Hmong participants' reactions to return of individual and community pharmacogenetic research results: "A positive light for our community".

Pharmacogenetic research has historically lacked racial and ethnic diversity, limiting the application of findings to minority populations. Recent studies, including the Hmong, have gauged communities' interest in participating in genomic research and receiving their individual results. This study was conducted to create a culturally and linguistically appropriate format to return pharmacogenomic results and identify Minnesota Hmong research participants' reactions to their personal and collective results. Using a community-based participatory research approach, researchers collaborated with Hmong community members to format the pharmacogenetic disclosure process. Three focus groups were completed with 24 Hmong participants and three major themes emerged using thematic analysis. Many Hmong focus group participants viewed the results positively, finding them useful for themselves and their community as a means to optimize responses to and avoid harms from medicines. However, some participants expressed concerns about harms that the pharmacogenetic information could bring, including anxiety, misunderstanding, discrimination, exploitation, and lack of a clinician involvement in interpreting and applying the result. Many participants interpreted their results through an experiential lens, trusting their experience of medicines more than trusting genetic information, and through a cultural lens, expressing the belief that environmental factors may influence how people's bodies respond to medicines by influencing their inherited flesh and blood (roj ntsha). Lastly, participants stressed the importance of disseminating the information while acknowledging the complex linguistic, educational, and cultural factors that limit understanding of the results. Researchers, genetic counselors, pharmacists, and healthcare providers should strive to return results in meaningful ways to all members of society.

Multicultural curricula in family practice residencies.

BACKGROUND AND OBJECTIVES: In 1985, results from a national survey indicated that 25% of family practice residencies taught about multicultural issues in their programs. Our current study identified the current status and content of the curricula and determined facilitating and impeding factors to multicultural curricula. METHODS: In 1998, the Society of Teachers of Family Medicine's Group on Multicultural Health Care and Education conducted a cross-sectional mail survey of all 476 family practice residency programs. RESULTS: With a 59% response rate, 58% of responding programs have an informal curriculum on multicultural issues, 28% have a formal curriculum, and 14% have no curriculum. Programs with a formal curriculum teach more content, employ more educational methods, use more evaluation techniques, and feel more successful than programs with an informal curriculum. Important factors that facilitate curricula include cultural diversity of communities and residents, multicultural interests of faculty and residents, and faculty's multicultural expertise. Factors that impede curricula include lack of time, money, resources, faculty expertise, and cultural diversity in the community. Programs with formal, informal, and no curriculum identify different facilitators and impediments. CONCLUSION: There was a marked increase in the prevalence of multicultural curricula in family practice residencies from 1985 to 1998.

A curriculum for multicultural education in family medicine.

BACKGROUND AND OBJECTIVES: To deliver effective medical care to patients from all cultural backgrounds, family physicians need to be culturally sensitive and culturally competent. Our department implemented and evaluated a 3-year curriculum to increase residents' knowledge, skills, and attitudes in multicultural medicine. Our three curricular goals were to increase self-awareness about cultural influences on physicians, increase awareness about cultural influences on patients, and improve multicultural communication in clinical settings. Curricular objectives were arranged into five levels of cultural competence. Content was presented in didactic sessions, clinical settings, and community medicine projects. METHODS AND RESULTS: Residents did self-assessments at the beginning of the second year and at the end of the third year of the curriculum about their achievement and their level of cultural competence. Faculty's evaluations of residents' levels of cultural competence correlated significantly with the residents' final self-evaluations. Residents and faculty rated the overall curriculum as 4.26 on a 5-point scale (with 5 as the highest rating). CONCLUSIONS: Family practice residents' cultural knowledge, cross-cultural communication skills, and level of cultural competence increased significantly after participating in a multicultural curriculum.