title: Cultural Respect Encompassing Simulation Training: Being Heard About Health Through Broadband.
abstract: BACKGROUND
  Cultural Respect Encompassing Simulation Training (CREST) is a learning program that uses simulation to provide health professional students and practitioners with strategies to communicate sensitively with culturally and linguistically diverse (CALD) patients. It consists of training modules with a cultural competency evaluation framework and CALD simulated patients to interact with trainees in immersive simulation scenarios. The aim of this study was to test the feasibility of expanding the delivery of CREST to rural Australia using live video streaming; and to investigate the fidelity of cultural sensitivity - defined within the process of cultural competency which includes awareness, knowledge, skills, encounters and desire - of the streamed simulations.
  
  
  METHODS
  In this mixed-methods evaluative study, health professional trainees were recruited at three rural academic campuses and one rural hospital to pilot CREST sessions via live video streaming and simulation from the city campus in 2014. Cultural competency, teaching and learning evaluations were conducted.
  
  
  RESULTS
  Forty-five participants rated 26 reliable items before and after each session and reported statistically significant improvement in 4 of 5 cultural competency domains, particularly in cultural skills (P<0.05). Qualitative data indicated an overall acknowledgement amongst participants of the importance of communication training and the quality of the simulation training provided remotely by CREST.
  
  
  CONCLUSIONS
  Cultural sensitivity education using live video-streaming and simulation can contribute to health professionals' learning and is effective in improving cultural competency. CREST has the potential to be embedded within health professional curricula across Australian universities to address issues of health inequalities arising from a lack of cultural sensitivity training. Significance for public healthThere are significant health inequalities for migrant populations. They commonly have poorer access to health services and poorer health outcomes than the Australian-born population. The factors are multiple, complex and include language and cultural barriers. To address these disparities, culturally competent patient-centred care is increasingly recognised to be critical to improving care quality, patient satisfaction, patient compliance and patient outcomes. Yet there is a lack of quality in the teaching and learning of cultural competence in healthcare education curricula, particularly in rural settings where qualified trainers and resources can be limited. The Cultural Respect Encompassing Simulation Training (CREST) program offers opportunities to health professional students and practitioners to learn and develop communication skills with professionally trained culturally and linguistically diverse simulated patients who contribute their experiences and health perspectives. It has already been shown to contribute to health professionals' learning and is effective in improving cultural competency in urban settings. This study demonstrates that CREST when delivered via live video-streaming and simulation can achieve similar results in rural settings.
authors.affiliation: The University of Melbourne , Australia.
authors.forename: Phyllis
authors.initials: P
authors.lastname: Min-Yu Lau
authors.affiliation: The University of Melbourne , Australia.
authors.forename: Robyn
authors.initials: R
authors.lastname: Woodward-Kron
authors.affiliation: Victoria University , Australia.
authors.forename: Karen
authors.initials: K
authors.lastname: Livesay
authors.affiliation: The University of Melbourne , Australia.
authors.forename: Kristine
authors.initials: K
authors.lastname: Elliott
authors.affiliation: Deakin University , Australia.
authors.forename: Patricia
authors.initials: P
authors.lastname: Nicholson
keywords: Culturally and linguistically diversity; communication skills; e-learning; migrant health; simulation