Psychology Learning and Teaching Volume 13 Number 3 2014 www.wwwords.co.uk/PLAT REPORT
Multicultural Grand Rounds: competency-based training model for clinical psychology graduate students SHANA D. STITES & CHRISTINA L. WARHOLIC Department of Psychology, School of Graduate Studies, Chestnut Hill College, Philadelphia, USA
Preparing students to enter the field of psychology as competent professionals requires that multicultural practices be infused into all areas of training. This article describes how the Grand Rounds model was adapted to a graduate clinical psychology training program to foster applied learning in multicultural competence. This extension of Grand Rounds as A? student-driven program to enhance multiculturalism may help others in doctoral psychology training programs develop experiential learning opportunities to further enhance professional competence.
Introduction Multiculturalism has become increasingly recognized as an important factor in the profession of psychology. Within the last decade, substantial research has shown that culturally inclusive clinical interventions typically yield stronger therapeutic alliances and better clinical outcomes than usual care (Griner & Smith, 2006; Smith, Constantine, Dunn, Dinehart, & Montoya, 2006). Concurrent with the emergence of empirical research, the American Psychological Association (APA) has highlighted the importance of multiculturalism throughout the profession of psychology (APA, 2002, 2003, 2007). In fact, appropriately incorporating ‘critical aspects of an individual’s ethnic/racial and personal identity’ has become a fundamental component of practice, research, and teaching (APA, 2003, p. 380). Graduate programs in professional psychology are tasked with preparing students to enter the field of psychology as competent new career professionals (APA, 2007; Kamen, Veilleux, Bangen, VanderVeen, & Klonoff, 2010). As part of this groundwork, the capacity for training programs to imbue students with multicultural competence is paramount to the generativity of producing a culturally competent profession. To accomplish this task, clinical psychology training programs tend to focus on teaching students cultural competency in therapeutic contexts (Vera & Speight, 2003). Academic curricula typically require students to meet the expectations for multicultural competence that are established by clinical practica supervisors and complete one or two traditional lecture-style courses on the topic of multiculturalism. However, development of multicultural competence requires aspects be infused into all areas of training (APA, 2007; Arredondo & Arciniega, 2001; Kiselica, Maben, & Locke, 1999; Ponterotto, 1998). Broadly defined, psychology students must achieve multicultural competence on three dimensions: awareness, knowledge, and skills (Sue, Arredondo, & McDavis, 1992; Sue et al., 1982). Awareness of salient multicultural factors such as age, gender, race, ethnicity, physical ability, sexual orientation, religion and socioeconomic status, may be one of the earliest steps in moving towards cultural competence (APA, 2002). Students must also develop a knowledge base and comfort in conversation in order to professionally and appropriately engage these aforementioned 261
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Shana D. Stites & Christina L. Warholic domains (Cardemil & Battle, 2003). It is also crucial that they learn skills and adaptation of those skills to different populations and situations (Clay, 2010). Competency-based skills relate to the ability of a psychologist to bring together the elements of awareness, knowledge and skills, in order to incorporate aspects of cultural identity in the therapeutic process that impact a client’s experience. Many times clients have more than one cultural element relevant to their situation. In fact, conflicts between aspects of a client’s identity often precipitate them seeking mental health care. Issues of multiculturalism are also becoming increasingly pertinent as the world becomes a more global community and psychologists less often provide services to clients with whom they share a common cultural background. Developing competency-based skills is crucial for graduate students in clinical psychology programs; however, there are few training models to help students learn these skills. This multicultural Grand Rounds program was conceived in a novel effort to more fully integrate multiculturalism into all aspects of graduate student training in clinical psychology. This multicultural Grand Rounds program extends the traditional Grand Rounds model as a studentdriven initiative to create an ecologically ground learning opportunity. As a student-driven initiative, the potential benefits of the multicultural Grand Rounds program include opportunities to develop skills in leadership, professional collaboration, and clinical consultation. This novel element also appears to aid the sustainability of the program as an ongoing feature within a graduate curriculum. To our knowledge, it is the first such program to be offered as a requirement in a graduate student curriculum and be implemented on-site in the college setting. In this article we describe the adaptation and implementation of the Grand Rounds training model to augment teaching of multicultural competence in a clinical psychology training program. To provide enough information so that others may critique and replicate the initiative, we first describe the general applicability of the Grand Rounds framework as a training model. We then describe each component of the multicultural Grand Rounds program. Results from participant surveys are also reported. The primary goal of this program was to augment teaching of multicultural competence in an existing APA-accredited curriculum. Grand Rounds: a model for clinical training Historically, the Grand Rounds model has a rich tradition spanning more than a century that has established it as a valuable format in which to learn clinical skills (Hull, Cullen, & Heckelman, 1989; Parrino & White, 1990). Grand Rounds was first initiated by clinicians who conducted bedside rotations with senior and junior colleagues. As the popularity of Grand Rounds increased, the forum was eventually moved from the patient bedside to hospital auditoriums, where patients were invited to talk with groups of physicians. The Grand Rounds and its variations, including ward rounds and clinical rounds, has been used by psychologists in clinical settings (Salman, Stone, & Warlow, 2007). The objectives of Grand Rounds have changed over the years to meet the expectations of attendees. Originally a patient-centered experience aimed at increasing clinician knowledge for treating unique cases, today Grand Rounds is more commonly used to educate students, showcase faculty role models, and promote collegiality in clinical settings (Herbert & Wright, 2003; Hull et al., 1989). As model of delivering experiential learning opportunities, the Grand Rounds forum has been used as an important mechanism for teaching new information, facilitating clinical reasoning skills, and enhancing competency among clinicians (Hull et al., 1989; Van Hoof, Monson, Majdalany, Giannotti, & Meehan, 2009). Participation in Grand Rounds has also been associated with increased flexibility in thinking and memory for clinical knowledge (Praschinger, Steiger, & Kainberger, 2007). Moreover, a single presenter typically leads these events. Presenting at Grand Rounds has been noted as a form of professional currency and a means of advancement for junior colleagues (Medina-Walpole, Fonzi, & Katz, 2007). In sum, the Grand Rounds model has been shown to be an effective method for facilitating case-based learning of clinical information and enhancing professionalism.
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Multicultural Grand Rounds Graduate Student Adaptation of Multicultural Grand Rounds At its origin, a delegation of students submitted a formal proposal to faculty members that outlined the plan for implementing multicultural Grand Rounds. Following faculty approval, the proposed program was reviewed by the Institutional Review Board of Chestnut Hill College. The multicultural Grand Rounds is a student-driven program, however its implementation would not have been possible without the collaboration and ongoing support of faculty members. In brief overview, the multicultural Grand Rounds program has been intentionally designed to provide a relaxed, open forum that fosters sharing and questioning among attendees. Students are provided with a mock clinical case to review prior to the events. The general structure of each event begins with a succinct review of the mock clinical case, followed by skill demonstration videos that reflect core competencies related to the case. Next, professional panelists, vetted as licensed mental health clinicians, are invited to describe their conceptualizations of the case before opening discussion among panelists, program faculty, and student attendees. Table 1 shows a summary of the principal elements of multicultural Grand Rounds. The sections of the article that follow detail these core components of the events. Table 1. Multicultural Grand Rounds: principal elements of psychology graduate student Grand Rounds. Grand Rounds component Professional panelists
Description Three volunteer mental health professionals from the local community are invited as panelists to share clinical and content expertise.
Composite clinical case
A mock case created by the student leadership committee with feedback from the general student body, mentorship from faculty, and APA legal and ethical standards. Mock cases focus on a core multicultural aspect of a client’s identity, such as gender, religion, or race, and one that is crucial to the clinical presentation.
Multicultural clinical skills videos
Videos created by a group of 2 to 4 graduate students that exemplify multiculturally competent clinical skills related to the mock case. Examples of skill videos have included sexuality interviews and family structure interviews.
Student leadership committee
Typically, 4 to 6 graduate students enrolled in the clinical psychology program that volunteer to take responsibility in planning the event and preparing event materials.
Student attendees
Forums are open to graduate students in clinical psychology pursuing Master’s and doctoral degrees. Student attendees prepare in advance for the forums by reviewing the mock case and generating questions for panelists.
Program evaluation
Student organization committee conducts, analyzes and reports on anonymous satisfaction surveys.
Clinical psychology program faculty member mentor
A member of the psychology program faculty who volunteers to mentor members of the student leadership committee on preparation of the mock clinical case.
Student Leadership For each multicultural Grand Rounds, four to six students volunteer for the leadership group through one of the three student organizations, which alternate responsibility for maintaining the program. These student groups focus on three broad categories of multiculturalism addressed by APA’s Division 44: Sexuality and Sexual Orientation, Race and Ethnicity, and Human Rights. Each of the triannual 75-minute, student-driven forums alternates focus on at least one of the aforementioned areas. Students are involved as leaders and role models in all aspects of the program’s administration. Participation in the leadership group is voluntary and open to all currently enrolled 263
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Shana D. Stites & Christina L. Warholic students. With guidance from faculty members, these students are tasked with developing strategies to address all of the logistical planning for events, which includes identifying panel volunteers, working with faculty to identify times to hold the events, and arranging logistics associated with the venues. Professional Panelists Psychologists or other mental health professionals, who volunteer their time, serve as panelists in the events. Three panelists with content expertise relevant to the composite case are selected from: (1) a program faculty, (2) program alumni, and (3) mental health professionals in the local community. Each panelist provides a brief (five-minute) commentary on the mock case that consists of his or her specific reactions and conceptualization of the case. Panelist responses address the course and type of treatment based on current scientific literature and their clinical experiences. They are encouraged to consult with one another during the student-panelist inquiry to model professional interactions and allow students to observe first-hand the dialog between professionals as they acknowledge and defer areas of expertise. Student Attendees Students who attend and participate in these events are a paramount force. Because the notion of Grand Rounds and its format can be novel for psychology graduate students, they are given clear direction with respect to their attendance and participation. Students are asked to thoroughly review the composite case and prepare questions in advance. In addition, at the outset of each event, a brief overview is given to explain the structure of the forum and encourage active engagement. Unlike a traditional classroom setting or Grand Rounds forum, there are multiple clinicians participating in the discussion of multiculturalism. The environment is collegial rather than hierarchical as is common in lecture-based classes. An overarching goal of the multicultural Grand Rounds is to provide an open and comfortable forum for students to actively learn and apply aspects of multiculturalism in all areas of professional practice. Once students understand the parameters of the forum, they appear to often make the most of the opportunity to seek mentorship and expertise from panelists as well as engage peer-to-peer learning. They frequently ask for feedback on their case conceptualizations, clarification about the perceived relevancy of multicultural factors, help in identifying culturally appropriate modifications to interventions, and ways to broach sensitive cultural issues with patients, colleagues, and others. Mock Case Conceptualization A mock case is used to promote ‘real world’ clinical inquiry. The goal is to facilitate the learning of the role of multiculturalism in clinical assessment, diagnosis, and conceptualization. Development of the mock case is the responsibility of the leadership group. They ask others throughout all six academic years in the program to submit specific issues related to multicultural diversity that they would like to examine in the mock case. The leadership group creates the mock case and ensures it is distributed to students two weeks prior to the scheduled event. As students work together to create the composite case, they are expected to consult with faculty. A faculty adviser volunteers to mentor based on having a specific interest and expertise in the core clinical issue of the case. Although the majority of the effort in devising the composite case falls to the students who are organizing the event, the faculty adviser provides expert feedback to help students develop the most realistic case possible while also helping to hone the focus of the case to maximize discussion of the most clinically relevant aspects. During this consultation, students are given opportunities to understand the adviser’s reasoning in terms of both clinical and instructional pragmatism. Each panelist offers a unique conceptualization of the mock case. These multiple points of view share commonalities that demonstrate to students critical elements that seem universal as important factors to be considered in the case. The differences in the conceptualizations plausibly 264
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Multicultural Grand Rounds encourage students’ flexibility in clinical reasoning. Moreover, students can see how different responses and lines of questioning affect the selection of treatment interventions and cultural accommodations. Student attendees have underscored the value of this unique feature of the multicultural Grand Rounds as key in helping them gain awareness about how their clinical decisions can impact clinical care. In multiculturalism courses, each prominent aspect of diversity is commonly discussed but each topic discussion is often maintained separate from any others. In contrast, individuals who seek psychotherapy or other psychological services often identify with more than one area of diversity. The mock cases are meant to promote similar complexity as found in clinical practice. For example, one mock case was a 14-year-old adopted Chinese male with borderline intellectual functioning and a significant history of trauma. He also presented himself in a traditionally feminine manner. He may be considered diverse in terms of race, culture, and gender identity. These facets of diversity must be understood and addressed within the context of a singular human being and in terms for psychological assessment and treatment practices that must be tailored to respectfully and holistically meet the needs of the individual. Because the cases are intentionally developed using student feedback to include multiple areas of cultural diversity, they allow for the complexity that would be expected of actual clients as compared to traditional lecture-based learning models that tend to cover one topic area at a time. They also tend to focus on issues in multiculturalism that students have identified as areas for learning. The mock cases tend to include varying numbers of cultural factors, these factors are often weighted in varying degrees of importance to the client (i.e., some clients are presented as less concerned with racial issues and more with gender identity), and different types of diversity (race, culture, gender identity, sexual orientation, etc.). However, the format of each mock case follows closely the accepted format for case presentation, in which a client’s history, presenting concerns, and treatment goals are reviewed. Skill Demonstrations Before each event, students create skill demonstration videos to showcase specific therapist clinical skills or features of the mock client’s presentation. The video presentations are intended to demonstrate competency-based skills for new clinicians. The skills shown in the videos are modeled on the standards for evidence-based practice and relate to core features of the composite case. For example, during one event, the video demonstrations focused on best practices for conducting sexuality interviews. In another, the video concentrated on an initial interview with an ethnically diverse family. The videos are scripted and created by students then vetted by faculty members. These videos remain available in a library archive for later viewing. Ethical-legal Standards Attending to legal and ethical issues is an important part of the multicultural Grand Rounds. These issues are addressed in both the organizational structure of the program as well as during the forums. In implementing the multicultural Grand Rounds, client information that is presented reflects strictly composite or pseudo information and is clearly identified as ‘mock’. In addition, the roles of organizers, faculty mentors, and panelists have been clearly delineated. Panelists receive communications that describe the events, including the role and commitments of volunteers and the organizational structure in a given event. Additionally, panelists exemplify ethical behavior to students through decision-making about the mock case. Research Evaluation Panelists respond to student inquiry with frequent reference to published research. Their references tend to include elements of what is established and not yet known in current research. They demonstrate for students the ways this information is contextualized and applied directly to clinical practice using the mock case. Panelists often introduce student attendees to different areas of scientific knowledge and research methods. 265
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Shana D. Stites & Christina L. Warholic The multicultural Grand Rounds also provides opportunities for students to participate in program evaluation. Following each event, the leadership group analyzes data from the satisfaction surveys and presents summaries of these results to the faculty. The results can be used by students and faculty to improve future events. The collected data are intentionally limited to issues of satisfaction in order to encourage the event as a safe forum for students to take individual risks in terms of exploring multicultural issues and engaging professional exchanges without concern for external evaluation. It is also hoped that students make use of these forums as opportunities to foster self-evaluation and self-reflection. Evaluation of Student-driven Multicultural Grand Rounds We evaluated the feasibility and sustainability of implementing this student-driven multicultural Grand Rounds program in an existing graduate psychology curriculum. The basis of our examination was informed by the concerns expressed when the program was initially proposed to faculty. These concerns related to potential costs to students both financially and in terms of expended time and effort; time and effort required of faculty; and interest and perceived value to students. The amount of time and effort required to organize and implement each event appears easily accommodated into the schedules of students, faculty, and staff. Those in the leadership group commit approximately ten hours, and the student leader also typically invests about six hours. The faculty adviser tends to commit about two hours to mentorship. Because the tasks of the organization group are shared across several students, the per student time commitment did not appear sufficient to justify pursuit of academic credit. Although attendance is mandatory, participation does not receive an academic grade. We examined interest and perceived value of the multicultural Grand Rounds by attendee responses on satisfaction surveys that were administered immediately following each event. Students indicated their ratings on 7-point Likert scales anchored at ‘not at all’ (1), ‘neutral’ (4), and ‘very’ (7) on three separate questions. Figure 1 shows the mean response for each question during the first four consecutive multicultural Grand Rounds. Figure 1. Mean responses from multicultural Grand Rounds satisfaction survey, fall 2009 to spring 2011.
Note. Error bars are normal 95% confidence intervals. Respondents indicated their answer as a rating on a 7-point Likert Scale with 1 = not at all, 4 = neutral, and 7 = very. (A) How helpful did you find the Grand Rounds with regards to your development as a clinical psychologist (circle one)? (B) How much did the Grand Rounds expand your knowledge or
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Multicultural Grand Rounds comfort for working with diverse clients (circle one)? (C) How satisfied were you with the quality of the panel’s responses (circle one)?
When asked to rate how helpful the multicultural Grand Rounds event was in their development as clinical psychologists, the mean student rating in fall 2009 was 5.37 (95% CI 5.14 to 5.59) and in spring 2011 the mean was 5.92 (95% CI 5.72 to 6.13). Students were also asked to rate how much the multicultural Grand Rounds expanded their knowledge or comfort for working with diverse clients. The mean student rating on this item in fall 2009 was 5.24 (95% CI 5.00 to 5.48) and in spring 2011 the mean was 5.95 (5.75 to 6.15). When asked to rate their satisfaction with the quality of the panel’s responses, the mean student rating in fall 2009 was 5.83 (5.65 to 6.02), whereas in spring 2011 the mean was 6.45 (6.29 to 6.62). The surveys also encouraged students to provide feedback to improve the events. The majority of responses to this open-ended question were comments that the program should not be modified. A small number of students (6 to 8) recommended the duration of the events extend beyond 75 minutes. Student organizers frequently offered unprompted compliments about the multicultural Grand Rounds. They reported valuing the clinical learning opportunities provided by the events and enjoying the chance to collaborate with other students. In both instances in which criticisms were offered, students reported minor frustrations about miscommunications with the college facility’s department. We also found that the four to six volunteer positions in the leadership group are typically filled within one calendar week of the student leader announcing the request for volunteers, suggesting students quickly take advantage of the opportunity to participate. Moreover, we found most students opted to volunteer on an ongoing basis following their initial experience. Summary and Future Directions This multicultural Grand Rounds model extends the case-based learning approach of traditional Grand Rounds to an ecologically based training experience that aims to foster multiculturalism among psychology graduate students. Unlike traditional Grand Rounds, this model is fully studentdriven with graduate students as the key designers, organizers, and stakeholders of each event. The model also extends the Grand Rounds model by including multiple teaching modalities such as panel-student discussion and skill demonstration videos. As an adjunct to the traditional method of teaching multiculturalism in the university setting, these multicultural Grand Rounds allow for students to integrate information learned in lecture-based settings in dynamic and interactive discussion of clinical cases. As often encountered in professional practice, the content of the composite cases aims to mirror the vibrant complexity of the lives of clients, who commonly identify and experience the effects of multiple aspects of diversity. Participation in multicultural Grand Rounds during doctoral training may help prepare psychology students to succeed in professional activities later in their careers. Each element of the multicultural Grand Rounds is intended to illuminate the roles of cultural factors affecting professionals in the practice of clinical psychology. Prior research suggests that Grand Rounds events facilitate professional competency, including clinical knowledge and decision-making (Hull et al., 1989; Praschinger et al., 2007; Van Hoof et al., 2009). A particularly engaging and important benefit of the Grand Rounds forum is the spontaneity of the panel-student discussion regarding ways to adapt clinical interventions to meet the needs of culturally diverse patients. The multicultural Grand Rounds is a student-driven program that appears easily sustainable within psychology graduate training curricula. Although it requires busy students and faculty to voluntarily commit time, the program has been well received with many student participants offering informal and spontaneous positive feedback and volunteering for the opportunity to be part of the leadership group. Initial findings from participant surveys are promising in that they suggest students find value in how this program helps development of their clinical skills and furthers their development as clinical psychologists. In the future, more rigorous investigation may help determine whether the multicultural Grand Rounds could serve as an evidence-based training method to foster multicultural competence among clinical psychology graduate students. Future evaluation that includes assessment of changes in interest levels and self-assessed clinical knowledge may be particularly useful in understanding the effectiveness of the multicultural Grand Rounds training model. 267
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Shana D. Stites & Christina L. Warholic It is hoped that this thorough review of the multicultural Grand Rounds model may facilitate adoption of this or similar programs in other doctoral training programs in order to enhance multicultural training. As a well-established format for case-based learning, we have demonstrated that the Grand Rounds model can be successfully extended to aid in teaching multiculturalism. Adaptations of the Grand Rounds model could also aid student learning in a broad array of other content areas. Subject areas in which instructional cases can be easily applied appear a natural use of the Grand Rounds case-based teaching method. For graduate psychology students, these areas may include differential diagnosis or specific types of treatment interventions for clients with varying diagnoses. One of the key components of the Grand Rounds model that appears to greatly appeal and facilitate learning for psychology students is the interactive large-group discussion with peers and mentors. This aspect of the Grand Rounds model could be used to facilitate interactive in topic areas that may not be considered to traditionally lend to case-based learning, such as research design and methods. Acknowledgements The authors sincerely thank Joseph Micucci, Eileen Webb, Laura Serbonich, Kate Altman, Crystal Taylor, and faculty of the Chestnut Hill College MS/PsyD Program for their valuable contributions that made the multicultural Grand Rounds possible. References American Psychological Association (APA). (2002). Ethical principles of psychologists and code of conduct. American Psychologist, 57(12), 1060-1073. http://dx.doi.org/10.1037/0003-066X.57.12.1060 American Psychological Association (APA). (2003). Guidelines on multicultural education, training, research, practice, and organizational change for psychologists. American Psychologist, 58(5), 377-402. http://dx.doi.org/10.1037/0003-066X.58.5.377 American Psychological Association (APA). (2007). Guidelines and principles for accreditation of programs in professional psychology. Washington: Author. http://www.apa.org/ed/accreditation/about/policies/guiding-principles.pdf Arredondo, P., & Arciniega, G. M. (2001). Strategies and techniques for counselor training based on the multicultural counseling competencies. Journal of Multicultural Counseling and Development, 29(4), 263-273. http://dx.doi.org/10.1002/j.2161-1912.2001.tb00469.x Cardemil, E. V., & Battle, C. L. (2003). Guess who’s coming to therapy? Getting comfortable with conversations about race and ethnicity in psychotherapy. Professional Psychology, 34(3), 278-286. http://dx.doi.org/10.1037/0735-7028.34.3.278 Clay, R. A. (2010). How do I become culturally competent? Grad Psych, 8(3), 24-26. http://dx.doi.org/10.1037/e598512010-013 Griner, D., & Smith, T. B. (2006). Culturally adapted mental health interventions: A meta-analytic review. Psychotherapy, 43(4), 531-548. http://dx.doi.org/10.1037/0033-3204.43.4.531 Herbert, R. S., & Wright, S. M. (2003). Re-examining the value of medical Grand Rounds. Academic Medicine, 78, 1248-1252. http://dx.doi.org/10.1097/00001888-200312000-00013 Hull, A. L., Cullen, R. J., & Hekelman, F. P. (1989). A retrospective analysis of Grand Rounds in continuing medical education. Journal of Continuing Education Health Professions, 9(4), 257-266. http://dx.doi.org/10.1002/chp.4750090410 Kamen, C., Veilleux, J. C., Bangen, K. J., VanderVeen, J. W., & Klonoff, E. A. (2010). Climbing the stairway to competency: Trainee perspectives on competency development. Training and Education in Professional Psychology, 4(4), 227-234. http://dx.doi.org/10.1037/a0021092 Kiselica, M. S., Maben, P., & Locke, D. C. (1999). Do multicultural education and diversity appreciation training reduce prejudice among counseling trainees? Journal of Mental Health Counseling, 21(3), 240-255. Medina-Walpole, A., Fonzi, J., & Katz, P. R. (2007). Academic career development in geriatric fellowship training. Journal of the American Geriatrics Society, 55(12), 2061-2067. http://dx.doi.org/10.1111/j.1532-5415.2007.01425.x Parrino, T. A., & White, A. T. (1990). Grand Rounds revisited: Results of the survey of US departments of medicine. American Journal of Medicine, 89(4), 491-495. http://dx.doi.org/10.1016/0002-9343(90)90381-M
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Multicultural Grand Rounds Ponterotto, J. G. (1998). Charting a course for research in multicultural counseling training. Counseling Psychologist, 26, 43-68. http://dx.doi.org/10.1177/0011000098261004 Praschinger, A., Stieger, S., & Kainberger, F. (2007). Diagnostic Grand Rounds in undergraduate medical education. Medical Education, 41(11), 1083-1111. http://dx.doi.org/10.1111/j.1365-2923.2007.02888.x Salman, R. A., Stone, J., & Warlow, C. (2007). What do patients think about appearing in neurology ‘Grand Rounds’? Journal of Neurology, Neurosurgery, & Psychiatry, 78(5), 454-456. http://dx.doi.org/10.1136/jnnp.2006.110148 Smith, T. B., Constantine, M. G., Dunn, T. W., Dinehart, J. M., & Montoya, J. A. (2006). Multicultural education in mental health professions: A meta-analytic review. Journal of Counseling Psychology, 53(1), 132-145. http://dx.doi.org/10.1037/0022-0167.53.1.132 Sue, D. W., Arredondo, P., & McDavis, R. J. (1992). Multicultural counseling competencies and standards: A call to the profession. Journal of Counseling and Development, 70, 477-483. http://dx.doi.org/10.1002/j.1556-6676.1992.tb01642.x Sue, D. W., Bernier, J., Durran, M., Feinberg, L., Pederson, P., Smith, E., & Vasque-Nuttal, E. (1982). Position paper: Multicultural counseling competencies. Counseling Psychologist, 10, 45-52. http://dx.doi.org/10.1177/0011000082102008 Van Hoof, T. J., Monson, R. J., Majdalany, G. T., Giannotti, T. E., & Meehan, T. P. (2009). A case study of medical Grand Rounds: Are we using effective methods? Academic Medicine, 84(8), 1144-1151. http://dx.doi.org/10.1097/ACM.0b013e3181ad1c0e Vera, E. M., & Speight, S. L. (2003). Multicultural competence, social justice, and counseling psychology: Expanding our roles. Counseling Psychologist, 31(3), 253-272. http://dx.doi.org/10.1177/0011000003031003001
SHANA STITES*, PsyD, MS, is a social policy researcher in Philadelphia, PA. She recently completed her doctorate in clinical psychology at Chestnut Hill College and internship at the Philadelphia VA Medical Center. Dr Stites’s primary area of research interest is the use of quantitative methodologies to bridge research and clinical practice. She has a special interest in improving access to culturally appropriate care for persons who identify with minority groups based race, gender, and physical disability. Correspondence:
[email protected] CHRISTINA WARHOLIC, PsyD, is a neuropsychologist in Grand Rapids, MI. She recently completed her doctorate in clinical psychology at Chestnut Hill College and internship at the Behavioral Resources Institute for Neuropsychological Services. Her primary area of research interest is using quantitative methodology to understand neurodiversity and its effects on psychological functioning. Correspondence:
[email protected] *Contact author Manuscript received 19 January 2014 Revision accepted for publication 20 June 2014
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