected as student learning outcomes from each of the attitudes, knowledge, and skills domains, based on priorities identified by three sources, a faculty survey, patient and family advisors’ focus groups, and the crosswalk of accreditation standards. The faculty and patient responses indicated significant agreement. In addition, the student learning outcomes deemed most important by the faculty and patient advisors were also most often noted in the various professional accreditation documents. By triangulating the data sources, the Development Committee recommended the six core competencies upon which to base the student learning outcomes for the QEP. To garner broad support of these learning objectives, the QEP Director met with the deans, faculty, and students from each college to discuss the proposal and garner their endorsement.

The following student learning outcomes were proposed and adopted: Attitudes 1. Recognize the importance of understanding self and personal biases, assumptions, and their own cultural backgrounds and practices (AACN, 2008; AAMC, 2008; AMSA, 2007; APTA, 2008; LCME, 2010).

2. Appreciate the differences that exist within and across cultural groups and the need to avoid overgeneralization and negative stereotyping (ACOTE, 2010; APTA, 2008; NLNAC, 2008).

Knowledge 1. Demonstrate knowledge about varying cultural beliefs about health, disease, and treatment that influence health care practice (ACOTE, 2010; AACN, 2008; AAMC, 2008; AMSA, 2007; APTA, 2008; LCME, 2010).

2. Explain changing demographics in the United States and the presence of health disparities in health care and strategies to reduce disparities and improve quality of health care (APTA 2008; AMSA 2007; AACN, 2008; ACOTE, 2010, ARC-PA, 2010).

Skills 1. Demonstrate verbal and non-verbal communication in culturally competent practice that includes sensitivity to dimensions of diversity such as age, disability, gender, sexual

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Georgia Health Sciences University orientation, socioeconomic status, race, ethnicity/nationality, and religion (ACOTE 2010; APTA, 2008; CODA, 2010; LCME, 2010; NLNAC, 2008). a. This module will involve working with interpreter services and taking a cultural profile (APTA, 2008; AMSA, 2007; AAMC, 2005).

2. Collaborate with health care providers, patients, and families to achieve a mutually acceptable, culturally responsible plan for individual patients (ACOTE, 2010; APTA, 2008; AMSA, 2007; LCME, 2010).

Once the student learning outcomes were chosen, the committees and workgroups began working on the various components for the student learning modalities, assessment, and resources.

V.

Literature Review and Best Practices

The QEP Development committee built an educationally-sound QEP by establishing a framework grounded in best practices reported in the literature. The conceptual model for the QEP, Healthy Perspectives, is based on two assumptions: that cultural competency is broadly defined and that health care professionals are neither culturally nor ethnically neutral (Seeleman, 2009). Another basic tenet in developing Healthy Perspectives was that GHSU would incorporate innovative technology as part of the student learning experiences.

A librarian faculty member, who was also a member of the development and assessment committees, conducted systematic and extensive literature searches, posted articles on Basecamp, and located key resources to inform the committees and workgroups. Literature searches in MEDLINE, CINAHL, and Web of Knowledge were performed so that the committee could review and evaluate curriculum development concepts, cultural competency models, interprofessional educational programs, and assessment tools for each of the relevant health disciplines and the student learning outcomes.

Cultural Competence – Rationale for its Importance Historically, cultural competence focused on increasing health equity by reducing disparities between people of color and other disadvantaged populations and the majority population (Beach, 2006). Cultural competence is evolving to involve “an all-encompassing approach to address interpersonal and institutional sources of racial and ethnic disparities in health care with patient-centered health care delivery at its core” (Saha, 2008). Continued growth of minority populations in the US, and the persistence of health disparities, highlights the importance of the topic (Poirier, 2009). Medical institutions must ensure that their students reach a level of cultural competency in addition to mastering clinical skills in order to improve health care quality for all patients (Joint Commission, 2010). Understanding the linkage between cultural competency and health disparities puts this emphasis into context.

In 2002, an Institute of Medicine Report, Unequal Treatment, noted that sources of disparities “include failures in the health care system, cultural or linguistic barriers, and a subtle mix of bias and prejudice during the clinical encounter.” These biases and prejudices are compounded by a shortage of minority providers in all health care professions (Ciesielka, 2005). At the clinical level, the inability of a health care professional to understand and appreciate the cultural differences he or she may have with patients can lead to miscommunication and an unequal provision of medical procedures, a reduced likelihood of patients being offered appropriate diagnostic tests, patients’ poor adherence to medication and interventions, or a disproportionate

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Georgia Health Sciences University occurrence of medical errors, all resulting in disparities in care. Racial and ethnic disparities in health care outcomes persisted even after accounting for “insurance status, income, age, comorbid conditions, and symptom expression” (Betancourt, 2006). To address these disparities, a multi-faceted approach to increasing cultural competence in health care has been advocated and includes organizational (promoting minorities in health care service), systemic (language access services and community involvement to improve care), and clinical (training for health care providers) elements (Betancourt, 2002).

The Accreditation Council on Graduate Medical Education (ACGME) requires that physicians-intraining demonstrate sensitivity and responsiveness to a patient’s culture as part of its professionalism competency (Betancourt, 2005). Accrediting bodies for other health and social service professions, including dental education, nursing, physical therapy, occupational therapy, psychiatry, public health, and social work, have similar requirements. The Joint Commission recently released patient-centered communication standards, effective in 2011, that emphasize cultural competence and patient- and family-centered care applicable to all health professions, with a goal of improving the quality and safety of health care for all patients.

A systematic review of health care provider educational interventions addressing cultural competence revealed that most of the interventions improved attitudes, knowledge, and skills of health care providers; however, only three studies in the review actually evaluated patient outcomes (Beach, 2005). Assessing patient outcomes is beyond the scope of our Healthy Perspectives QEP, but it is important to help students to develop attitudes, knowledge, and skills that will enable them to be culturally competent health care providers. GHSU is committed to having our students, faculty and staff achieve the Joint Commission’s definition of cultural competence: “a set of congruent behaviors, knowledge, and attitudes that enables effective work in cross-cultural situations.” Accomplishing our goal includes valuing diversity, assessing ourselves, managing the dynamics of differences, acquiring and institutionalizing cultural knowledge, and adapting to diversity and cultural contexts of the individuals and communities we serve.

Cultural Competence – Definitions A framework for cultural competency education and skills acquisition for the health professions includes defining cultural competence to ensure that all stakeholders understand what the QEP is designed to accomplish and to ensure effective evaluation of student learning outcomes.

Several definitions of cultural competence are currently in use. The Joint Commission defines it as “the ability of health care providers and health care organizations to understand and respond effectively to the cultural and language needs brought by the patient to the health care encounter” (Joint Commission, 2010). The Association of American Medical Colleges (AAMC) cites a widely accepted definition of cultural and linguistic competence as “a set of congruent behaviors, knowledge, attitudes, and policies that come together in a system, organization, or among professionals that enables effective work in cross-cultural situations” (AAMC, 2005).

The committees decided that the operational definitions should be broad to serve as a guide for identifying specific student learning outcomes. The Development and Executive committees agreed to these operational definitions: • Cultural competence is the knowledge, attitudes, and skills that come together to integrate and apply knowledge of various cultures into health care.

• Culture refers to integrated patterns of human behavior that include the language, thoughts, actions, customs, beliefs, and institutions of racial, ethnic, gender, sexual orientation, social, or religious groups.

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Georgia Health Sciences University • • •

Competence implies being able to function effectively within the context of the cultural beliefs, practices, and needs presented by patients and their families and communities.

Interprofessional competence occurs when members of more than one health care profession work interactively together for the explicit purpose of improving professional collaboration and/or the health of patients/clients.

Interactive learning requires active learner participation and active exchange between learners from different professions (Cochran Collaboration #21).

Technology-infused Learning Environment – Rationale at GHSU Infusing technology into the curriculum is a GHSU priority because it addresses the needs of the current generation of learners, reinforces digital literacy (Rogers, Graham & Mayes, 2007), and creates robust and ubiquitous learning experiences. Technology can literally provide students with the power of learning in their palms. Incorporating technology in the curriculum further advances health care education and clinical practice since technology is a critical component of today’s health care systems. Technology can also bridge any generational divides that may exist between faculty and students. Senior faculty tend to be Baby Boomers while their students tend to belong to Generation Y (Twenge, 2009). Generation Y has been ascribed with such traits as being adept with state-of-the-art technology, having a preference for instructional informality, being more likely to embrace diversity, and possessing an ability to learn quickly (Shangraw, 2007). In addition to bridging generational differences, a technology-infused curriculum can effectively tailor course content to students’ learning styles.

Integrating technology into Healthy Perspectives is meant to enhance students’ learning outcomes while providing synchronous and asynchronous interprofessional and Web-based multi-media instruction designed to promote cultural competence. To determine the effectiveness of integrating technology with education, we will need to regularly assess whether student learning is enhanced. In their investigation of the effective use of educational technology in medical education, the AAMC‘s Institute for Improving Medical Education (2007) identified three types of educational technology: • Computer aided instruction (CAI), in which computers provide information and users can interact directly with the computer; • Virtual patients (VP); in which simulated clinical scenarios are designed to reflect realworld situations; • Human patient simulation (HPS), in which mannequins or models are employed to simulate patient care.

Other studies reinforce infusing technology into health professions education and training. A meta-analysis of 201 studies indicated that Internet-based learning is better than no intervention and, more importantly, is as good as traditional learning methods (Cook, 2008). Similarly, a randomized controlled trial showed that both technology-based and standard classroom-based teaching led to an improvement in evidence-based management knowledge (Hadley, 2010).

A GHSU on-line campus-wide survey was conducted in 2009 to ascertain faculty, student, and staff perceptions of technology in health professions education. Respondents’ opinions on the use of educational technology ran the gamut from strong support to qualified support to nonsupport. Respondents cited many advantages. For example, a technology infused curriculum should have the following features • Offers a flexible format; • Easily fits into distance education programs;

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Georgia Health Sciences University • • • • • •

Prepares students to be life-long learners; Makes available a variety of teaching methods to enhance student teaching, learning, and assessment (e.g., virtual and simulated patients, computer-assisted learning); Increases opportunities to access the expertise of health care professionals from around the globe; Increases opportunities to share GHSU’s own resources and expertise throughout the world; Puts GHSU on the cutting-edge of medical training and enables our graduating students to compete for the top health care positions; and Enables our institution to be more competitive in student and faculty recruitment.

Respondents also recognized the need for professional development when fusing education and technology as illustrated by this comment: “We must also ensure that both faculty and staff are properly trained to identify, implement, and support such technology.”

Concerns centered on maintaining a balance between technology and the personal, interactive component of traditional teaching and learning. One student asked, “How about focusing on a ‘technology-defused’ curriculum to emphasize physical exam skills, patient interviewing and patient-doctor relationship skills, etc.?” Other concerns included time commitment required for project implementation, Ability of the institution’s infrastructure to support the technology-based project, and budget limitations.

Because of the time involved in developing a technology-infused curriculum, it was suggested that release time from teaching be given to faculty to develop it. Further, the importance of measuring student learning outcomes as well as the long-term impact of a technology-infused curriculum was reiterated. It should be noted that GHSU’s Information Technology department has worked closely with the colleges within the health sciences university and is an integral component of the QEP. In addition, GHSU students already learn clinical skills through virtual patients, scenarios using high-fidelity mannequins, standardized patients, and actual encounters with patients. Student feedback is conducted online via One45 and the use of other Web-based survey tools such as Survey Monkey. A technology-infused QEP curriculum will reinforce the way our students learn today, and this experience can help them to excel in their careers.

Interprofessional Education – Rationale for Interprofessional Competence “Interprofessional cultural competence” is another important element of our QEP, Healthy Perspectives, and can be defined as “essential for effective, competent and culturally sensitive health care delivery” (Pecukonis, Doyle & Bliss, 2008). It has been found that health care professionals who work well with those from other disciplines can reduce medical errors due to poor communication (Bandali, 2008). Such training aligns with recommendations by the Institute of Medicine (2003) and Pew Health Commission (1998) to institute interdisciplinary competency requirements: “[A]all health professionals should be educated to deliver patient-centered care as members of an interdisciplinary team, emphasizing evidence-based practice, quality improvement approaches, patient safety and informatics because it has been noted that poor communication contributes to patient risk” (Bandali, 2008).

A Canadian program outlined important elements for a successful interprofessional program including champions who bring “energy, dedication, persistence and a substantial time commitment to the cause,” organizational structures that “facilitate and coordinate interprofessional collaboration,” and allocated funding of human resources (including faculty

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Georgia Health Sciences University development) and infrastructure (Ho, 2008). Another program that successfully created teams from the fields of medicine, nursing, physician assistants, physical therapy, occupational therapy, midwifery, and diagnostic medical imaging included two phases of implementation: group dynamics and interprofessional collaborative skills. The students first learned methods of group decision making, conflict mediation, and alliance building, and then implemented a healthrelated community action project (Hope, 2005). This group noted that collaboration is “crucial to patient care, team morale, and administrative efficiency.” Participants evaluated their groups and reported improved team atmosphere, teamwork skills, multicultural skills, interdisciplinary understanding, and interdisciplinary attitudes (Hope, 2005). The merger and application of interprofessional and cultural competence education in practice experiences help students solidify their understanding of and ability to provide culturally competent care (Chernett, 2010; Sasnet, 2010).

Interprofessional cultural competence is a process that is developed most successfully when the skills and attitudes are expected and modeled at the earliest stages of clinical education (Pecukonis, Doyle, & Bliss, 2008). The process requires reflection, engagement, sensitivity development, and acceptance of differences, all of which can enhance patient, provider, and community communication (Chernett, 2010). Healthy Perspectives will incorporate interprofessional, online modules during the first semester of the students’ programs. Using interactive, social learning modalities, students will engage in interprofessional interactions to understand how their own values, beliefs, and ethics affect provider-patient interactions and how health professionals’ cultures affect clinical practice. In this context, they will assess their own culture, biases, and values at the start of their journey to enhance their cultural competency. Interprofessional teams of faculty, students, staff, and patient advisors will develop the online learning modules to ensure the incorporation of multiple cultural perspectives and the assessment of interprofessional cultural competence as one component of overall cultural competency. The simulated and clinical learning experiences of Healthy Perspectives will further incorporate interprofessional cultural competence.

VI. Implementation Implementation of the QEP will involve adjustments, transformations and opportunities at multiple levels of the university as we work toward enhancing students’ cultural competency through the Healthy Perspectives initiative. The implementation of Healthy Perspectives will involve enterprise integration, professional development of faculty and staff at both the university and academic health center, hiring of key personnel, development of the educational modules (online, simulation, and patient care), incorporation of the assessment plan, and adjustments in programs based on the results of ongoing assessments. Healthy Perspectives draws on resources and expertise that already exist all across the enterprise within the university and health care system in addition to the new resources identified and elaborated in section IX. Enterprise Reintegration Our organization has dramatically changed since the QEP process began almost two years ago.

In July 2010, the Georgia Health Sciences University embarked on significant governance restructuring with the reintegration of the tripartite health sciences university (formerly known as MCG); the associated hospitals, clinics, and practice sites (MCG Health Inc.); and the Physicians Practice Group (PPG). A goal of the restructuring was to coordinate GHSU’s overall mission. As part of the process, a new, private, non-profit, tax-exempt corporation, the MCG Health System, Inc. (MCGHS), was established as the centralized governing body, led by the

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Georgia Health Sciences University newly appointed eighth president of GHSU, Ricardo Azziz, MD, MPH, MBA. The GHSU president also serves as the Chairman and Chief Executive Officer of MCGHS and Chairman of the MCGHI Board of Directors. A newly established joint operating agreement enables GHSU, MCGHI, and PPG to coordinate strategic planning and clinical and educational activities across the broader GHSU enterprise. Integration of the GHSU enterprise–comprised of GHSU, MCG Health Inc., faculty practice groups, faculty, students, staff, patients, and the community at large–will provide even greater opportunities to enhance faculty, staff, and students’ cultural competencies in the implementation of the QEP. This includes the critical element of faculty development.

To facilitate the coalescence of the enterprise, a rapid, short-term (90-day) Enterprise-Wide Strategic Planning (ESP) initiative was deployed on August 1, 2010, to produce a road map to guide and focus GHSU’s efforts over the next three years. The ESP strategic plan was organized around four primary pillars: educational excellence, research growth, clinical integration/development, and workforce development. The QEP will be incorporated into the enterprise’s focus. The confluence of GHSU’s patient- and family-centered care orientation and expertise, the QEP focal point of cultural competency, and our Culturally and Linguistically Accessible Services (CLAS) resources enable GHSU to foster student, staff, and faculty learning in cultural competency, to strengthen patient- and family-centered care expertise, and to bridge the enterprise’s reintegration.

Patient- and Family-Centered Care Collectively, GHSU and MCG Health, Inc. are a national and international leader in patient- and family-centered care (PFCC). GHSU has been profiled in the Agency for Healthcare Research and Quality (AHRQ) Innovation Profile (2010), identified as a high performing academic medical center by the Picker International Institute (2008), and noted for providing care in partnership with patients and families by the Institute for Patient- and Family-Centered Care’s Profiles of Change. Our academic health sciences center was also profiled in the PBS Television Series, Remaking of American Medicine, Part 4 (http://www.pbs.org/remakingamericanmedicine/), which was broadcast in 2006. The fourth program of the series, Hand in Hand, shows how GHSU’s partnership between patients, families, and providers can transform a teaching hospital. With the establishment of the GHSU Center for Patient- and Family-Centered Care in 2004, the PFCC linkage between patient care practices in the hospital and clinic settings and the academic health sciences university was formalized. The Center has two goals, to integrate a patient- and family-centered approach into health professions education and research and to continue contributing to the integration of PFCC into the health services offered by GHSU. The core concepts of patient- and family-centered care–respect and dignity, information sharing, participation, and collaboration–and MCGHI’s existing PFCC Care Standards complement and reinforce culturally competent care practices and skills. These values will be integrated throughout the QEP. Patient advisors suggested specific actions for health care providers to promote cultural competency, particularly in the areas of demonstrating respect for patients, communication, patient education, and teamwork among medical professionals. They identified ways in which patient advisors can be involved in students’ cultural competence education and faculty professional development: • One-on-one access to patient advisors by students, • Interactive panel presentations, • Participating in existing home visiting programs,

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Georgia Health Sciences University • • •

Teaching how to access qualified interpreter services/resources, Broadening connections to the multi-cultural community, Participating in a multi-cultural health fair reflecting the community at large.

The patient advisors noted that GHSU’s culturally diverse student body and faculty could educate one another and GHSU staff about their own cultural beliefs and practices that impact patient care and outcomes. They enthusiastically supported being an instructional resource to the university about cultural and ethnic patient-related topics.

Culturally and Linguistically Appropriate Services (CLAS) The QEP draws on existing resources to strengthen the cultural competency of our health professions students, faculty, and staff. For example, MCGHI’s CLAS staff help meet the communication needs of our diverse patient population by providing interpreter services for nonEnglish speaking or limited English proficiency patients and their families, sign language for hearing impaired patients, and translations of educational materials and forms that are accessible online and through direct service. The MCGHI CLAS Department, housed in the adult care hospital, aims to improve access to care, quality, and health outcomes of GHSU’s patients. CLAS provides qualified medical interpreter services twenty-four hours per day, seven days per week in both the pediatric and adult care settings. Students already benefit from presentations by CLAS personnel in the classroom. Healthy Perspectives will incorporate these services into the patient care components of the curriculum to strengthen our students’ cultural competency skills, especially in the areas of communication and collaboration.

Joint Commission Standards – Patient-Centered Communication The Joint Commission, a national hospital accrediting body, released patient-centered communication standards for hospitals with the aim of improving patient-provider communication and promoting safer inpatient care, particularly across language barriers (Joint Commission, 2010). The pilot phase of assessing compliance with these standards began January 2011; the standards are expected to be included in accreditation decisions in 2012.

These standards promote the integration of patient- and family-centered care, cultural competence, and provider-patient communication and reinforce the timeliness and need for a cultural competency focus in the training of our health professions students and faculty.

Enhancing Students’ Cultural Competency As soon as cultural competency was selected as the topic, the QEP director met with the Deans of the colleges to determine the disciplines and students that would be involved in the initiative.

The university was committed to broad participation of as many students as appropriate but was aware that not every program would necessarily be involved. Early discussions led to the conclusion that the enhancement of students’ cultural competency should occur within the context of patient care. Consideration of resources, logistics, and contextualizing the learning led to the decision to involve new students enrolled in health professions programs that led to licensure or certification in the QEP. For this reason, students enrolled in post-professional programs or graduate research programs will not be part of Healthy Perspectives. The institution is committed to diversity, cultural competency, and inclusive excellence across the enterprise and will address additional goals for the graduate college and across the institution beyond the context of Healthy Perspectives.

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Georgia Health Sciences University Students involved in Healthy Perspectives will be from the Clinical Laboratory Sciences, Dental Hygiene, Dentistry, Medicine, Nursing (BSN, CNL), Occupational Therapy, Physical Therapy, Physician Assistant, Radiologic Sciences, and Respiratory Therapy disciplines. The participating allied health sciences programs will be clinical laboratory science, dental hygiene, occupational therapy, physical therapy, physician assistant, radiologic sciences, and respiratory therapy. The students will participate in cultural competency education in three phases: (1) interprofessional online modules or problem-based learning cases; (2) experiential laboratories, simulations, and/or standardized patients; and (3) patient care experiences during clinical rotations. The activities and student learning outcomes will be tracked and evaluated in accordance with the timeline included in the assessment plan.

The goals of the QEP are to provide students, faculty, and staff with the knowledge, attitudes, and skills necessary to develop as culturally competent health professionals. As a result, GHSU will graduate culturally competent health care professionals who will be better prepared to provide patient- and family-centered, culturally appropriate care to diverse populations. Our ultimate goal is to help reduce health disparities and improve the quality of care in Georgia and wherever else our graduates practice their professions. The QEP project will be integrated throughout the curriculum to emphasize its importance at all phases of the educational continuum.

Integration into Existing Curricula across Disciplines The GHSU Colleges of Allied Health Sciences, Dental Medicine, Medicine, and Nursing have identified strategies for incorporating interdisciplinary core modules and infusing cultural competence education throughout their curricula. All four professional schools will participate in Healthy Perspectives by sharing an overarching conceptual framework, online modules, simulations, and a common assessment plan. The education model (Figure 2) illustrates student involvement from the various professional programs and the progression of learning from core competencies to clinical rotations with direct patient care experiences.

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Georgia Health Sciences University Figure 2: Education Model for Cultural Competency

Health Care Disciplines •

• • • • • • • • •

Clinical Laboratory Sciences Dental Hygiene Dentistry Medicine Nursing (BSN,CNL) Occupational Therapy Physical Therapy Physician Assistant Radiologic Sciences Respiratory Therapy

Core Competencies (Interprofessional Online Modules or Live Small Group Cases)

Further Competency Development (Labs, Simulations, Standardized Patients)

Competency Demonstration (Patient Care, Clinical Rotations) Healthy Perspectives: Better Health Care through Better Understanding

Evaluation of all Activities and Student Learning Outcomes

The QEP is designed to infuse cultural competence education throughout the educational continuum, beginning with online modules, followed by practice in simulated environments, and culminating with practice in real clinical settings. The learning activities will have three sections and include six topics: • Section 1 will include assessing biases and backgrounds and cultural differences. The pedagogical approach uses online modules and online interprofessional groups.

• Section 2 will address health beliefs and demographics and disparities. This section will use simulations (e.g., avatars, mannequins) and/or standardized patients to enhance student learning. They will be incorporated by discipline or be used in interprofessional groups.

• Section 3 will focus on the topics of communication and collaboration in a clinical setting.

They will be incorporated by discipline into each school’s own curriculum.

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Georgia Health Sciences University Figure 3: Healthy Perspectives Educational Delivery Model

Assess Biases and Backgrounds

Cultural Differences

Demographics and Disparities

Health Beliefs

Collaboration

Communication

Online Interprofessional Modules

Simulations, Standardized Patients

Clinical

Interprofessional groups of health professional students

Incorporate by discipline or interprofessional

Incorporate by discipline

groups

Section 1 will involve interprofessional groups of students from across the various colleges who will work together on the same modules. Sections 2 and 3 will be implemented by each college within the context of the existing curricula. In Section 2, simulations or standardized patients will be used to help students apply cultural competency skills and knowledge. The simulations will be developed so that they can be incorporated into each individual program with, if logistically feasible, potential for continued interprofessional learning. The content will draw on GHSU simulations and standardized patient expertise and include collaboration with other experts located beyond the university. Standardized patient experiences will be developed in collaboration with the Clinical Skills Center, which recruits and trains standardized patients, which are people who act as patients and provide students with immediate feedback. The focus of these experiences will be on health beliefs, demographics, and disparities.

The third section emphasizes the application of cultural competence attitudes and knowledge in clinical practice with actual patients. Communication and collaboration among health care disciplines and between health care professionals and their patients is the focus of Section 3.

The QEP Development Committee reviewed a variety of educational theory and delivery models to determine the content, development, and implementation of the online modules (AAMC, 2007; Rogers, 2007; Tobiason, 2010). Appendix E illustrates the various learning theories

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Georgia Health Sciences University considered and the choices made to guide the development of the learning modules. The circled choices indicate the learning theory and educational delivery methods that form the basis of our QEP to ensure active student learning and appropriate use of technology. The online modules will incorporate social learning and simulation videos. The simulations will be handson. Students in each program will demonstrate satisfactory completion of all modules and learning activities prior to graduation.

Figure 4: Healthy Perspectives Student Progression Flowchart

1. Register for Project

2. On-line Course 1 Module 1

3. On-line Course 2 Module 2

4. Laboratory Simulation/Avatar Modules 3 and 4

5. Clinical Modules 5 and 6

6. Project Completion

Pre-test Self-efficacy

IE* tracking

Content Quiz

Course level tracking

Facilitated Activity

Portfolio

Course Evaluation

Quality Improvement

Content Quiz

Course level tracking

Facilitated Activity

Portfolio

Course Evaluation

Quality Improvement

Content Quiz

Course level tracking

Course Evaluation

Quality Improvement

Reflective Activity

Portfolio

Course Evaluation

Quality Improvement

Post-test Self-efficacy

IE* tracking

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*IE – Institutional Effectiveness

Georgia Health Sciences University Tables 4.1 – 4.6: Healthy Perspectives Content Outlines Content outlines have been developed to guide the learning activities for each module in order to achieve the desired student learning outcomes. The content outlines are being used to develop the online modules, Avatars, and clinical experiences that will enhance the attitudes, knowledge, and skills of our students and prepare them to be culturally competent health professionals.

Table 4.1: Healthy Perspectives Content Outline Competency 1 Student Learning Outcome: Assess Biases and Backgrounds Recognize the importance of understanding self and personal biases, assumptions, and their own cultural backgrounds and practices.

Rationale: Cultural self-awareness is important to culturally effective health care education. The premise of understanding cultural biases as a health care practitioner is through better understanding ourselves, the environment from which we come, and inevitably the environment in which we practice.

Content may include: • Cultural self-awareness and development of worldviews •

Cultural awareness, cultural sensitivity, and cultural competence

•

Cultural diversity including attitudes, values, and expectations

•

Biases about racial, ethnic, religious, and other social groups (i.e., disabilities, lower socioeconomic groups, age, gender, sexual orientation, etc.)

•

Ethnocentrism, discrimination, and racism in health care settings

•

Healthcare provider culture as well as organizational culture

Examples of Integrated Learning Strategies • Conduct assessment of personal cultural make-up •

Define culture and its impact on healthcare

•

Read and critique a guided case study allowing students to analyze the cultural components and identify examples of cultural biases modeled by the simulated practitioner

•

Read an unguided case study in which the student serves as the practitioner and must identify cultural practices and factors of the patient and family; challenge students to determine how they distinguished the cultural factors

•

Read a series of situations to assess personal biases–have students reflect on how personal biases affect others; while personal biases will not be shared interactively,

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Georgia Health Sciences University students will reflect on experience to the group •

Read and critique case study on culture of western bio-medicine and discuss rules, roles, and health care practice

•

Create journaling and interactive response activities

•

Discuss students’ cultural self-awareness and any personal experiences of discrimination due to culture

•

Read substantive articles on cultural awareness, sensitivity, and competence

Table 4.2: Healthy Perspectives Content Outline Competency 2 Student Learning Outcome: Cultural Differences Appreciate the differences that exist within and across cultural groups and the need to avoid overgeneralization and negative stereotyping.

Rationale: “There are many definitions of diversity; however, most of the definitions include differences among groups or between individuals. These include, but are not limited to: gender, cultural, spiritual, biological/physical, social, environmental, moral, ethical, economical, educational, political, and ethnical differences. Many definitions include the acknowledgement that not everyone is alike and that it is imperative that differences be acknowledged for understanding and growth to occur between those who are diverse. This diversity can range from slight differences, such as those within family members, to major differences such as those between nations, religions, and geographical locations. All of these diversities affect health care practices and beliefs.” http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/Table ofContents/Volume82003/No1Jan2003/TheManyFacesofDiversityOverview.aspx It is important that health care providers are aware of what makes people different from one another, as well as recognize that it is necessary to avoid overgeneralization and stereotyping in order to provide health care based on the patients’ needs, not on incorrect assumptions.

Content may include: • Glossary or cultural definitions of humanism, holism, stereotyping, ethnocentrism, discrimination, racism, socioeconomic status, and poverty • Differentiate among the concepts of race, ethnicity, ethnic group, culture, and subculture • Differences in values and beliefs regarding health and illness • Understanding of a client’s cultural frame-of-reference impact on the quality of health care • Importance of cultural health beliefs as related to health care • Perceptions by cultural groups about health care providers and health institutions • Cultural barriers to health care including interprofessional culture • Interprofessional culture and its impact on health care delivery, effectiveness and patient outcomes

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Georgia Health Sciences University Examples of Integrated Learning Strategies: • Computerized maps (international, national, and local) to address geographic groups, Videos presenting samples of patient care opportunities when health care workers encounter cultural diversity, slide shows, and reading assignments •

Blog posting of experiences with patients when cultural diversity played an important role during health care treatment.

•

Discuss patient cases/vignettes that bring to light stereotyping, ethnocentrism, discrimination, racism, and interprofessional culture.

•

Reading assignments and quizzes to provide grading capabilities. Annual training activity for employees and students who already took the course, e.g., activity found in the following link: http://www11.georgetown.edu/research/gucchd/nccc/projects/sids/dvd/health%20beliefs. pdf http://www.stfm.org/group/minority/guidelines.cfm

Other Related sites that could be used as links from the online course: http://www.musc.edu/fm_ruralclerkship/culture.html http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/Table ofContents/Volume82003/No1Jan2003/DisparitiesinHealthandHealthCare.aspx http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/Table ofContents/Volume82003/No1Jan2003/AddressingDiversityinHealthCare.aspx http://www.hrsa.gov/culturalcompetence/ http://www.hrsa.gov/publichealth/healthliteracy/index.html http://www.mcg.edu/centers/cpfcc/Culturalcompetence.html http://www11.georgetown.edu/research/gucchd/nccc/projects/sids/dvd/view_online/index.html http://www.hrsa.gov/culturalcompetence/ http://www.hrsa.gov/publichealth/healthliteracy/index.html Table 4.3: Healthy Perspectives Content Outline Competency 3 Student Learning Outcome: Health Beliefs Demonstrate knowledge about varying cultural beliefs about health, disease, and treatment that influence health care practice.

Rationale: Health professions students should articulate their knowledge and understanding of the varying cultural beliefs about health, disease, and treatment that influence health care practice. This competency is important to the students because understanding and applying varying cultural beliefs about health, disease, and treatment directly affects the quality of health care and practice. This competency is fundamental to health professions students because it will enable them to be better equipped to help meet the needs of patients in ways that are affirming and useful. As populations become increasingly diverse, understanding the varying cultural beliefs of the people they serve enables health professionals to interact with people more effectively and enhances their abilities as practitioners to care for patients.

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Georgia Health Sciences University Content may include: • Cultural beliefs about health, disease, and treatment, and how to advocate for individualized care.

•

Cultural beliefs’ influence on health care practice and treatment and appropriate adjustments needed to improve outcomes.

•

Perceptions by cultural groups about health care providers and health institutions.

•

Examples of cultural beliefs of illness or disease that differ from a scientific, bio-medical model.

•

o

Reference: Anne Fadiman. 1997. The Spirit Catches You and You Fall Down. A Hmong Child, her American Doctors, and the Collision of two Cultures. (pp: 141153; 250-261)

o

Hmong Health www.hmonghealth.org

Studies or framework of the effective models of practicing culturally competent care and engaging in cross cultural communication such as LEARN or ETHNIC o

LEARN L E A

Listen to patient’s perspective Explain and share one’s own perspective Acknowledge differences and similarities between these perspectives R Recommend a treatment plan N Negotiate a mutually agreed-on treatment plant Source: Medical University of South Carolina, School of Medicine http://etl2.library.musc.edu/cultural/communication/communication_2.php o ETHNIC E Explanation (How do you explain your illness?)

T Treatment (What treatment have you tried?)

H Healers (Have you sought any advice from folk healers?)

N Negotiate (mutually acceptable options) I (Agree on) Intervention C Collaboration (with patient, family, and healers) Source: Medical University of South Carolina, School of Medicine http://etl2.library.musc.edu/cultural/communication/communication_4.php Examples of Integrated Learning Strategies to demonstrate knowledge through practice: • Avatar simulation modules of interactive learning of the contents. o Students assume the role of a patient and/or family member from varying cultures.

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Georgia Health Sciences University o

•

Web-based resources, including cultural profiles or multi-cultural health generalizations as a starting point, taken from leading national health systems (e.g., Canadian Health Service), academic medical centers, universities, governmental health agency (e.g., US Office of Minority Health), and organizations specializing in cultural competency and health. o

•

Students assume the role of a health professional caring for a patient from a culture different from their own.

Students access Web-based resources to learn about the beliefs of health, disease, illness, and treatment of at least five of the major cultural, ethnic, and religious groups represented in the patient population of the MCG Health System or affiliated hospitals and clinics or preceptor/internship sites.

Case studies of cultural beliefs in relation to health, diet, nutrition, and body weight; medications; medical, dental, or allied health practice; and disease prevention, treatment and wellness modalities. o

Standardized patient encounter in which the student must obtain information about and gain an understanding of a culturally diverse patient’s cultural beliefs.

•

Outline an approach for providing individualized care in one of the case studies presented.

•

Locating and evaluating evidenced-based, objective outcomes related to cultural competency. o

Give examples of studies (references) that demonstrate culturally competent practice in patient communication and delivery of care.

•

Identification of non-allopathic, osteopathic or non-dentist healthcare practitioners in the community.

•

Invited guest speakers of varying cultural backgrounds representing the patient population to present examples of their cultural beliefs about health, disease, and treatment utilizing WIMBA technology, allowing students to ask questions. Incorporate student reflective journaling to describe how the person’s health beliefs may impact the clinical interactions and treatments and how they anticipate their understanding will inform their care practices.

Resources: Asian Nation: www.asian-nation.org/health.shtml www.asian-nation.org/religion.shtml Boston Healing Landscape Project: www.bu.edu/bhlp/Resources/crosscultural/Best_Practice/index.html Cross Cultural Health: www.xculture.org/index.php Diversity Rx www.diversityrx.org Ethno Med: http://ethnomed.org/clinical http://ethnomed.org/cross-cultural-health Medical University of South Carolina, School of Medicine:

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Georgia Health Sciences University http://etl2.library.musc.edu/cultural/resources/index.php Think Cultural Health: www.thinkculturalhealth.hhs.gov University of Michigan Medical School: www.med.umich.edu/multicultural/ccp/culture/culture.htm Case studies: Example: http://ethnomed.org/clinical/case-study-example Table 4.4: Healthy Perspectives Content Outline Competency 4 Student Learning Outcome: Demographics and Disparities Explain changing demographics in the US and the presence of health disparities in health care and strategies to reduce disparities and improve quality of health care.

Rationale: This competency is important because the inability of a student to understand and appreciate the cultural differences he/she may have with patients can lead to miscommunication and inequity in the delivery and quality of care. Participants should be able to explain the impact of demographic disparities and interact with simulated technology strategies to improve their interactions.

Content may include: • Demographic factors that impact health disparities as well as healthcare disparities • Cultural beliefs about health, disease, and treatment for populations in various regions • The influence of health disparities on healthcare practice, patient interactions, and outcomes • Strategies to reduce disparities • Strategies to improve care processes and the quality of health care • Interpreting information from patient records and interviews to determine how beliefs may impact care delivery and outcomes • The following cultural ethnic exposures should be included in simulation technology developed for this student learning objective, based on projected regional demographics: o English and non-English speaking: non-Hispanic African American Hispanic Non-Hispanic Asian o Females o Elderly (over the age of 65) Examples of Integrated Learning Strategies: • Conduct interactive patient interview with standardized patient or simulation technology • Conduct evidence-based research on changing demographics in the US and presence of healthcare disparities • Critique case study of example where health disparities affected the outcome of a patient scenario • Compare and contrast demographic-based health and healthcare disparity examples • Participate in an interactive session with a standardized patient or simulation technology to create a positive healthcare delivery outcome to a posed health disparities interaction

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Georgia Health Sciences University Table 4.5: Healthy Perspectives Content Outline Competency 5 Student Learning Outcome: Communication Demonstrate verbal and non-verbal communication in culturally competent practice that includes sensitivity to dimensions of diversity such as age, disability, gender, sexual orientation, socioeconomic status, race, ethnicity/nationality, and religion. Inherent in this module would be working with interpreter services and taking a cultural profile.

Rationale: Appropriate communication is essential for delivering high quality Patient- and Family-Centered Care (PFCC) in a culturally competent manner. For patients and families to be fully involved in their own or their loved one’s care they must be able to communicate their concerns. Students must be able to communicate despite significant cultural or language barriers between the health care team, the patient, and the family. Understanding when to access interpreter services, as well as how to effectively utilize those services, is essential to providing culturally competent care.

Content may include: • Culturally and Linguistically Appropriate Services (CLAS) o 14 national standards o Types of organizational support available to meet CLAS standards o Situations where CLAS standards are invoked • Cultural profiles • Understanding Medical Interpreter Services • Working with a medical interpreter to provide health care • How to communicate, using verbal and nonverbal techniques, in culturally competent practice Examples of Integrated Learning Strategies: • Access Medical Interpreter Services •

Work with a Medical Interpreter

•

Interact with culturally diverse patient/family groups, either through clinical practice or role playing

•

Explore effective and ineffective communication techniques in the clinical setting

•

Interview a culturally diverse patient and administer a cultural profile

•

Assess communication, caring, and leadership styles of diverse staff

•

Practice communication through verbal and non-verbal interactions

•

Apply CLAS standards

•

Apply cultural competency attitudes and skills when communicating with other health care professionals, patients and families

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Georgia Health Sciences University Table 4.6: Healthy Perspectives Content Outline Competency 6 Student Learning Outcome: Collaboration Collaborate with healthcare providers, patients, and families to achieve a mutually acceptable, culturally responsive plan for individual patients.

Rationale: Health care providers need to be skilled at working collaboratively with support staff, health care providers, and patients and their families to achieve safety, quality, and optimal health outcomes.

Content may include: • Collaborating with support staff •

Collaborating with health care providers from a myriad of disciplines

•

Facilitating collaborative and engaging communication with patients and their families

•

Participatory decision-making

•

Inviting and valuing participation and communication from other providers, patients, and families

•

Communicating with respect and reflective listening

•

Giving and receiving feedback effectively

•

Engaging and negotiating to provide optimal patient care

•

Utilizing information gained from providers, patients, and families in decision-making

•

Treating providers, patients, and families as allies in decision-making, quality, and safety

Examples of Integrated Learning Strategies: • Create cultural care plans with patients and families •

Collaborate with other healthcare providers in patient education and treatment

•

Demonstrate understanding and ability for interprofessional competence

•

Demonstrate patient-and family-centered care values

•

Discussing options collaboratively with patients and families from various cultural backgrounds

•

Translate medical terms into layperson language

•

Practice active listening in the clinical environment

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Georgia Health Sciences University •

Practice respectful communication in the clinical environment

•

Apply cultural competency attitudes and skills

Professional Development of Faculty and Staff The first phase of implementing the QEP will involve professional development for faculty and staff to enhance their cultural competency attitudes, knowledge, and skills. The professional development workgroup was charged with examining best practices in employee training programs for cultural competency. The initial training program will consist of online modules to be implemented in the spring of 2012. Annual updates will be incorporated into GHSU’s existing training program that is conducted each November via MC Strategies, an online learning and training system.

The professional development workgroup consists of content experts, students, faculty, the Director of Instructional Support and Educational Design (ISED), associate provost office staff, and university and hospital human resources staff. This workgroup examined available resources online and through other organizations engaged in cultural competency development.

The workgroup is creating a professional development program consisting of online modules and campus activities to enhance the cultural competency of our faculty and staff. The faculty and staff will also test pilot the modules as they are developed for student learning.

In addition, the QEP Director and the SACS Liaison are working with the Director of the Residency Training Programs at MCG Hospital and Clinics to incorporate the cultural competency modules into residency training. The residents will assist the clinical preceptors to provide students to provide clinical learning experiences and assessments when they are on clinical rotations at the hospital, and these activities will enhance their ability to communicate with patients and collaborate with health professionals from other fields of study.

Faculty, staff, and residents will be required to complete the cultural competency modules in 2011 and to take “refresher” competency training in each successive year. Assessment of faculty and staff cultural competency will occur prior to and at the completion of the program using the CCERT for Health care Institutions.

VII.

Timeline

Appendix A shows the project timeline as a Gantt chart that was used in developing the QEP. The timeline for implementation of the QEP over a five-year period (Academic Years 20112015) with assessments and benchmark measures is shown in Table 5

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Georgia Health Sciences University Table 5: Five-Year Implementation and Assessment Chart Professional Development of Faculty and Staff Goal/Outcome Create modules for faculty and staff professional development

Means of Assessment

Criteria for Success

Implementation Year

Person(s) Responsible

Benchmark with similar programs

Approval from Cultural Competency experts

February - April, 2011

Professional Development Committee

CCERT

Establish baseline; 80% of faculty will complete assessment tool.

By May 1, 2011, annually

Professional Development Committee

Pre- and Post-tests Course Evaluations

>30% of faculty will score >80% on the Pre-test After the intervention, >60% of faculty will score >80% on the Post-test 80% or higher satisfaction ratings

By May 1, 2011, annually

Professional Development Committee

Assess Cultural Competency of faculty and staff

Implement Cultural Competency Professional Development for Faculty and Staff

Healthy Perspectives Office CCERT

Faculty with 80% or higher score

Spring 2011, annually

Healthy Perspectives Administrator

Space Request Form

Space Request Form Approved

Summer 2011

Provost Office

Identify faculty with Cultural Competency expertise

Obtain confirmation of space allocation

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Georgia Health Sciences University Conduct searches

Fill 100% of positions by end of calendar year

July 1, 2011 - June 30, 2012

Healthy Perspectives Administrator with assistance from Human Resources

Faculty satisfaction survey

Healthy Perspectives office will receive an 80% or higher satisfaction rating

Spring 2012; annually

Healthy Perspectives Administrator

Hire faculty and personnel: - Complete employment requisitions - Obtain approval - Gather applications of qualified individuals - Conduct interviews - Make offers

Establish office - Identify and obtain resources - Order furniture - Install equipment - Establish office hours

Learning Activities and Modules Goal/Outcome Develop online modules for student learning outcomes one and two

Develop Avatars for student learning outcomes three and four

Implement online modules for attitudes one and two

Means of Assessment Pilot testing, focus groups, surveys

Criteria for Success 80% or higher satisfaction rating

Implementation Year February 2011 - June 2012

Person(s) Responsible Module Development Workgroup

Pilot testing, focus groups, surveys

80% or higher satisfaction rating

February 2011 - June 2012

Module Development Workgroup

Course evaluations

80% or higher satisfaction rating

2012 (See Table 6 for details by program)

Healthy Perspectives Administrator

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Georgia Health Sciences University Implement laboratory/experiential component; simulations, small group cases and/or standardized patients for knowledge one and two

Course evaluations

80% or higher satisfaction rating

2012 (See Table 6 for details by program)

Healthy Perspectives Administrator

Course evaluations

80% or higher satisfaction rating

2012 (See Table 6 for details by program)

Healthy Perspectives Administrator

2011-2016

Healthy Perspectives Assessment Director

Annually

Healthy Perspectives Administrator and Assessment Director

Implementation Year 2012-2013, annually

Person(s) Responsible Healthy Perspectives Assessment Director and Faculty

Implement clinical experiences for skills one and two

Analyze data

Course Evaluations Assessment Tools Survey Data

Utilize data to make continuous improvements

Demonstrate within group and across group improvements in cultural competency assessments

Student Learning Outcomes Goal/Outcome Recognize the importance of understanding self and personal biases, assumptions and their own cultural backgrounds and practices

Means of Assessment Pre-test student’s Cultural Competence (CCERT and CCSAQ assessment tools) Students are assessed using developed online modules with QEP rubrics one and two (see Tables 9.1 and 9.2)

Criteria for Success 30% of students will score >80% on the Pre-test After the intervention, >60% of students will score >80% on the Posttest; Demonstrate significant improvement in posttest scores 100% of students will achieve passing score

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Georgia Health Sciences University (7-12) using rubric one, including critical criteria Students are assessed using developed online modules with QEP rubrics one and two (see Tables 9.1 and 9.2)

100% of students will achieve passing score (7-12) using rubric two, including critical criteria

2012-2013, annually

Healthy Perspectives Assessment Director and Faculty

Demonstrate knowledge about varying cultural beliefs about health, disease and treatment that influence health care practice

Students are assessed using developed online modules with QEP rubrics three and four (see Tables 9.3 and 9.4)

100% of students will achieve passing score (7-12) using rubric three, including critical criteria

2012-2013, annually

Healthy Perspectives Assessment Director and Faculty

Explain changing demographics in the US, presence of health care disparities, strategies to reduce disparities and improve quality of health care

Students are assessed using developed online modules with QEP rubrics three and four (see Tables 9.3 and 9.4)

100% of students will achieve passing score (7-12) using rubric four, including critical criteria

2012-2013, annually

Healthy Perspectives Assessment Director and Faculty

Demonstrate verbal and non-verbal communication in culturally competent practice that includes sensitivity to dimensions of diversity

Students are assessed using developed online modules with QEP rubrics five and six (see Tables 9.5 and 9.6)

Student learning: Focus on communication in a clinical setting (specific to each school)

2013-2015, annually

Healthy Perspectives Assessment Director and Faculty

Appreciate the differences that exist within and across cultural groups and the need to avoid overgeneralization and negative stereotyping

100% of students will achieve passing score (7-12) using rubric five, including critical criteria

35

Georgia Health Sciences University Collaborate with health care providers, patients, and families to achieve a mutually acceptable, culturally responsible plan for individual patients

Students are assessed using developed online modules with QEP rubrics five and six (see Tables 9.5 and 9.6)

Student learning: Focus on collaboration in a clinical setting (specific to each school) 100% of students will achieve passing score (7-12) using rubric six, including critical criteria

36

2013-2015, annually

Healthy Perspectives Assessment Director and Faculty

Georgia Health Sciences University Incorporating Cultural Competency into GHSU Curricula The QEP is designed to infuse cultural competence education throughout the educational continuum, beginning with online modules, followed by practice in simulated environments, and culminating with practice in real clinical settings. Content outlines are being used to develop the online modules, Avatars, and clinical experiences which will enhance the attitudes, knowledge, and skills of our students and prepare them to be culturally competent health professionals. The timeline indicates the implementation schedule for the various phases of the QEP over the next five years. The QEP committees also worked with the colleges to determine the specific course name and number into which cultural competency will be incorporated for each program. The first section of cultural competence will incorporate online modules emphasizing Assessing Bias and Backgrounds and Cultural Differences. The second section will incorporate simulated learning using Avatars and standardized patients to teach the cultural competence areas of Health Beliefs, Demographics, and Disparities. The third section will be included in each college’s clinical rotations to achieve the student learning outcomes of Communication and Collaboration with other health care professionals, patients, and families from diverse backgrounds. Table 6 provides details with course numbers and titles showing how cultural competency will be incorporated into the existing curricula for each of the student learning outcomes.

37

Georgia Health Sciences University Table 6: Incorporating Cultural Competency in the Curricula

A

Program:

B Section 1

C Section 1

D Section 2

E Section 2

QEP Online Modules (2) will be incorporated during students’ first semester as: (1) part of a course (see Column C) and/or (2) graduation requirement

Course Number & Title where Online Modules will be incorporated (see Column B).

Laboratory/ Experiential component will use: (a) Simulations and/or (b) Small group cases and/or (c)Standardized patients

Course Number(s) & Title(s):

F Section 3 Clinical Experiences will incorporate the student learning outcomes into: (i) All clinical courses or (ii) Specific clinical courses.

G Section 3

H All Sections

I All Sections

Course Number(s) & Title(s) for Clinical Experience (refer to Column F):

Rubrics used to assess cultural competency

Assigned faculty involved in the QEP to assist in development/ review of the assessment tools

College of Allied Health Sciences Physician Assistant

(1)

PHAS 5050, Cultural Competency (Summer first year)

Physical Therapy

(1)

PTHP 7212 Professional Practice Expectations 2 (Fall, year one)

Key:

(1) – Part of a Course (2) – Graduation Requirement (a) – Simulations (b) – Small Group Cases (c) – Standardized Patients

(a), (b) & (c)

(i) – All Clinical Courses (ii) – Specific Clinical Courses

(b)

PHAS 5050, Cultural Competency (Summer, year one), PHAS 5230 Clinical Skills Application II (Spring, year one) & PHAS 5340 Clinical Skills Application III (Summer, year two)

(ii)

PHAS 6015 Adult Medicine, Long Term & Critical Care Practicum, PHAS 6020 Surgery Practicum PHAS 6030 Family Practice Practicum PHAS 6040 Emergency Medicine Practicum PHAS 6050 Pediatrics Practicum PHAS 6060 Behavioral Medicine Clinical Practicum PHAS 6070 OB/GYN Practicum (Incorporated throughout Curriculum)

QEP Rubrics (See Table 9.19.6)

Lisa Daitch

PTHP 7341 &7223 General Concepts 1&2 PTHP 9171 Integrated PatientClient Management

(i)

PTHP 8191 Clinical Education Experience 1 (Summer, year two) 9292 Clinical Education

QEP Rubrics (See Table 9.19.6)

TBD (pending results of faculty survey)

38

Georgia Health Sciences University PTHP 7341, 8243 & 9144 Med Con 2,3 & 4 PTHP 8351 Neuro PTHP 9152 Pediatric PTHP 7212, PTHP 7313, PTHP 8214 Professional Practice Expectations II, III, & IV PTHP 8361 Management PTHP 8305 Research PTHP 9393 Clinical Experience III PTHP 7331 Ortho PTHP 8351 Neuromuscular (Incorporated throughout Curriculum) Occupational Therapy

Key:

(2)

(1) – Part of a Course (2) – Graduation Requirement (a) – Simulations (b) – Small Group Cases (c) – Standardized Patients

N/A

(i) – All Clinical Courses (ii) – Specific Clinical Courses

OTHP 6313 Mental Health Programming OTHP 6604 Pediatric Evaluation & Intervention OTHP 6106 Development of Lifespan Occupations OTHP 7304 Contemporary Practice OTHP 6103 Professional Foundations & Therapeutic Occupation OTHP 6304 Applied Concepts of Wellness and Illness OTHP 6606 Adult Evaluation &

39

Experience 2 (Fall, year three) 9393 Clinical Education Experience 3 (Spring, year three)

(i)

OTHP 6313 Mental Health Programming OTHP 6604 Pediatric Evaluation & Intervention OTHP 6106 Development of Lifespan Occupations OTHP 7304 Contemporary Practice OTHP 6103 Professional Foundations & Therapeutic Occupation OTHP 6304 Applied Concepts of Wellness and Illness OTHP 6606 Adult Evaluation & Intervention

Georgia Health Sciences University Intervention OTHP 6343 Adult Models of Practice OTHP 6854 School Systems OTHP 6708 Professional Issues & Service Management (Incorporated throughout Curriculum) Respiratory Therapy

(2)

Clinical Laboratory Science

(1)

Dental Hygiene

(1)

Key:

(1) – Part of a Course (2) – Graduation Requirement (a) – Simulations (b) – Small Group Cases (c) – Standardized Patients

N/A

(a)

CLSC 3320 (Summer, Senior year) & CLSC 6220 Introduction to CLS (Fall, year one)

(b)

DHYG 3120 Introduction to Clinic II (Spring, Junior year)

(b) Incorporated into daily patient care assessment

OTHP 6343 Adult Models of Practice OTHP 6854 School Systems OTHP 6708 Professional Issues & Service Management (Incorporated throughout Curriculum)

(i)

RTHP 3525 (Spring, Junior year), 4426 & 4427 (Summer, Junior year), 4428 (Fall, Senior year), 4429, 4430, & 4431 (Spring, Senior year)

CLSC 4280 (Spring Junior year) & CLSC 7280 Venipuncture Internship (Spring, year one)

(ii)

CLSC 4280 (Spring, Junior year) & CLSC 7280 Venipuncture Internship (Spring, year one)

DHYG 3120 Introduction to Clinic II (Spring, Junior year) DHYG 3200 Patient Care I (Fall, Senior year) DHYG 3230 Patient Care II (Spring, Senior year)

(ii)

(i) – All Clinical Courses (ii) – Specific Clinical Courses

40

DHYG 3120 Introduction to Clinic II (Spring, Junior year) DHYG 3200 Patient Care I (Fall, Senior year) DHYG 3230 Patient Care II (Spring, Senior year)

Kitty Hernlen & Susan Whiddon

Professionalism Evaluation

Daily Clinical Evaluation (particularly patient communication and documentation section)

N/A

Georgia Health Sciences University Nuclear Medicine Technology

(1)

BRTC 3100 Intro to Patient Care (Fall, Junior year) and/or NMMT 3611 Intro to Nuclear Medicine I (Fall, Junior year)

(a) & (b)

BRTC 3105 Patient Care Lab (Fall, Junior year) and/or NMMT 3621 Intro to NM I Lab (Fall, Junior year)

(ii)

NMMT 3641 Clinical Internship (Fall, Junior year)

BRT Professionalism Evaluation

College of Dental Medicine College of Dental Medicine

(1)

BSAD 5001 Behavioral Science Applied to Dentistry (Fall, year one)

(a)

PTSR 5001 Introduction to Patient Services (Fall, year two)

(ii)

PTSR 5902 (Summer, year three) PTSR 5903 Patient Services (Spring, year three) COMC 5902 (Spring, year four) COMC 5901 Comprehensive Care (Fall, year four)

None

Philip Hanes, Martha Brackett, Robert Kaltenbach, & Carol Hanes

Medical College of Georgia Medical College of Georgia (Augusta)

Medical College of Georgia (Athens)

Key:

(1)

Not incorporated, continuing with the small group, PBL cases that include cultural competency

(1) – Part of a Course (2) – Graduation Requirement (a) – Simulations (b) – Small Group Cases (c) – Standardized Patients

Essentials of Clinical Medicine I (Year one)

(a), (b) & (c)

Essentials of Clinical Medicine II (Year two)

(i)

FMPC 5000, GMED 5000, GMED 5100, PEDS 5000, NEUR 5000, SURG 5000, SURG 5100, PSRY 5000, OBGYN 5000, MEDI 6000 (Year three)

Multiple choice questions on the ECM exams.

Evaluated as an overall assessment of the course.

Ralph Gillies & Kim Halbur

Essentials of Clinical Medicine (Year 1)

(b) & (c)

Essentials of Clinical medicine I & II (Years one and two)

(i)

Clinical Clerkships and Electives (Year three)

Currently used rubrics to assess students for course modules

Cheryl Dickson, Gerald Crites, & Stephen Goggins

(i) – All Clinical Courses (ii) – Specific Clinical Courses

41

Georgia Health Sciences University College of Nursing BSN Program

(1)

NURS 3110 Essentials of Nursing Practice (Fall, Junior year)

(a)

NURS 3210 Clinical Nursing Care of Adults (Spring, junior year) and NURS 4310 Clinical Nursing Care of Women, Children, and Families (Fall, Senior year)

(ii)

NURS 4410 Clinical Synthesis of Nursing Practice (Spring, Senior year) NURS 4415 Population and Community Health (Spring, Senior year)

CNL Program

(2)

NURS 6700 (Fall, year one)

(a)

Developed online, asynchronous avatars to allow for inter-professional work. (Spring, year one)

(i)

NURS 6700 Nursing Therapeutics (Fall, year one) NURS 7000 MedSurg (Spring, year one) NURS 7300 PychMental Health (Spring, year one) NURS 7215 MedSurg II (Summer, year one) NURS 7100 Community Health (Summer, year one) NURS 7400 PedsOB (Summer, year one) NURS 7800 (Residency course names) (Fall, year two)

If avatars are not completed by the spring semester, objectives will be integrated into nursing simulation lab cases

Key:

(1) – Part of a Course (2) – Graduation Requirement (a) – Simulations (b) – Small Group Cases (c) – Standardized Patients

(i) – All Clinical Courses (ii) – Specific Clinical Courses

42

Clinical Evaluation form (students perform selfevaluation and faculty evaluates at mid-term and end of semester)

TBD; Cultural competency taught by all faculty; not a faculty specializing in this area.

Georgia Health Sciences University The timeline also shows a schedule for regular assessment of the student learning outcomes, using the established rubrics and two cultural competency assessment tools described in detail with the assessment plan. The QEP assessment director will work with the faculty to administer the pre-tests to all students upon entrance into their respective programs, an assessment midway through the curricula, and a post-test prior to graduation. Adjustments will be made in the learning activities and assessments as needed, based on this assessment process to enhance student learning and to promote student cultural competency improvements.

VIII.

Organizational Structure

The Executive Committee, with endorsement from the Development Committee, developed an organizational structure to fully implement and assess all aspects of the QEP. We believe that this organizational structure addresses the personnel needs to achieve measurable outcomes in students’ cultural competency to include interprofessional cultural competency. This organizational structure will assure central organization for the various components of the QEP, including incorporation of the online learning modules, experiential learning, and clinical learning to achieve the assessment of the learning activities and overall assessment of measurable outcomes in cultural competency, as well as integration of cultural competency across the program curricula. The organizational structure includes a combination of existing positions, new positions, and advisory committees to fully implement and assess all phases and sections of Healthy Perspectives. Figure 5 depicts the organizational chart and position descriptions for the QEP.

43

Georgia Health Sciences University Figure 5: QEP Organizational Structure and Position Descriptions

President

Provost

Associate Provost and Healthy Perspectives Administrator

Executive Assistant/ Healthy Perspectives Administrative Manager

Center for Patientand Family-Centered Care Program Coordinator

Healthy Perspectives Program Director

Office Associate

Patient Advisors/Family Faculty

Healthy Perspectives Faculty (5)*

Academic Affairs Administrators (One from each college)

Student Government Association Representative

ISED Director

Healthy Perspectives Instructional Design and Development Coordinator

Healthy Perspectives Assessment Director

Healthy Perspectives Instructional Developer

Healthy Perspectives Advisory Committee

Faculty Senate Representative

Students

Vice President for Quality Development Management

Faculty and Staff

Alumni

*Five faculty FTE to include new hires and “buy-out� percentage of GHSU faculty time.

44

CLAS Representative

Patient Advisors Representative

Georgia Health Sciences University Position Descriptions The position descriptions and pay grades for each of the paid Healthy Perspectives staff are as follows: Executive Assistant/Healthy Perspectives Administrative Manager Job Title: Executive Assistant/Administrative Manager Pay Grade: 14 $36,197 - $48,866 - $61,535 Occupational Summary: This position functions as the administrative manager for the Healthy Perspectives initiative and serves as the executive assistant to the Associate Provost; is responsible for providing support to the division administration by planning, organizing, and managing the administrative staffing resources; has the responsibility for assisting with budget planning and budgetary oversight for the section/department; is responsible for managing dayto-day administration and planning of the standard administrative support activities and for assisting with the management of personnel, facilities management, and office management under the direction of the department director.

Minimum Hiring Requirements: Graduate from an accredited college or university with a Bachelor’s degree and one year progressive office experience, to include supervisory experience; or an Associate’s degree and seven years of progressive office experience, to include supervisory experience.

Healthy Perspectives Office Associate Job Title: Office Associate Pay Grade: 7 $21,817 - $28,362 - $34,907 Occupational Summary: Under general supervision, this person will perform a variety of routine and non-routine clerical and administrative duties in support of an office or department. Work requires knowledge of departmental policies and procedures and decision-making within wellestablished guidelines.

Minimum Hiring Requirements: High school diploma or GED required with a minimum of three years’ experience performing secretarial/clerical assistant duties in an office setting. An Associate’s degree in a related field may be substituted for the experience.

45

Georgia Health Sciences University Healthy Perspectives Assessment Director Job Title: Assessment Coordinator Pay Grade: 16 $41,846 - $56,492 - $71,138 Occupational Summary: This position will gather, analyze, and interpret evidence that will assist academic decision-makers in the continuous improvement of administrative and business processes at the Georgia Health Sciences University.

Minimum Hiring Requirements: Bachelor’s degree from an accredited college or university with a minimum of two years’ directly related experience. This position will lead the effort to ensure optimal effectiveness of institutional programs and incentives by coordinating initiatives and gathering, analyzing, and interpreting evidence that will assist decision-makers in and the continuous improvement of the Quality Enhancement Plan at GHSU. This position will gather, analyze, and interpret evidence that will assist in the continuous improvement of the Quality Enhancement Plan at GHSU; coordinate the design, administration, and analysis of assessment surveys; provide support for QEP Faculty; and assist the departments with the development and implementation of assessment programs.

Preferred: Masters degree from an accredited college or university.

Healthy Perspectives Program Director Job Title: Program Director and Assistant or Associate Professor Pay Grade: 26 $86,225 - $120,715 - $155,205 Occupational Summary: Positions in this classification are responsible for strategic planning, business development, development of course content and instructional design education initiatives, and/or instruction; is responsible for grant writing, securing grant funds, budget monitoring, and planning; and serves as liaison with internal and external agencies.

Minimum Hiring Requirements: Master’s degree from an accredited college or university combined with three years’ experience in strategic planning/business development, program management, instruction, training and/or group facilitation. Formal educational experience (16 credit hours) and experience with cultural competency in a health care setting is required.

Preferred: Doctoral degree from an accredited college or university.

Healthy Perspectives Faculty (5) Job Title: Assistant or Associate Professor Salary range: $86,225 - $120,715 - $155,205 Occupational Summary: These faculty positions will be responsible for teaching the online modules and simulation portions of the QEP; are responsible for assisting other faculty in the integration of the QEP into the curricula, applying the rubrics and cultural competency assessment tools, assigning grades, providing student advisement, collecting data and providing assistance with the assessment and making modifications as needed based on outcome data for the QEP. Minimum Hiring Requirements: Master’s degree from an accredited college or university combined with formal educational experience (16 credit hours) in cultural competency or

46

Georgia Health Sciences University patient- and family-centered care. Experience with cultural competency in a health care setting and a credential in health care is required.

Preferred: Doctoral degree from an accredited college or university.

Healthy Perspectives Support Design Coordinator Job Title: Instructional Design and Development Coordinator Pay Grade: 23 $69,398 - $93,687 - $117,977 Occupational Summary: Under the general supervision of the Director of Instructional Support & Educational Design, the Instructional Design and Development Coordinator leads an instructional design, development, and support team tasked with designing and developing a technology-infused curriculum such as learning assets, simulations, mobile applications, online courses, and other learning content. The Coordinator will manage the design and development process adhering to standardized instructional design methodologies and processes. The Coordinator will work with faculty subject matter experts to turn their subject material content into compelling, engaging, and active learning instructional products that are delivered successfully on time and within budget.

Minimum Hiring Requirements: Master’s degree from an accredited college or university in Educational Technology, Information Technology (IT), or a related field and five years of experience in designing and developing technology-infused learning assets, simulations, online courses, mobile applications and related learning content OR Bachelor's degree from an accredited college or university in IT, education, or a related field and seven years of experience in designing and developing technology-infused learning assets, simulations, online courses, mobile applications and related learning content.

Healthy Perspectives Instructional Developer Job Title: Instructional Developer Pay Grade: 18 $48,341 - $65,260 - $82,180 Occupational Summary: This position primarily creates interactive Web-based e-learning content using a combination of technologies. The developer will translate story boards into engaging Web-based learning modules, including user interface design, graphical elements, animations, and videos as part of a complete e-learning strategy.

Minimum Hiring Requirements: A Bachelor’s degree from an accredited college or university in Graphics Design, Instructional Design, or related field.

IX.

Resources (Budget and Space)

The QEP will require one-time expenses as well as recurring personnel and nonpersonnel expenses. A detailed budget of all the anticipated direct and indirect costs is shown in Table 7.

The detailed budget accounts for existing personnel effort as well as the proposal for new hires.

In addition, the work space resources needed are included in this plan. The QEP Executive Committee suggests that the space utilization committee incorporate the QEP offices for Healthy Perspectives into the GHSU Educational Commons proposed in the facilities master plan. A preliminary design has been developed prior to this request and will require further consideration. Prior to building the Educational Commons, the Executive Committee proposed that space be identified in the current dental school building, which will have capacity soon after

47

Georgia Health Sciences University the move and ribbon cutting for the new College of Dental Medicine. Table 8 outlines anticipated work space requirements.

Table 7: QEP Budget and Space Allocations (FY 2012-2016) Expenses Category PERSONNEL Existing Positions: Associate Provost (30% effort for implementation) Executive Assistant/Healthy Perspectives Admin. Mngr.

Center for Patient- and FamilyCentered Care Program Coordinator (50% effort for implementation) New Positions: Healthy Perspectives Program Director Healthy Perspectives Assessment Director (70% effort for implementation) Healthy Perspectives Faculty (5) (Avg. Salary $115,000) Healthy Perspectives Instructional Design and Development Coordinator (50% effort for implementation) Health Perspectives Instructional Developer Office Associate Fringe Benefits (34% per person) NONPERSONNEL Recurring: Office Supplies, Registration Fees Telecom (Phone, voicemail, Equipment (3-year refresh cycle) Travel Video Content Instructional Design Hardware/Software ($20,000 each) Cultural Competency Development Events (3 per year) Online Modules and Avatar Professional Development Faculty and Staff Non-recurring: Office Furniture TOTAL

Year 1

Year 2

Year 3

Year 4

Year 5

59,400

59,400

59,400

59,400

59,400

48,866

48,866

48,866

48,866

48,866

32,250

32,250

32,250

32,250

32,250

115,000

115,000

115,000

115,000

115,000

49,797

49,797

49,797

49,797

49,797

200,000

575,000

575,000

575,000

575,000

46,844

46,844

46,844

46,844

46,844

65,260

65,260

65,260

65,260

65,260

28,362 219,489

28,362 346,989

28,362 346,989

28,362 346,989

28,362 346,989

35,000 10,219 8,500 15,000 50,000 40,000

35,000 13,006 11,662 35,000 30,000 40,000

45,000 13,006 11,662 35,000 10,000 40,000

45,000 13,006 11,662 35,000 10,000 40,000

45,000 13,006 11,662 35,000 10,000 40,000

60,000

60,000

60,000

60,000

60,000

500,000 25,000

35,000 10,000

35,000 10,000

35,000 10,000

35,000 10,000

70,000

24,000

$1,678,767

$1,661,216

$1,627,216

$1,627,216

$1,627,216

48

Georgia Health Sciences University Table 8: Preliminary Space Requirements (in sq ft) Functional Type of Space

No. of Units

Net Area Unit

Net Area Required

1 1

225 150

225 150

Administrative Space Administrator/Associate Provost Executive Assistant/Admin.

Manager Office Associate PFCC Coordinator Program Director Assessment Director Instructional Design and Development Coordinator Instructional Developer Faculty Reception Area

1 1 1 1 1

150 175 175 175 175

150 175 175 175 175

1 5 1

145 175 90

145 875 90

Support Spaces Storage Closet File Room Telephone Closet

1 1 1

100 120 75

100 120 75

Electric Closet

1

50

50

Janitor Closet

1

75

75

Conference Room – Large Kitchenette/Break Room

1 1

300 120

300 120

Net Area Required Efficiency Factors Classroom/Faculty Offices Administration Research Laboratory

Including files Including files

May vary – minimum of one May vary – minimum of one May vary – minimum of one Seating for 20

3320 0 1 0

1.5 1.6 1.6

Total Gross Area Required

X.

Comments

0 5312 0 5312

Development of the Assessment Plan for the QEP

A QEP assessment workgroup was formed to (1) develop the assessment plan including a review of content outlines to develop rubrics to assess student learning outcomes; (2) review and recommend professionally designed assessment instruments to be incorporated into the plan; and (3) develop a timeline for incorporation of assessment throughout the implementation of the QEP. Members of this workgroup included a biostatistician, an outside consultant with

49

Georgia Health Sciences University expertise in institutional effectiveness, faculty and staff with expertise in educational assessment, and faculty with expertise in cultural competency.

Rubrics for Assessing Cultural Competence The QEP assessment committee used Curran’s Guide for Rubric Development (Curran, 2009).

The committee followed six steps to identify the rubrics: 1. Identifying the type and purpose of the rubric by considering what is to be assessed; 2. Identifying the distinct criteria to be evaluated; 3. Determining the levels of assessment, including range and score scales; 4. Differentiating clearly between the levels of expectation; 5. Involving learners in the development and effective use of the rubric; and 6. Pre-testing the rubric using focus groups with students and faculty.

Tables 9.1 – 9.6 show the rubrics for the assessment of each student learning outcome.

Selected criteria were identified as critical elements, identified by an asterisk. For each critical element, students must be able to demonstrate competency at a level of adequacy or excellence in order to meet the QEP requirements. Remediation would be required if the critical element was not met with competency or the minimum overall score is not met.

Table 9.1: Assessment Rubric

Criteria Score per Criteria *Understanding of own personal and cultural backgrounds and their effect on peers, patients, and co-workers

Awareness of effects of personal biases and assumptions

ASSESS BIASES AND BACKGROUNDS (Attitudes 1)

Insufficient Adequate Excellent Score 1 Score 2 Score 3 • Is unaware that • Is aware that his/her • Understands that his/her personal and personal and his/her personal and cultural background cultural background cultural background can affect can affect can affect relationships with relationships with relationships with peers, patients, or peers, patients, or peers, patients, or co-workers in co-workers in co-workers in positive and positive and positive and negative ways. negative ways. negative ways.

• Skillfully modifies interactions with patients for best results.

• Does not recognize • Recognizes that • Recognizes, that understanding understanding self identifies, and self and personal and personal biases understands his/her biases is important. is important. biases.

• Does not recognize • Identifies personal • Recognizes the the effect of biases. effect of personal personal biases on biases on others • Recognizes the others. and makes effect of personal modifications. biases on others.

• Makes assumptions • Consistently infuses about others. this knowledge into

50

Georgia Health Sciences University *Interprofessional competence

• Does not interact

• Interacts positively

•

with other health professions students from varying cultural and ethnic backgrounds.

• Does not recognize benefits of interprofessional collaboration.

with other health professions students from varying cultural and ethnic backgrounds.

• Recognizes and articulates benefits of interprofessional collaboration.

•

•

Functioning member of a team

• Is not engaged.

• Does not complete assigned tasks.

• May be a distraction to the group.

• Does not demonstrate respect for other team members.

• Is adequately engaged.

• Usually completes assigned tasks.

• Is not a distraction to the group.

• Usually demonstrates respect for other team members.

• •

•

•

•

Total Possible Score: Range to Pass: 7-12

4

8

51

his/her perspectives.

Consistently interacts well with other health professions students from varying cultural and ethnic backgrounds and helps others in the class to interact.

Recognizes and articulates benefits of interprofessional collaboration and is a role model for interprofessional collaboration.

Consistently demonstrates collegial interactions by inviting participation and engaging in respectful communication.

Is actively engaged.

Consistently assumes leadership for assigned tasks and goes beyond assigned tasks.

Demonstrates leadership for the group without any distractions.

Consistently provides significant contributions to the group.

Consistently demonstrates respect for other team members and invites participation of other team members.

12

Georgia Health Sciences University *must be achieved with adequate or excellent score Table 9.2: Assessment Rubric CULTURAL DIFFERENCES (Attitudes 2) Criteria Score per Criteria Appreciation of differences within and across cultural groups

Insufficient Score 1 • Does not recognize or appreciate differences that exist within or across cultural groups.

Adequate Score 2 • Recognizes and articulates differences that exist within and across cultural groups.

*Avoid overgeneralization and negative stereotyping

• Is unaware of the

• Is aware and can list

negative effects of overgeneralization.

• Displays tendencies to negatively stereotype.

the negative effects of overgeneralization and stereotyping.

• Does not display negative stereotyping.

• Differentiates culturally sensitive practice from stereotyping.

Functioning member of a team

Student: • Is not engaged.

• Does not complete assigned tasks.

• May be a distraction

Student: • Usually participates.

• Completes assigned tasks.

• Is not a distraction

52

Excellent Score 3 • Skillfully explains differences that exist within and across cultural groups.

• Consistently provides leadership for integration of differences within and across cultural groups.

• Creates an environment where differences are valued.

• Is keenly aware of the negative effects of overgeneralization and openly discusses these limitations with peers and colleagues.

• Acts as a positive role model to other students to avoid negative stereotyping by willingly pointing it out and discussing with colleagues.

• Differentiates culturally sensitive practice from stereotyping.

Student: • Is actively engaged.

• Assumes leadership for tasks.

• Consistently

Georgia Health Sciences University to the group.

• Does not demonstrate respect for other team members.

to the group.

• Usually demonstrates respect for other team members.

• •

• •

Total Possible Score: Range to Pass: 7-12

4

8

communicates effectively.

Invites participation by other members of the team.

Provides a significant contribution to the group.

Is not a distraction to the group.

Consistently demonstrates respect for other team members.

12

*must be achieved with adequate or excellent score Table 9.3: Assessment Rubric HEALTH BELIEFS (Knowledge 1) Criteria Score per Criteria Demonstrate knowledge of cultural beliefs

Insufficient Score 1 • Is unable to describe knowledge of varying cultural beliefs about health, disease, and treatment.

Adequate Score 2 • Describes knowledge of varying cultural beliefs about health, disease, and treatment.

•

•

*Understanding of cultural beliefs’ influence on health care practice

*Knowledge seeking

• Does not

• Identifies how

demonstrate understanding that cultural beliefs can influence health care practice nor how this may occur.

• Does not retrieve

•

cultural beliefs can influence health care practice.

•

• Usually asks

pertinent information on the

pertinent questions to learn

53

•

Excellent Score 3 Demonstrates an indepth knowledge of varying cultural beliefs about health, disease, and treatment.

Demonstrates this knowledge by advocating for individualized care.

Demonstrates an indepth understanding of how cultural beliefs can influence health care practice.

Consistently adjusts his/her patient interaction to improve outcomes.

Consistently asks pertinent and timely questions to learn

Georgia Health Sciences University patient’s cultural beliefs.

• Unable to describe how the person’s health beliefs may impact clinical interaction and treatments.

Total Possible 4 Score: Range to Pass: 7-12

about the patient’s cultural beliefs.

• Describes how the person’s health beliefs may impact clinical interactions and treatments.

8

about the patient’s cultural beliefs.

• Skillfully determines how the patients’ health beliefs may impact clinical interaction and treatments to improve outcomes.

12

*must be achieved with adequate or excellent score Table 9.4: Assessment Rubric DEMOGRAPHICS AND DISPARITIES (Knowledge 2) Criteria Score per Criteria Explain changing demographics

Understand causes of health disparities

Insufficient Score 1 • Unable to describe national, regional, and local population demographics.

• Does not understand and is unable to discuss the varying cultural beliefs about health, disease, and treatment that accompany populations in this region.

Adequate Score 2 • Describes national, regional, and local population demographics.

• Discusses varying cultural beliefs about health, disease, and treatment for populations in this region.

• Unable to define the

• Defines the factors

factors that affect health disparities.

• Unable to describe how demographics impact health care disparities.

• Unable to identify how health disparities influence health care practices, patient interactions, and

that affect health disparities.

• Describes how demographics impact health care disparities.

• Identifies how health disparities influence health care practices, patient interactions, and outcomes.

54

•

•

•

•

•

Excellent Score 3 Describes national, regional, and local population demographics and can elaborate on their impact on health and health care.

Skillfully articulates the varying cultural beliefs about health, disease, and treatment for populations in this region.

Skillfully describes the factors that affect health disparities.

Skillfully articulates the impact of demographics on health care disparities.

Explains how health disparities influence health care practices, patient

Georgia Health Sciences University outcomes.

Awareness of strategies to reduce disparities

*Understands importance of improving quality of health care

• Does not

• Identifies knowledge

demonstrate knowledge about strategies to reduce disparities.

• Avoids retrieving information on the patient’s cultural beliefs.

• Does not understand how these beliefs may impact the clinical interaction.

about strategies to reduce disparities.

• Usually asks relevant questions to learn about the patient’s cultural beliefs.

• Usually uses information from the patient’s health beliefs to determine how this patient’s beliefs may impact the interaction.

• Does not

• Describes the

understand the importance of improving care processes.

• Is unable to articulate strategies to improve the quality of health care.

importance of improving care processes (access, delivery, coordination, and follow-up).

• Articulates some strategies to improve the quality of health care.

8

Total Possible Score: Range to Pass: 7-12

4

•

•

•

•

•

interactions, and outcomes.

Consistently demonstrates indepth knowledge about strategies to reduce disparities.

Consistently asks relevant questions to learn about the patient’s cultural beliefs.

Skillfully applies information from the patient’s health beliefs to determine how this may impact the clinical interaction.

Skillfully assesses the importance of improving care processes (access, delivery, coordination, and follow-up).

Articulates many strategies to improve the quality of health care.

12

*must be achieved with adequate or excellent score Table 9.5: Assessment Rubric COMMUNICATION (Skills 1) Criteria Score per Criteria *Verbal communication

Insufficient Score 1 • Unable to identify patient’s communication needs.

• Unable to recognize when to access medical interpreter

Adequate Score 2 • Usually identifies patient’s communication needs.

• Usually recognizes the need to access medical interpreter

55

Excellent Score 3 • Consistently identifies patient’s communication needs.

• Consistently recognizes the need to access medical

Georgia Health Sciences University

Ability to work with an interpreter

Non-verbal communication

*Sensitivity to dimensions of diversity

services for spoken and sign languages.

• Does not effectively communicate verbally with patients/families of varying cultural and ethnic backgrounds or with limited English proficiency.

• Ineffectively communicates in challenging situations.

• Does not demonstrate respect for others.

services for spoken and sign languages.

• Demonstrates verbal communication with patients/families of varying cultural and ethnic backgrounds or with limited English proficiency.

• Effectively communicates in challenging situations.

• Usually demonstrates respect for others.

• Does not identify or

• Usually identifies

address patient’s/family’s communication needs or language preference.

• Does not access appropriate cultural and language services.

• Does not work successfully with an interpreter.

• Does not demonstrate meaningful nonverbal communication with patients/families in cross-cultural, limited English proficiency, and communication challenging situations at first point of contact.

and addresses patient’s/family’s communication needs or language preference.

• Accesses appropriate cultural and language services.

• Works successfully with an interpreter.

• Does not assess various dimensions of diversity.

• Usually demonstrates meaningful nonverbal communication with patients/families in cross-cultural, limited English proficiency, and communication challenging situations.

• Assesses the many dimensions of diversity (e.g., age,

56

•

•

• •

•

• •

•

interpreter services for spoken and sign languages.

Skillfully and effectively demonstrates verbal communication with patients/families of varying cultural and ethnic backgrounds or with limited English proficiency.

Skillfully and effectively communicates in challenging situations.

Consistently demonstrates respect for others.

Consistently identifies and addresses patient’s/family’s communication needs or language preference.

Accesses appropriate cultural and language services.

Works superbly with an interpreter.

Consistently demonstrates effective and meaningful nonverbal communication with patients/families in cross-cultural, limited English proficiency, and communication challenging situations.

Assesses the many dimensions of diversity (e.g., age,

Georgia Health Sciences University • Exhibits a lack of sensitivity or awareness.

• Does not adjust interactions for best patient outcomes.

• Does not demonstrate respect for others.

• Does not incorporate understanding of cultural beliefs and practices into communication and care practices.

•

• •

•

Total Possible Score: Range to Pass: 7-12

4

race, gender, ethnicity, religion, sexual orientation, disability, socioeconomic status, and health literacy).

Usually demonstrates sensitivity and awareness.

Usually demonstrates respect for others.

Responds to cultural differences and patient’s or family’s questions regarding needs or possible changes in procedures to help make patients and families feel more comfortable.

Usually incorporates understanding of cultural beliefs and practices into communication and care practices and adjusts interactions for best patient outcomes.

8

•

• •

•

race, gender, ethnicity, religion, sexual orientation, disability, socioeconomic status, and health literacy).

Consistently demonstrates sensitivity and awareness.

Consistently demonstrates respect for others.

Anticipates possible cultural differences by suggesting or implementing programmatic changes in the delivery of health services.

Consistently incorporates understanding of cultural beliefs and practices into communication and care practices and adjusts interactions for best patient outcomes.

12

*must be achieved with adequate or excellent score Table 9.6: Assessment Rubric COLLABORATION (Skills 2) Criteria Score per Criteria *Collaboration with health care providers and other team

Insufficient Score 1 • Does not demonstrate ability to collaborate with health care

Adequate Score 2 • Usually demonstrates ability to collaborate with

57

Excellent Score 3 • Consistently, skillfully, and effectively demonstrates

Georgia Health Sciences University members including support staff

• •

•

•

•

*Collaboration with patients

providers and other team members.

Does not invite participation.

Does not engage in respectful communication or reflective listening.

Does not appear to value the perspectives and participation of fellow co-workers.

Does not give or receive constructive criticism/feedback effectively.

Does not engage other health care providers and team members as allies in quality and safety.

• Does not

• •

• •

demonstrate ability to collaborate with patients.

Does not invite participation.

Does not engage in respectful communication or reflective listening.

Does not negotiate in a way to better serve patients.

Does not value the patient’s perspectives and participation.

• •

•

•

•

health care providers and other team members.

Usually invites participation.

Usually engages in respectful communication and reflective listening.

Usually values the perspectives and participation of fellow co-workers.

Effectively gives and receives constructive criticism/feedback.

Usually engages other health care providers and team members as allies in quality and safety.

• Usually demonstrates ability to collaborate with patients.

• Usually invites participation.

• Engages in respectful communication and reflective listening.

• Negotiates in a way to better serve patients.

• Values the patient’s

58

ability to collaborate with health care providers and other team members.

• Consistently invites participation.

• Consistently engages in respectful communication and reflective listening.

• Consistently values the perspectives and participation of fellow co-workers.

• Consistently gives and receives constructive criticism/feedback effectively.

• Consistently engages other health care providers and team members as allies in quality and safety.

• Consistently, skillfully, and effectively demonstrates ability to collaborate with patients when engaged in direct patient care.

• Consistently and skillfully collaborates with the health care team when engaged in indirect care of patients.

• Consistently

Georgia Health Sciences University • Does not attempt to engage patients as partners in care nor as allies in quality and safety.

Collaboration with patients’ families

• Does not

• •

•

•

•

demonstrate ability to collaborate with patients’ families.

Does not invite participation.

Does not engage in respectful communication or reflective listening.

Does not negotiate in a way that is helpful for patients’ families.

Does not value the patients’ families’ perspectives and participation in decision-making and care.

Does not engage patients’ families as partners in care or as allies in quality and safety.

perspectives and participation.

• Engages patients as partners in care and as allies in quality and safety.

invites participation.

• Consistently and skillfully engages in respectful communication and reflective listening.

• Consistently and skillfully negotiates in a way to better serve patients.

• Consistently values the patient’s perspectives and participation.

• Consistently and skillfully engages patients as partners in care and as allies in quality and safety.

• Usually

• Consistently,

• •

•

•

•

59

demonstrates ability to collaborate with patients’ families.

Usually invites participation.

Engages in respectful communication and reflective listening.

Negotiates in a way that is helpful for patients’ families.

Values the perspectives and participation of patients’ families in decision-making and care.

Engages patients’ families as partners in care

• •

•

•

skillfully, and effectively demonstrates ability to collaborate with patients’ families.

Consistently and skillfully invites participation.

Consistently and skillfully engages in respectful communication and reflective listening.

Consistently and skillfully negotiates in a way that is helpful for patients’ families.

Consistently and skillfully values the perspectives and participation of

Georgia Health Sciences University and as allies in quality and safety.

Total Possible Score: Range to Pass: 7-12

4

8

patients’ families in decision-making and care.

• Consistently and skillfully engages patients’ families as partners in care and as allies in quality and safety.

12

*must be achieved with adequate or excellent score Assessment Instruments After working with stakeholders to define the cultural competencies for each of the six components, the assessment workgroup began its search for reliable and validated instruments to be used to assess students’ level of cultural competence. The assessment plan will include a pre-test to assess students’ baseline level of cultural competence and proceed with cultural competency interventions as they are phased into the curriculum. Each section of the cultural competence curriculum has been planned for specific semesters and/or courses. All courses are designed to enable the use of the assessment rubrics for formative and summative evaluations (see Tables 9.1 – 9.6).

Selection of Pre- and Post-Test Assessment Instruments In addition to development of the assessment rubrics, the QEP assessment workgroup was charged with selecting a professionally designed assessment instrument. The instrument needed to (1) have documented statistical reliability and validity; (2) be short, not requiring more than 20 minutes to complete; (3) have questions concerning the rubrics developed to assess cultural competency; (4) have been tested several times on a large sample; (5) have been used successfully to identify areas of concern; (6) be able to identify measureable changes in cultural competence after intervention; and (7) be within the budgetary constraints of the QEP project.

The committee reviewed 21 instruments. Each committee member reviewed several surveys and presented his/her findings at the QEP assessment committee meetings, after which seven assessment tools were selected. A secondary review was conducted to identify the primary instrument for the QEP survey as well as a secondary survey in the event the primary survey was not successful. The primary assessment instrument selected was The Cultural Competence Education Resource Toolkit, designed by Marianne R. Jeffreys, EdD, RN. The secondary instrument, Cultural Competence Self-Assessment Questionnaire, was developed and sponsored by the Regional Research Institute for Human Services, Portland State University. Copies of the instruments are found in the supporting documentation of the QEP. Table 10 summarizes the review of the two instruments.

60

Georgia Health Sciences University Table 10: Summary of Cultural Competence Surveys (Surveys have met all Six Committee Requirements) 1. The Cultural Competence Education Resource Toolkit Author: Marianne R. Jeffreys, EdD, RN Description: This consists of a set of three different toolkits, one each for academic settings, health care institutions, and professional associations. The assessment committee recommends using the toolkit with instruments designed for health care institutions. This toolkit contains 21 resources, including the Transcultural Self-Efficacy Tool (TSET), the Transcultural Self Efficacy Tool-Multidisciplinary Health Provider (TSET-MHP), and the Cultural Competence Clinical Evaluation Tool (CCCET).

Rating: This set of instruments offers the best and most comprehensive set of questions that have the ability to address outcomes for faculty and students at GHSU. The toolkit items correspond with seven essential components for optimal cultural competency including self assessment, active promotion, systematic inquiry, action/intervention, measurement and evaluation. The questions in the instruments are clear, easy to comprehend, and appear to address issues relevant to cultural competency.

2. Cultural Competence Self-Assessment Questionnaire Author: Developed/sponsored by the Regional Research Institute for Human Services, Portland State University.

Description: The survey has a total of 59 questions; however, several questions have multiple parts. The scale for the survey (NOT AT ALL, SOMETIMES, OFTEN) is not optimal; an additional option, such as SELDOM, might be necessary.

Rating: The survey should be considered as an addition to the Cultural Competence Education Resource Toolkit. However, the use of numbers in the scales is not optimal.

The assessment committee selected these two instruments because they met the established criteria and can specifically assess the identified student learning outcomes and program components. The assessment plan includes both quantitative and qualitative measures for student and faculty outcomes, an implementation schedule, systematic procedures for collecting and analyzing results, plus reporting and evaluating the results in each professional program each semester and on an annual basis. A timeline for implementation with the assessment plan is shown in Table 4 and a flowchart showing assessment with student progression is shown in Figure 4. Assessment data will be used to make modifications as needed in any aspect of Healthy Perspectives for continuous improvement.

61

Georgia Health Sciences University XI.

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Hope, J.M., Lugassy, D., Meyer, R., Jeanty, F., Myers, S., Jones, S. Cramer, E. (2005). Bridging interdisciplinary and multicultural team building to health care education: the downstate team-building initiative. Academic Medicine, 80(1), 74-83.

Institute of Medicine (IOM). (2003). Health professions education a bridge to quality Washington, DC. National Academy Press. Retrieved from http://books.nap.edu/openbook.php?record_id=10681 (Accessed February 16, 2011).

Institute of Medicine (IOM). (2004). In the Nation’s Compelling Interest: Ensuring Diversity in the Health Care Workforce. Washington, DC: National Academics Press. Retrieved from http://books.nap.edu/openbook.php?record_id=10885 (Accessed February 16, 2011).

Joint Commission. (2020). Advancing effective communication, cultural competence, and patient- and family-centered care: a roadmap for hospitals. Oakbrook Terrace, IL: The Joint Commission.

The Joint Review Committee on Educational Programs in Nuclear Medicine Technology (JRCNMT). Retrieved from http://www.jrcnmt.org/ (Accessed June 21, 2010).

Joint Review Committee on Medial Dosimetry. Retrieved from http://www.jrcert.org/pdfs/accreditation_process/standards/standards_for_an_accredited _educational_program_in_medical_dosimetry.pdf http://www.jrcert.org/ (Accessed June 21, 2010).

Joint Review Committee on Radiation Therapy (CAAHEP). Retrieved from http://www.jrcert.org/acc_standards.html (Accessed June 21, 2010).

Liaison Committee for Medical Education (LCME). (2008). LCME Accreditation Standards (with annotations). http://www.lcme.org/functionslist.htm (Accessed March 25, 2010).

Medical College of Georgia Work Group on Global Health. (October, 2009).

Recommendations from the workgroup on global health, Augusta, GA. National Accrediting Agency for Clinical Laboratory Sciences (NAACLS). Retrieved from http://www.naacls.org/ (Accessed June 21, 2010).

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Georgia Health Sciences University National League for Nursing Accrediting Commission (NLNAC). (2008). Standards and Criteria Baccalaureate Degree Programs in Nursing. Retrieved from http://nlnac.org/manuals/SC2008.htm. (Accessed April 9, 2010).

National League for Nursing Accrediting Commission (NLNAC). (2008). Standards and Criteria Master’s Degree Programs in Nursing. http://nlnac.org/manuals/SC2008.htm.

(Accessed December 14, 2010).

Pecukonis, E., Doyle, O., & Bliss, D.L. (2008). Reducing barriers to interprofessional training: Promoting interprofessional cultural competence. J Interprofessional Care, 22(4), 417-428.

Office of Minority Health. (2001). National Standards for Culturally and Linguistically Appropriate Services in Health Care: Final Report. Washington, DC: US Department of Health and Human Services, (March 2001). Retrieved from http://minorityhealth.hhs.gov/assets/pdf/checked/executive.pdf (Accessed December 1, 2010).

Poirier, T.I., Butler, L.M., Devraj, R., Gupchup, G.V., Santanello, C., & Lynch, J.C. (2009). A Cultural Competency Course for Pharmacy Students. Am J Pharm Educ, 73(5), Article 81.

Public Health Program, iMPH: Council on Education for Public Health (CEPH). http://www.ceph.org/pdf/Logo_Policy.pdf (Accessed February 16, 2011).

Rogers, P. C., Graham, C. R., & Mayes, C. T. (2007). Cultural competence and instructional design: Exploration research into the delivery of online instruction crossculturally. Educational Technology Research and Development, 55(2), 197-217.

Saha, S., Beach, & M.C., Cooper, L.A. (2008). Patient Centeredness, Cultural and Healthcare Quality. J Nat Med Assoc, 100(11), 1275-1285.

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Sasnett, B., Royal, P.D., & Ross, T. (2010). Introduction of a cultural training experience into interdisciplinary health science education program. J Allied Health, 39:2, e-55-e59.

Seeleman, C., Suurmond, J., & Stronks, K. (2009). Cultural competence: a conceptual framework for teaching and learning. Medical Education, 43, 229-237.

Shangraw, R.E., & Whitten, C.W. (2007). Managing intergenerational differences in academic anesthesiology. Current Opinions in Anesthesiology, 20, 558-563.

Tobiason, T. (2010). Curriculum design and educational technology. University of Washington Tacoma Education Program. Retrieved from http://cnx.org/content/m19017/latest (Accessed July 27, 2010).

Twenge, J.M. (2009). Generational changes and their impact in the classroom: teaching generation me. Medical Education 2009, 43, 398-405.

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Appendices

Appendix A............................................................................... Gantt Chart for QEP Development Appendix B........................................................................... Marketing and Communications Plan Appendix C ................................................. Quality Enhancement Plan Survey for the QEP Topic Appendix D ............................. Formal Request for Quality Enhancement Plan Project Proposals Appendix E.......................................................................... Theories and Positionality of Learning Appendix F ....................................................................... Rubric for Project Proposal Evaluations Appendix G ................................................................... Survey of Faculty on Core Competencies

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Georgia Health Sciences University Appendix A: Gantt Chart for QEP Development

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July 29, 2010: Develop top-five titles and taglines for SACS Committee vote. Manager: Deriso

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July 30, 2010: Begin populating QEP Web site. Manager: Deriso

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July 30, 2010: Contact Dale Hartenburg about December and March grand-prize drawing event at Wellness Center. Manager: Reese

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July 30, 2010: Pam Hayes and Deriso will meet with Dr. Mishoe at 1:30 p.m. to discuss logo. Manager: Deriso

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July 30, 2010: Collect estimates on QEP-related giveaways and promotional materials.

Manager: Reese

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August 9, 2010: Begin video production. Managers: Deriso/Mishoe

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August 9, 2010: Determine SACS Committee’s top-3 titles/taglines. Manager: Mishoe

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August 10, 2010: Launch title/tagline vote in a campus wide email and Daily Beep.

Deadline to vote: Aug. 18. Manager: Deriso

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August 17, 2010: Determine SACS Committee’s top-3 titles/taglines. Manager: Mishoe (listed twice)

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August 31, 2010: Pam Hayes’ deadline for logo design. Manager: Deriso

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September 13, 2010: Pam Hayes’ deadline for poster designs. Manager: Deriso

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September 13, 2010: VIDS deadline for QEP video intro footage. Managers: Deriso/Mishoe

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September 13-20, 2010: Obtain necessary approvals for posters. Manager: Mishoe

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September 15, 2010: Publish Beeper article on QEP title, tagline, upcoming contests/activities, grand prizes, timeline, etc. Manager: Deriso

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September 20, 2010: Order first set of posters from Print Shop. Manager: Reese

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September 20, 2010: Publicize first contest in campus wide email, Daily Beep. Manager: Deriso

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September 27, 2010: VIDS deadline for QEP narration. Managers: Deriso, Mishoe

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September 27, 2010: Distribute prizes for first contest. Manager: Reese

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September 27, 2010: Arrange campus wide distribution of first set of posters. Manager: Reese

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September 27, 2010: Publicize second contest in campus-wide email, Daily Beep.

Manager: Deriso

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September 29, 2010: Publish Beeper article about QEP progress, contests. Manager: Deriso

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October 4, 2010: Distribute prizes for second contest. Manager: Reese

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October 4, 2010: Publicize third contest in campus-wide email, Daily Beep. Manager: Deriso

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October 11, 2010: VIDS deadline for incorporating interviews into QEP video. Managers: Deriso, Mishoe

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October 11, 2010: Distribute prizes for third contest. Manager: Reese

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October 13, 2010: Publish Beeper article about QEP progress, contests, Manager: Deriso

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October 18, 2010: VIDS deadline for incorporating revisions into QEP video.

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October 18, 2010: Publicize fourth contest in campus-wide email, Daily Beep. Manager: Deriso

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October 25, 2010: Publicize fifth contest in campus-wide email, Daily Beep. Manager: Deriso

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October 25, 2010: Distribute prizes for fourth contest. Manager: Reese

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October 27, 2010: Publish Beeper article about QEP progress, contests. Manager: Deriso

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November 1, 2011: Deadline for QEP video. Managers: Deriso/Mishoe

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November 1, 2010: Arrange banners to be hung across Laney-Walker and Harper Streets for the month. Manager: Reese

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November 1, 2010: Distribute prizes for fifth contest. Manager: Reese

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November 8, 2010: Publicize sixth contest in campus-wide email, Daily Beep. Manager: Deriso

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November 10, 2010: Publish Beeper article about QEP progress, contests, December grand-prize drawing/lunch in Wellness Center. Manager: Deriso

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November 10, 2010: Order second set of posters from Print Shop. Manager: Reese

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November 15, 2010: Publicize seventh contest in campus-wide email, Daily Beep.

Manager: Deriso

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November 15, 2010: Distribute prizes for sixth contest. Manager: Reese

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November 22, 2010: Distribute prizes for seventh contest. Manager: Reese

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November 24, 2010: Arrange campus-wide distribution of second set of posters.

Manager: Reese

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November 24, 2010: Publish Beeper article about QEP progress, contests, December grand-prize drawing/lunch in Wellness Center. Manager: Deriso

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December 9, 2010: Host grand-prize drawing, lunch in Wellness Center. Manager: Reese

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January 2011: Launch third Azziz video on QEP Web site. Manager: Deriso

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January 2011: Launch QEP video on Web site. Manager: Deriso

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January 3, 2010: Order third set of posters from Print Shop. Manager: Reese

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January 10, 2011: Arrange campus wide distribution of third set of posters. Manager: Reese

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January 10, 2011: Publicize eighth contest in campus-wide email, Daily Beep. Manager: Deriso

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January 17, 2011: Publicize ninth contest in campus-wide email, Daily Beep. Manager: Deriso

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January 17, 2011: Distribute prizes for eighth contest. Manager: Reese

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January 24, 2011: Publicize tenth contest in campus-wide email, Daily Beep. Manager: Deriso

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January 24, 2011: Distribute prizes for ninth contest. Manager: Reese

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January 31, 2011: Distribute prizes for tenth contest. Manager: Reese

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February 7, 2011: Publicize eleventh contest in campus-wide email, Daily Beep.

Manager: Deriso

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February 14, 2011: Distribute prizes for eleventh contest. Manager: Reese

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February 14, 2011: Publicize twelfth contest in campus-wide email, Daily Beep.

Manager: Deriso

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February 21, 2011: Distribute prizes for twelfth contest. Manager: Reese

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February 21, 2011: Publicize thirteenth contest in campus-wide email, Daily Beep.

Manger: Deriso

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March 1, 2011: Arrange banners to be hung across Laney-Walker and Harper Streets for the month. Manager: Reese

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March 2011: Host grand-prize drawing, lunch in Wellness Center. Manager: Reese

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Georgia Health Sciences University Appendix C: Quality Enhancement Plan Survey for the QEP Topic

Quality Enhancement Plan Survey 2009 1. Introduction

Quality Enhancement Plan Survey 2009 The Medical College of Georgia is currently seeking reaccreditation with the Southern Association of Colleges and Schools (SACS), the recognized regional education accrediting body for U.S. Southern states.

Accreditation plays a significant role in fostering public confidence in the U.S. education enterprise, in maintaining institutional standards, in enhancing institutional effectiveness and in improving higher education as a whole. Accreditation is also linked to program accreditation and to an institution's ability to offer federal student financial aid.

As part of our preparation for reaccreditation, MCG is inviting you to offer your insight on educational enhancement initiatives toward the development of a Quality Enhancement Plan (QEP). A QEP is a core element of the accreditation process. It is a future-oriented project that enhances some crucial aspect of student learning or institutional mission and one that involves the effort of the entire MCG community. If you have ever had opinions about how to make MCG a better place for each and every student on campus, this is your chance to voice your ideas.

Survey participation is voluntary and information is confidential. All survey respondent data will be reported in aggregate form only.

For questions regarding this survey, please visit http://www.mcg.edu/qep or contact John Cooper (johcooper@mail.mcg.edu).

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Georgia Health Sciences University Quality Enhancement Plan Survey 2009 2. General Questions Faculty Quality Enhancement Plan Survey 2009

*1. Prior to beginning this survey, what was your level of familiarity with the following concepts? (Please answer all three items) Not Familiar

Somewhat Familiar

Very Familiar

Accreditation Southern Association of Colleges and Schools (SACS) Quality Enhancement Plan (QEP)

2. If you are familiar with MCG's current accreditation effort, what are your sources of information? (Please note all that apply) MCG campus newsletter ('The Beeper') campus website (www.mcg.edu) MCG Today Magazine MCG Annual Report discussed among classmates discussed in class discussed within my academic program or department / school discussed within my administrative unit a communication from a department head or my supervisor local media other: (please specify)

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Georgia Health Sciences University Quality Enhancement Plan Survey 2009 3. Emerging Institutional Themes As faculty/staff/students, what do you think students as future health care providers should be learning at MCG in each of the themes listed below? Please provide ideas, suggestions and as much detail as possible.

1. Diversity: MCG is committed to a culture of inclusiveness, one that provides opportunities for all individuals to achieve their full potential. Our responsibility is to align our efforts with the needs of the community and society at large. Increasing faculty and student diversity, particularly regarding race and ethnicity, is an institutional strategic initiative. An inclusive learning environment will foster the development of more compassionate, culturally competent health professionals.

2. Global Health: At MCG, the essence of global health, to reduce health disparities worldwide, is interdisciplinary - integrating biologic, epidemiologic, behavioral, cultural, socio-economic, legal, and political aspects of health. Global health encompasses not only people living in foreign lands, but also inhabitants of our nation, region, state and local communities. As the next generation of health care leaders, students must understand the global context in which health problems occur and acknowledge and value the cultural influences and perspectives of the populations they serve.

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Georgia Health Sciences University Quality Enhancement Plan Survey 2009 3. Technology-Infused Curriculum: MCG considers it absolutely important to infuse technology into the curriculum because it addresses the needs of the Millennial Generation. The goal and purpose is to enhance student learning outcomes for this group of students that think, learn and understand in a different way.

4. Cultural Competency: MCG defines cultural competence as a set of congruent behaviors, knowledge, and attitudes that enable effective work in cross-cultural situations. Students understanding cultures different from our own so that they can treat patients and collaborate with families from multiple backgrounds are crucial in this diversified nation. This topic bridges the recommendations of the Workgroup on Diversity with those of the Workgroup on Global Health, aligning our programs with societal health needs to ensure success in addressing the changing health needs of a changing population.

5. Reflecting your perception of relevancy to MCG's mission of educating tomorrow's health care workforce, rank-order the following themes. (Using a scale of 1 to 4, '1' denotes Least Relevant and '4' denotes Most Relevant.)

Diversity Global Health Technology-Infused Curriculum Cultural Competency

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Georgia Health Sciences University Quality Enhancement Plan Survey 2009 6. In the space below, please suggest any additional topic(s) or theme(s) that you consider relevant to MCG's mission of educating tomorrow's health care workforce.

7. Do you feel your suggested topic(s) or theme(s) is more relevant to MCG's mission of educating tomorrow's health care workforce than the item you ranked as 'Most Relevant' in Question 5?

Yes No

8. Referring to all themes listed above (including your suggestion), for the theme you perceive is 'Most Relevant' to MCG's mission of educating tomorrow's health care workforce, please offer additional comments, insights and suggestions that you feel would offer broad insight on your selected topic or theme. Also, how do you feel this topic or theme might be implemented? Please provide ideas, suggestions and as much detail as possible. You do not need to provide any technical or budgetary specifics.

Thank you for completing this survey. Your participation helps us build a stronger and more responsive MCG that is committed to discovering, disseminating and applying knowledge to improve health and reduce the burden of illness on society.

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Georgia Health Sciences University Appendix D: Formal Request for Quality Enhancement Plan Project Proposals

REQUEST FOR QUALITY ENHANCEMENT PLAN PROJECT PROPOSALS DEADLINE: January 22, 2010 AWARD: $1500 for each group proposal selected 1. Purpose The purpose of this request is to obtain proposals that identify and provide basic justification for the selection of a project for the five-year MCG Quality Enhancement Plan (QEP). Multidisciplinary and multi-authored proposals are highly encouraged. Single author proposals will be considered provided the implementation section details multidisciplinary approaches for development and implementation to achieve broad student impact across the schools. Proposals received will guide MCG to a final selection of the institution’s QEP initiative. The QEP will be a primary part of the Southern Association of Colleges and Schools Commission on Colleges (SACS-COC), reaccreditation visit in the spring of 2011. This is a significant program that will be budgeted and implemented.

2. Background Some may ask “Why is MCG embarking on any new effort during these times of fiscal restraints and budget cuts?” The specific answer is that MCG must be accredited to fulfill its mission! MCG is a regionally accredited institution that is required to have a regular reaffirmation process, scheduled to take place during spring 2011. Regional accreditation makes MCG eligible to receive federal funding, including student financial aid.

A QEP is now required by SACS-COC Core Requirement 2.12 as part of reaffirmation of accreditation. The QEP is a plan that is a “carefully designed and focused course of action that addressees a well-defined issue or issues directly related to improving student learning.” Additional information about SACS, the QEP, and related resources, may be found at http://www.sacscoc.org.

SACS Core Requirement 2.12 currently states*: The institution has developed an acceptable Quality Enhancement Plan (QEP) that: (1) includes a broad-based institutional process identifying key issues emerging from institutional assessment, (2) focuses on learning outcomes and/or the environment supporting student learning and accomplishing the mission of the institution,

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Georgia Health Sciences University (3) demonstrates institutional capability for the initiation, implementation, and completion of the QEP, (4) includes broad-based involvement of institutional constituencies in the development and proposed implementation of the QEP, and (5) identifies goals and a plan to assess their achievement. *Note that at the SACSCOC December 2009 meeting in Atlanta, recommendations were approved to separate out parts 4-5 to form the core requirement to an accreditation standard, which will slightly impact the process and timeline for MCG. 3. Topics Under Consideration An MCG community survey, campus-wide forums, and institutional data and assessment activities have informed the QEP process to narrowing the QEP to the following two topic areas: Technology-Infused Curriculum: MCG considers it absolutely important to infuse technology into the curriculum because it addresses the needs of the Millennial Generation. The goal and purpose is to enhance student learning outcomes from this group of students that think, learn and understand in a different way.

Cultural Competence: MCG defines cultural competence as a set of congruent behaviors, knowledge, and attitudes that enables effective work in cross-cultural situations. Students understanding cultures different from their own so that they can treat patients and collaborate with families from multiple backgrounds are crucial in this diversified nation. This topic bridges the recommendations of the Workgroup on Diversity with those of the Workgroup on Global Health, aligning our programs with societal health needs to ensure success in addressing the changing health needs of a changing population.

These definitions are intended as general guidance to the topics and are not intended to be definitive or restrictive in how QEP proposals for a project are addressed. Proposals may be creative in blending various aspects of the two topics.

4. Project Proposal Requirements The project proposal must be developed using either, or both, of the areas above. It is strongly encouraged that the proposal be developed with input from as many MCG constituent groups as possible (e.g. faculty, staff and students).

The proposal should include a general description of the proposed project to enhance students learning and a narrative justification which addresses the following requirements.

• The proposed project should affect a well-defined and generally large group of students, not necessarily every student, but involving multiple schools.

• The proposed project should address potential actions to be taken to improve student learning outcomes through the project.

• The proposed project suggests ways to assess the student learning outcomes (SLOs).

• The proposed project may be a new endeavor or a significant extension of ongoing efforts.

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The proposed project must be feasible to initiate, implement and complete.

The proposed project should describe opportunities to include faculty, staff and students in its development and implementation.

5. Proposal Format The proposal should be prepared as an MS Word document with 1-inch margins with a typeface at least as large as 10-pt Times New Roman. The proposal should be double-spaced and not exceed 10 pages of text, including figures and references. Individuals and/or teams may submit more than one proposal.

The proposal format must include: I. Completed Submission Form – See attached II. Identification and Rationale for Project Selection – Relevance of the project in relation to institutional need along with evidence of the involvement of all appropriate campus constituencies. Explain why this initiative would be unique and vital to the long-term improvement of student learning at MCG. Obtain input from students and staff to the degree possible.

III. Desired Student Learning Outcomes – Specific, well-defined goals expected to lead to observable results.

IV. Measurement of Student Learning Outcomes – Ways to assess the student learning outcomes.

V. Literature Review and Best Practices – Evidence of consideration of best practices related to the project.

VI. Actions to be implemented – Evidence of careful analysis of institutional context in designing actions capable of generating the desired student learning outcomes VII. Timeline – A logical timeline of all actions to be implemented for the first three years.

VIII. Organization Structure – Proposed lines of responsibility for implementation and sustainability IX. Resources – A realistic allocation of sufficient human, financial, and physical resources X. Assessment – Overview of evaluation techniques XI. Appendices (additional data to be considered) 6. Submission Procedures In order to be considered, proposals must be submitted in electronic format as an MS Word document along with one hard copy. Both electronic copy and hard copy should be sent to Dr. Shelley Mishoe in the Office of the Provost, AA309 and smishoe@mcg.edu.

7. Evaluation Criteria* Each proposal will be evaluated by members of the QEP Executive Committee.

The QEP executive committee includes broad representation of the faculty, staff, students and administration with representation from the Employee Advisory Council, The Student Government Association, the Faculty Senate (President 83

Georgia Health Sciences University Designee), finance and the SACS Steering Committee. There will be 7 topic elements reviewed plus an overall evaluation element.

1. Rationale 2. Project is focused, relevant and appropriate 3. Proposal identifies key student learning outcomes 4. Project is measurable and assessable 5. Proposal is well grounded in research 6. Project impact on MCG 7. Multidisciplinary Project (Preferred) 8. Feasibility of implementation 9. Overall Evaluation *An evaluation rubric is in development and will be used to review project proposals.

The QEP project proposal review process will include an opportunity for an open discussion forum that will address the proposal format areas based on the potential for: • Being data and research based • Measuring student learning improvement • Identifying QEP Champions with content expertise • Budget implications • Practical implementation • Value of topic area to all students at MCG Award Details Each proposal selected to advance to the next level of consideration will be awarded $1500 to be split equally among the group members who developed the project proposal. Other award arrangements may be proposed by each group provided there is agreement that is expressed in writing on the signature page when the proposal is submitted.

8. Schedule December 22, 2009 January 22, 2010

Request for Proposals Released Proposal submission deadline

Proposal request document developed with assistance from The University of Texas Health Science Center at Houston. “Request for QEP Topic Proposals”, November 21, 2008.

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Georgia Health Sciences University MEDICAL COLLEGE OF GEORGIA QUALITY ENHANCEMENT PLAN PROJECT PROPOSAL SUBMISSION FORM

Topic Title: Theme Area:

Brief description of the Topic:

Name: E-mail address: Phone number: Department: Co-developers:

Signature Page Are you interested in participating in the development of the Quality Enhancement Plan after the topic is selected?

Yes No Please submit completed project proposals in electronic format as an MS Word document along with one hard copy to include the signature page signed by all participants. Both electronic copy and hard copy should be sent to Dr. Shelley Mishoe in the Office of the Provost, AA-309 and smishoe@mcg.edu. Please do not include your name(s) on the body of the proposal.

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Georgia Health Sciences University Appendix E: Theories and Positionality of Learning

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Georgia Health Sciences University Appendix F: Rubric for Project Proposal Evaluations

MEDICAL COLLEGE OF GEORGIA QUALITY ENHANCEMENT PLAN RUBRIC FOR PROJECT PROPOSAL EVALUATION Title of Project: _____________________________________________________________ Reviewer: __________________________________________________________________ There are 8 project elements to be reviewed. Evaluate each proposal and assign a score for each element using the scale provided. Please comment on the strengths and weaknesses of each proposal.

Elements 1. Definition of Project 0- Project is not well defined 1- Project is stated only in general terms 2- Project is adequately defined 3- Rationale is specific and provides a convincing case for the project 2. Review of Best Practices 0- No discussion of literature/best practices is provided 1- Minimal discussion of literature/best practices is provided 2- Good discussion of literature/best practices is provided 3- Excellent discussion of previous literature and clear best practices are provided 3. Student Impact 0 – Voluntary participation only 1- Limited to a single program or small population 2- Broad involvement in one or two schools 3 – Extensive, interdisciplinary involvement across schools 4. Student learning outcomes 0- Does not address student learning outcomes 1- Includes vague or inappropriately constructed student learning outcomes 2- Provides appropriately constructed student learning outcomes 3- Clearly describes appropriately constructed student learning outcomes 5. Measurable and Assessable 0- Non outcome assessment procedures are provided 1- Some outcome assessment procedures are provided but the project focuses most heavily on indirect measure of student learning 2- Outcomes assessment procedures include direct measures of student learning but are described only in general terms 3- Outcomes assessment procedures include direct measures that are clearly describes and feasible 6. Implementation 87

Score

Georgia Health Sciences University 0- No clear plan of actions to be implemented is provided 1- Discussion of implementation is not specific and/or realistic 2- Discussion of implementation is appropriate but not fully developed or convincing 3- Discussion of implementation is specific, clear, and reasonable given scope of project 7. Required resources (financial and human) 0- Proposal does not address resources needed 1- Proposal describes resource needs which are insufficient or excessive for scope of project 2- Proposal describes resource needs that can probably be adapted to the project 3- Proposal describes resource needs that are appropriate and sufficient to the project 8. Overall Evaluation 0- Proposal is not well developed given the scope of the QEP 1- Proposal is adequate but key elements seem to be missing 2- Proposal is very good and should receive consideration 3- Proposal is outstanding and should be a lead consideration for QEP project TOTAL SCORE Comments:

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Georgia Health Sciences University Appendix G: Survey of Faculty on Core Competencies

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