UPENN SOM || Cultural Competency Medical Education Program || Multiple Choice Questions for CME

Attention Educators: Quiz your audience after teaching this case.

Acquiring Cultural Competency: A 45-YEAR OLD russian woman WITH drug-resistant tuberculosis

Select the best answer.

1) Physicians encounter many patients who may be unaccustomed to the U.S. healthcare system. How can physicians effectively take care of patients from diverse backgrounds?

a) Physicians should focus on their communication skills over understanding a patient’s cultural context.
b) Physicians should emphasize good communication in combination with understanding a patient’s cultural context.
c) Physicians should prioritize understanding a patient’s cultural context and leave communication to a trained medical interpreter.
d) Physicians should treat all patients in the same manner, regardless of a patient’s preconceived notions of the U.S. healthcare system.

2) Language is an unavoidable barrier for many patients in the U.S. What role do ad hoc interpreters serve in bridging the language gap?

a) Ad hoc interpreters may be helpful, but they lack the clinical foundation and experience of trained medical interpreters.
b) Ad hoc interpreters make invaluable contributions to patient care.
c) Ad hoc interpreters are economical and convenient for physicians and patients.
d) Ad hoc interpreters offer little help in communicating with patients.

3) Which of the following skills do trained medical interpreters provide in the clinical setting?

a) They can help the patient make healthcare decisions
b) They are generally proficient in explaining clinical terminology to patients in an understandable cultural context and with limited distortion
c) They have an extensive knowledge of the patient’s medical history
d) They provide the social and spontaneous interactions with patients, such as “small talk” for the development of rapport

4) When employing a trained medical interpreter, which of the following is the ideal position relative to the doctor and the patient?

a) The interpreter should sit next to and slightly behind the physician and make eye contact with the patient.
b) The interpreter should sit between the patient and the physician to emphasize the facilitator role and avoid making eye contact with both parties.
c) The interpreter should sit next to the patient and make eye contact with the physician.
d) The interpreter should sit next to and slightly behind the patient and avoid eye contact with the physician.

5) A trusting physician-patient relationship is a key factor in improving patient adherence to prescribed medications. Which of the following might discourage a patient from taking his or her medications?

a) Using a trained medical interpreter to explain a prescription schedule
b) Discussing folk or culture beliefs in the context of treating the illness
c) Prescribing complex treatments
d) Reinforcing the urgency of the patient’s illness

6) Which of the following questions is an effective way to elicit a patient’s explanatory model of illness regarding tuberculosis symptoms?

a) What is your understanding of tuberculosis?
b) How long have you had tuberculosis?
c) Does your family have a history of tuberculosis?
d) Have you ever been tested for tuberculosis?

7) Direct observed treatment (DOT) is the appropriate treatment for patients with multi-drug resistant tuberculosis. What is the best approach for physicians to initially take when a patient requires DOT?

a) Immediately initiate DOT when the patient’s diagnosis is confirmed
b) Ensure the patient understands the diagnosis, the importance of the treatment, and how this will impact his or her life
c) Alert the patient’s family, friends and co-workers of the elevated risk of TB infection
d) Give the patient time to consider whether the DOT is within his or her budget

8) Why might immigrant patients be reluctant to participate in directly observed treatment (DOT)?

a) Immigrant patients are fearful of medical authority.
b) The patient may harbor feelings of inadequacy towards the U.S. healthcare system resulting from loss of privacy or cultural misunderstanding.
c) They may have had a similar experience in their native country.
d) They may feel DOT will make their illness worse.

9) Under what conditions is the DOT program most successful?

a) DOT is carried out in a way that is convenient for a patient to enable completion of the recommended therapy.
b) DOT is monitored directly by an attending physician at a local health center.
c) DOT is only administered when the patient’s symptoms of illness are most severe, based on the patient’s wishes.
d) DOT is administered when the patient cooperates with hospital instructions.

Answers: 1) B, 2) A, 3) , 4) D, 5) C, 6) A, 7) , 8) B, 9) A