Assessing cultural competency skills in gastroenterology fellowship training

Table 1 Health literacy n (%)

Competency areas and specific skills	Distribution of responses, n =11
	Not done	Partly done	Well done
Communication
Information gathering
Elicited responses using appropriate questions	0	5 (45)	6 (55)
Clarified information by repeating	4 (36)	5 (45)	2 (18)
Allowed patient to talk without interrupting	0	0	11 (100)
Relationship development
Communicated concern, intention to help	0	4 (36)	7 (63)
Non-verbal behavior enriched communication	0	1 (9)	10 (91)
Acknowledged emotions appropriately	5 (45)	2 (18)	4 (36)
Was accepting, non-judgmental	0	6 (55)	5 (45)
Used words patient understood, explained jargon	2 (18)	3 (27)	6 (55)
Patient education
Educated patient on Hep B in a culturally sensitive manner	0	6 (55)	5 (45)
Explained risks of transmission: unsafe contact and safe contact	0	4 (36)	7 (63)
Discussed general health education	2 (18)	9 (82)	0
Assessment
Evaluated reading skills in a compassionate and culturally sensitive manner	11 (100)	0	0
Evaluated patient's understanding of risks of transmission prior to explaining unsafe contact and safe contact	5 (45)	6 (55)	0
Treatment plan
Clearly discussed next step of follow up plan	1 (9)	9 (82)	1 (9)

Table 2 Apologizing for a complication n (%)

Competency areas and specific skills	Distribution of responses n = 11
	Not done	Partly done	Well done
Patient activation
Helped patient understand the cause of health condition	0	3 (27)	8 (73)
Helped patient understand the different available treatment options	0	3 (27)	8 (73)
Helped patient feel able to follow the recommendations or take the next steps	0	4 (36)	7 (63)
Accountability
Disclosed complication directly	0	0	11 (100)
Fully explained the complication	0	0	11 (100)
Personally apologized for this complication	7 (63)	0	4 (36)
Took responsibility for situation and recovery	7 (63)	0	4 (36)
Delivering bad news
Gave opportunity for patient to respond emotionally	0	0	11 (100)
Responded to patient's emotions.	0	0	11 (100)
Shared decision making
Explored patient's beliefs, values, and preferences	0	5 (45)	6 (55)
Engaged patient in the decision making process	0	1 (9)	10 (91)
Allowed for explicitly deferred decision making	0	4 (36)	7 (63)
Assessment
Reassured patient that care is appropriately supervised and executed, established trust	8 (73)	a	3 (27)
Elicited understanding that patient mistrusts system, negotiated trust in future quality of care	10 (91)	a	1 (9)

^aScored by faculty observer as performed or not performed.

Table 3 Breaking bad news n (%)

Competency areas and specific skills	Distribution of responses n =11
	Not done	Partly done	Well done
Patient education
Gave results of colonoscopy effectively	3 (27)	7 (63)	1 (9)
Explained procedures already done during colonoscopy	0	8 (73)	3 (27)
Explained next necessary steps, how results fit into longer term plans	0	7 (63)	4 (36)
Checked patient's understanding of treatment options	4 (36)	7 (63)	0
Delivering bad news
Physically set the tone for receiving bad news	3 (27)	8 (73)	0
Assessed your readiness to receive news, gave warning shot	4 (36)	7 (63)	0
Gave opportunity for patient to respond emotionally	1 (9)	7 (63)	3 (27)
Responded to patient's emotions.	1 (9)	7 (63)	3 (27)
Accountability
Conveyed accountability, assured appropriate treatment and follow up	1 (9)	5 (45)	5 (45)
Shared decision making
Explored patient's beliefs, values, and preferences	1 (9)	7 (63)	3 (27)
Engaged patient in the decision making process	3 (27)	6 (55)	2 (18)
Allowed for explicitly deferred decision making	1 (9)	6 (55)	4 (36)
Assessment
Explained and apologized for complication	3 (27)	8 (73)	0
Engaged patient in a discussion about next steps	0	7 (63)	4 (36)
Elicited understanding that patient has different beliefs, negotiated common goals	4 (36)	a	7 (63)

^aScored by faculty observer as performed or not performed.