Ensuring that individuals and families feel welcomed and affirmed, and are able to trust their providers, requires not only that providers and staff are culturally competent as individuals, but that the competencies of health care organizations and systems are continuously assessed and improved.
It is key that learners are self-motivated. As stated, self-motivated adult learning builds on the learner’s existing skills and meets their immediate needs.
The learning objectives for the training should be about 60% based on the individualized assessment before the training. This makes it more relevant to the learner’s practice. Usually the needs assessment is made by phone call with the person organizing the training, in particular to find out if there has been an incident that needs to be addressed.
If unable to do an in-depth needs assessment, the trainer can pass out index cards at the beginning of the class and ask learners o write down questions about the topic. The trainer can go through the questions and make sure they are answered before the session is over. This method allows the questions to be anonymous and compensates for not having the capacity to do a needs assessment.
Another alternative to a pre-assessment is to do a quick assessment of the room at the very beginning of the training by asking: “What do you want to get out of this workshop?” The trainer can list each answer and check them off as the training goes on. In any case, the trainer should try to get a sense of who is in the room and give people some time to tell what they want to get out of the training. Another interactive, learner-generated group exercise is to give learners a minute to jot down their thoughts and questions, and in groups decide on one or two priorities for the larger group.
If the learning objectives are created outside of the classroom, the trainer can contribute to an environment of self-motivated learning by circulating the learning objectives and reviewing them at the beginning. This is an opportunity to provide a reminder of the objectives that were agreed upon before the training was started and of the things that need to be accomplished in the room.
One trainer recommends a ground rule: “We are all teachers and learners.” This sets up the expectation from the beginning that the group recognizes that everyone has something to offer and something to learn, and that the trainer is there to facilitate that learning. One trainer phrases it this way, “I am much more interested in what you have to say than in what I have to say, because I present this material a lot. I want to know what you think of it and what your questions are.” These phrases remind learners that “we are all on the journey together” and helps to break down the barrier between the trainer and the learner. In adult learning environments, folks have expertise in their area far beyond what the trainer brings.
The language of “the journey” while potentially cliché, is a reminder that trainings are just the beginning of a process. One training is never enough, but it can be part of a life-long journey. Learners can hear, both implicitly and explicitly that mistakes and setbacks are normal, and that learning is part of the process, so please keep going forward. The trainer is giving them space and tools to get to a new place.
In the recent months of the COVID-19 pandemic, the in-person LGBTQIA+ cultural competency programs are now conducted almost exclusively in online, virtual meeting spaces.
Trainers have had to change the way they train, in the time of COVID, to account for the necessity of remote learning. Some trainings are done in a way that people can access as recorded, self-directed training. Self-directed learning refers to the automated presentations conducted online, which are self-paced. Even when the learner is alone during the training, going through the talk by themselves, the training is still more effective if it is interactive. Some interactive offline methods translate well to online, self-directed trainings. For example, quizzes that allow the learner to measure or assess themselves against the right answer and interactive case studies where the learner engages in a simulated visit or clinical encounter and afterwards compares notes to the experts.
Often self-directed trainings are considered “knowledge-based” trainings that are likely an efficient option for complying with different licensing requirements. The Fenway Institute’s National LGBTQIA+ Health Education Center has a number of online, self-guided modules that contain case studies on a variety topics related to LGBTQIA+ health. However, attitudes and behaviors-based trainings require different learning objectives and different methods.
Online trainings can blend technology tools together to maximize learner interactions, so picking the platform is very important. One expert finds the Zoom platform is very accessible. The trainer described that the Zoom platform has low bandwidth requirements and therefore increased accessibility in rural and technology-challenged places.
The more critical and skill practice the training is, the more important it is that they are on camera. With skills like motivational interviewing, the participants cannot participate if they are not on camera. The visual information from the video is helpful, even if it is limited to the torso or head. For knowledge-based learning, there is less need to be on camera. Virtual, or online attitudes and behavior trainings are difficult. Trainings on cultural competency require people to reflect on the importance of their work on marginalized communities, which needs empathy and reflection. You can make the most inroads with people when they are able to talk and have guided dialogues, skills training, role plays, and case studies.
Online trainings should be kept smaller, as small groups are better for practicing skills and learning from each other to develop skills. The smaller groups create safer spaces for sensitive topics. It allows room for people that are less likely to be verbal to find their way into the conversation.
Online platforms create novel opportunities. An example from a trainer, “When we had 80 people show up, we were able to divide them into 40 rooms, and practice with each other in pairs. We could make it work in the large context.” Large groups can be made smaller on some platforms by using breakout rooms. Trainers can divide the room in half for any reason, or construct groups of 4-6 people when appropriate, or do skill practice in groups of 2-3.
Live virtual trainings can benefit from recorded demonstrations on some of the challenging topics, like addiction in the brain or microaggressions. Recorded experts give the trainer a tool that allows them to insert the expertise, while still having the support of the skilled trainer for handling the questions and concerns. Even longer recordings can be trimmed down to accommodate the needs of the specific group.
Trainers find that polling questions are an interactive tool helpful for engaging learners. This gives learners another opportunity besides speaking on camera. Chat functions in virtual environments can be used for people who do not want to be on camera or speak out loud. The chat function is an excellent place for limited discussion and answers to straightforward questions.
There is sophisticated polling software available for purchase that allows for more interactive opportunities. Poll Everywhere is a polling software that is relatively accessible and relatively cheap. It allows different kinds of responses, and can display graphs, word clouds, and updates the visualization as data is collected. The different polling options allows the trainer to introduce group influence effects, or keep responses hidden until after the poll closes. These interactive, user generated activities help to build buy-in and keep attention. Interactive, learner generated activities also break the barriers that keep people from speaking to each other.
In the virtual training there are hard barriers to bringing people into discussion so the trainers have to make ways of breaking them into conversation. In one LGBT cultural competency training a trainer used a poll to ask people about the general feeling in their community toward the LGBT community, “Was it generally more positive or negative?” By asking about the community’s level of experience, comfort and knowledge, the learner’s feelings are stirred up, and propels them to be present in the learning experience, and gets them into thinking about their feelings.
Many trainers try to always start the training with a learner generated activity, like creating group norms. Here are other examples:
From a training on the impact of drugs on the brain: The trainer pulls up a white board and asks someone to draw an image of the brain and have learners write where in the brain the drugs have an impact. Afterwards, the trainer goes to a slide with a brain and the impacts and talk about them. Then they can compare the answers and get the contributions from the learners. They are primed and ready to think about what they already know and so they are more likely to bring it in and contribute to the discussion.
An example from a training on LGBTQIA+ cultural competency to social workers: The trainer, again at a white board, asks learners to name different identities. The trainer takes the list down or has learners come up and write the identities on the board. Afterwards, the trainer goes to a slide and discusses that everyone has a sexual orientation, sex, and gender identity. This list can be used throughout the training to discuss difference. Gender is frequently an issue where learners do not easily understand that the gender binary does not exist. When you add in that sex is also non-binary, and that sexual orientation is unrelated to these other non-binaries, is can be very confusing for people. Starting with vocabulary can help to work through the issue of creating affirming environments and poke at some biases early so learners can grow aware of their knowledge gaps. As you work through the content, their preconceived ideas and unconscious biases become more apparent as people play with the interaction between the communities and concepts.
Self-motivated learning values the expertise and knowledge of the learner and builds on existing experiences to develop new skills. The educator as facilitator should recognize and validate existing expertise in learners and use the learner’s experiences as grounds for discussion. Instead of disseminating knowledge to learners in a lecture, the facilitator is one of many resources available to learners and provides additional resources.
The facilitator guides learners to identify their learning needs. Allowing the learner to identify their needs requires reflection from the learner and patience by the facilitator. When time constraints do not allow for this level of engagement, sharing learning objectives with learners and discussing whether those objectives meet their needs or ought to be revised can set appropriate expectations and give learners more control over their experience.
Self-motivated learning provides the learner with opportunities to reflect on their own personal experience and performance, to recognize their deficits in their provision of care and professionalism, to measure their own learning needs against professional and regulatory standards, and to fill their self-identified knowledge and skill gaps.
The learner engages in the development of learning objectives. The facilitator assists the learner with identifying appropriate resources. Self-motivated learners may reveal expertise among their colleagues, patients, and the facilitator. In the limited time of many cultural competence trainings, the facilitator may be the primary resource for self-motivated learners. The learner begins research to meet their learning objectives. Finally, the learner is committed to the learning contract and conducts self-evaluation of learning.
