The target audience for the workshop was pharmacy educators at colleges and schools of pharmacy in the United States and Canada. The course was advertised through electronic mail and web-based announcements posted on the Center for the Health Professions' web site. All prospective participants completed a registration form and a brief baseline questionnaire. The questionnaire asked applicants to describe their current teaching and clinical experience and roles and their plans for developing and implementing cultural competence training into their PharmD curriculum.
The train-the-trainer workshop, entitled Incorporating Cultural Competency in Pharmacy Education
, was a 2-day, 16.5-hour (1.65 CEU) course offered once in 2004 and once in 2005 to a maximum of 30 participants per session. The aim of the workshop was to provide participants with an opportunity to learn relevant content and to apply this knowledge by initiating development of their curriculum plans. The training objectives are described in Appendix 1
. The workshop outline, organization, and content were based on previously developed train-the-trainer workshops for health professionals at the University of California at San Francisco. The content and activities were modified for an audience of pharmacy educators. A detailed program agenda and section-specific objectives are available from the corresponding author. The workshop consisted of didactic and experiential activities (eg, role plays, case discussions) designed to allow participants to learn and experience relevant content areas and discuss curriculum development and facilitation challenges. On the second day, participants were asked to initiate and present their plans for content development and implementation.
We evaluated the impact of the workshop using a quasi-experimental, one-group design involving survey administration. The study was approved by the Committee on Human Research (CHR) in the Office of Research at the University of California, San Francisco. The main purpose of the study was to evaluate participants' self-efficacy in: (1) cultural competence, and (2) developing and implementing related course materials. To do so, a set of 3 survey instruments was designed around training objectives and underlying constructs. The survey instruments were completed immediately before the workshop (pretraining baseline survey), at the end of the workshop (posttraining survey), and 9-months after the workshop. Survey instruments collected the following information: (1) sociodemographic factors, (2) prior cultural competence training and teaching experience, (3) measures of self-efficacy in teaching relevant content, and (4) perceptions of the adoptability of the workshop content and materials. The final survey was intended to capture participants' reported behaviors during the academic year following training. These instruments were based on previous instruments used by Center for the Health Professions to evaluate cultural competence trainings for health professionals and assessment materials utilized in the Rx for Change: Clinician-Assisted Tobacco Cessation
), a national train-the-trainer's course for health professions students, educators, and practitioners.11
Course participants were informed about the study by the lead author at the beginning of the workshop. Each subject was assigned a unique identifier to assure confidentiality and facilitate linking survey responses across the 3 assessments. To enhance response rates for the 9-month assessment, participants were contacted twice by e-mail: once to inform them of the follow-up survey and a second time to remind them of the survey deadline.
Sociodemographic factors were assessed in the pretraining survey. These included sex, age, race/ethnicity, years in current position, current academic level, and area of clinical expertise. Participants' experience in working and/or serving as a clinical preceptor in a patient-care setting serving a diverse patient population was also assessed.
Prior training and teaching experience were assessed in the pretraining survey by asking respondents to estimate the number of hours of cultural competence training they had completed. Teaching experience was assessed by asking participants to report the number of years they had taught cultural competence content and the the number of students they instructed in this content area annually. Participants were also asked to describe whether their teaching experiences included didactic lectures, conference sections, and/or continuing education programs on diversity, cultural sensitivity, and/or cultural competence.
The pretraining survey instrument and both posttraining survey instruments measured participants' confidence in developing and implementing cultural competence-related content. The survey conducted immediately after training also measured participants' perceptions of the workshop, training materials, and evaluation of course instructors and logistics. Participants were also asked whether they would recommend the course to other pharmacy and health professions educators.
Using Rogers' Diffusion of Innovations as an underlying theoretical framework for evaluating the dissemination process,12
posttraining perceptions associated with adoptability of the workshop content and materials were assessed with respect to: (1) compatibility for integration into the existing curriculum structure, (2) relative advantage over other available cultural competency training materials, (3) relative advantage over other cultural competence content and materials currently taught and used in the curriculum, (4) comprehensiveness of content, (5) appropriateness of teaching methodologies discussed, (6) confidence in their skills for teaching cultural competence, and (7) likelihood of adoption of cultural competence at their college or school of pharmacy. Response options included 1 = none, 2 = low, 3 = moderate, and 4 = high.
On both the posttraining and 9-month survey instruments, the perceived importance was assessed (1 = not at all, 2 = a little, 3 = moderately, 4 = very, and 5 = extremely important) and likelihood of adoption in the coming academic year (1 = definitely not, 2 = probably not, 3 = not sure, 4 = probably yes, 5 = definitely yes) for the content areas addressed in the workshop. We also assessed whether participants personally had the ability to determine whether cultural competence-related content would be integrated into their school's curriculum.
Using a 5-point scale (1 = not at all, 2 = a little, 3 = moderately, 4 = very, and 5 = extremely important), a series of perceived barriers to use of the workshop content were assessed, including lack of curriculum time, financial resources, faculty content expertise, faculty interest, faculty's perceptions of importance of cultural competence, access to comprehensive, evidence-based resources for teaching cultural competence-related content, and available advanced pharmacy practice experience (APPE or clerkship) sites with access and exposure to diverse patient populations. These items were assessed posttraining.
In the 9-month survey instrument, the extent to which faculty participants had integrated cultural competency content into the pharmacy curriculum at their institution was assessed. Specifically, we assessed the amount of curricular time dedicated to cultural competency, methods by which the content had been implemented or delivered (eg, lectures, conference sections) and the number of students taught.
Statistical analyses involved computation of simple summary statistics to characterize the questionnaire responses. Group comparisons were made using t tests. Analyses were conducted using SPSS Version 10.1.3. (SPSS Inc, Chicago, Ill).