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Electives - Family Medicine

Caring for Refugees in Charlottesville: International Family Medicine Clinic

Elective Number: 1416 (arranged)

Rotation Supervisors: Dr. Fern Hauck

Coordinator: Wanda Hudson, McKim 3161

Evaluation should be given to: Dr. Hauck or Ms. Hudson

Duration: 4 weeks

Available: All Rotations

Report to: Dr. Hauck

Time to Report: To be arranged in the week prior to start date

Place to Report: To be arranged in the week prior to start date

Typical day: 8:00 am - 5:00 pm

Attendance: Attendance at elective activities is mandatory.

  • Anyone who is ill or has a personal or family emergency must contact Student Affairs and the Attending on Service.
  • Students are allowed to take off up to 1 day per week to interview between November 1 and February 1.
    • Specific days missed must be approved by the Attending on Service.

Number of students per rotation: 1

Course Description: This elective is designed to prepare the student to care competently and sensatively for international patients. The focus will be on developing clinical skills to care for patients who present for initial and follow-up visits to the IFMC, including screening for common infections and illnesses, preventive care, management of acute problems and management of common chronic conditions. Above all, the student will learn how to communicate effectively with international patients, both in working with interpreters and learning to be culturally appropriate and sensative. The student will also learn about legal issues and distinctions between "immigrant" and "refugee" and the various community health, social and educational agencies that serve these populations locally. This elective will prepare students to work with international patients both at home and abroad.

Students will see patients during 4-5 half-day sessions each week in the IFMC, working with the IFMC providers. Students will also spend one session a month at the Health Department Refugee Clinic (where initial screening for infectious diseases occurs), the International Rescue Committee (resettlement agency), and UVA Traveler's Clinic, based on availability. The remainder of the time will be spent reading the required readings and preparing the final project. This project will focus on one cultural group and include an in-depth description of the group's home country, customs, health practices and common illnesses, and immigration history and circumstances leading to immigration. Other topics will be considered on a case-by-case basis. Students will be evaluated on clinical performance.

Learning Objectives:

The following objectives are from the SOM core competencies in cultural competence and apply to this elective. Students completing the elective will be able to:

  1. Key Concepts in Cultural Competence
    1. Address the importance of social determinants (e.g., education, culture, socioeconomic
      status, housing and employment) and community factors on health.
    2. Identify patients'/families' healing traditions/practices and beliefs, including ethno-medical
      beliefs (this includes the "historical models of common health beliefs" such as illness in
      the context of "hot and cold").
    3. Ask questions in a non-jUdgmental manner to elicit patient preferences, listen and
      respond appropriately to patient feedback about key cross-cultural issues.
    4. Discuss race, ethnicity, and culture in the context of the medical interview and health
      care. Exhibit comfort when conversing with patients/ colleagues and describe institutional
      cultural issues for own institution.
    5. Value the importance of curiosity, empathy, and respect in patient care and the
      importance of continuous growth as a healer.
  2. Bias, Stereotyping, Culture and Clinical Decision Making
    1. Recognize and identify own potential for bias and stereotyping; explore how attitudes,
      biases and stereotypes affect clinical encounters, clinical decision making and quality of
      care.
    2. Identify and appreciate how physiCian bias and stereotyping can affect interactions with
      patients, families, communities, and other members of the health-care team, and the link
      between effective communication and quality care.
  3. Cultural Competence in Patient Care
    1. Conduct and document a culturally responsive history and physical examination; elicit a
      cultural, social and medical history, including a patient's health beliefs or model of their
      illness using Kleinman's Explanatory Model questions.
    2. Demonstrate respect for the patient's cultural and health beliefs and use negotiating and
      problem-solving skills in shared decision-making with a patient.
    3. Discuss CLAS Standards (Culturally and Linguistically Appropriate Services) and how
      they are being implemented in the hospital, health system, or clinic in serving patients
      with limited English proficiency.
    4. Describe the functions of an interpreter (both in-person and via telephone) and effective
      ways of working with an interpreter.
    5. Identify when an interpreter is needed and collaborate effectively with an interpreter.
    6. Assess and enhance patient adherence based on the patient's explanatory model.
    7. Describe ways to enhance patient adherence by collaborating with traditional/community
      healers.

Additional learning objectives also specific to this elective:

    1. Develop clinical skills to care for refugee patients who present for initial and follow up visits
      to the IFMC including:
      • Identify and screening for common infections and illnesses.
      • Recognize appropriate preventive care screening and counseling.
      • Manage of acute medical problems.
      • Devise appropriate treatment plan for common chronic medical conditions
    2. Communicate effectively with international patients, including using interpreters.
    3. Describe the unique legal issues related to refugees
    4. Compare and contrast the distinction between "refugees" and "immigrants" and how this
      affects access to health to health benefits.
    5. Identify the community agencies that work with and/or assist refugees including the Health
      Department and International Rescue Committee.
    6. Conduct a project including submission of a written report under the supervision of the
      rotation supervisor or her designee that assesses a key learning point or issue related to
      the care of refugee patients in the ambulatory setting.