SELF-REFLECTION AS A TOOL TO ENCOURAGE CULTURAL COMPETENCY. D.W. Brady 1 , I. Genao 1 , J. Bussey-jones 1 ; 1 Emory University, Atlanta, GA OBJECTIVES: 1. To promote cultural competency through self-reflection. 2. To encourage residents to examine their own cultural biases and prejudices. 3. To provide a safe environment where residents can ask difficult questions about other cultures in a spirit of inquiry. METHODS: As part of our cross-cultural curriculum, we set aside one session to allow residents to self-reflect and ask questions they had about each other's cultures. The group consisted of 10 third-year primary care residents -six men and four women, including two African-Americans, two Asian-Americans, at least two evangelical Christians, one Jew, at least one atheist, and two homosexuals (these were some of the represented cultures known to the group). We asked them each to write down a question and place it in an envelope. They were asked to write questions that they had always wanted to ask a person of a different culture (race, ethnicity, religion, sexual orientation, etc.) but were either afraid to ask or thought was too stereotypical. The questions were not to be directed personally at any specific individual within the group. After collecting the questions, we passed the envelope back around the room and asked each person to take out one question and read it to the group. The intent was to create a safe environment where the residents could bring their "forbidden" questions into the open and to allow them to see the reaction of the group without being personally humiliated or attacked for asking their questions. Our hope was for each resident to become more aware of his or her own cultural competency and to learn to hear "the other" in a spirit of inquiry. RESULTS: The group rated this session higher than any other session in the curriculum. We originally intended for the group to just hear the questions and feel their impact. The group, however, at the beginning of the session decided by consensus to allow some discussion of each question by the group before proceeding. In evaluating the experience, the residents said that the discussion was integral to making the experience its most meaningful. They also said that late internship might be a good place to introduce this exercise as it would have helped them earlier in their training. They added, however, that introducing it too early, before the group has a chance to form, might have risked alienating members of the group, thus damaging their ability to develop cohesion. CONCLUSION: The depth of learning and the residents' evaluation of the exercise have encouraged us to retain it as a part of our multicultural curriculum. Whenever we as physicians can afford trainees the opportunity to be self-reflective, expecially in a cross-cultural context, we can enhance doctor-patient communication, learn more about ourselves and each other as human beings, and, ultimately, take better care of each individual patient and society as a whole. OBJECTIVES: To describe the efforts of one general internal medicine training program to promote the selection of generalist careers by residents. In the past couple of years, there has been a declining interest in generalist careers, yet primary care physicians play an important role in meeting the health care needs of the medically underserved. METHODS: Multiple strategies for promoting selection of primary care careers have been piloted in the Primary Care track of our internal medicine residency program: ÁMentorship: Each primary care resident is paired with a general internal medicine faculty member based on common career or personal interests and goals. Mentorship pairs meet at least twice a year to review clinical performance, research, educational plan, and career goals. ÁContinuity clinics: Primary care residents have two half days of clinic in settings which serve a large Medicaid and medically indigent population. ÁPrimary care rotations: Several primary care rotations including adolescent medicine, women's health, and outpatient HIV have been developed to improve the ability of residents to practice in a variety of outpatient settings. ÁPreceptorships: All primary care residents are required to do a preceptorship during the R2 year. Rotations in medically underserved and rural areas are strongly encouraged. ÁCareer development seminars: Topics such as Finding a Job, Evaluating Contracts, and interaction with a panel of internists who practice in various settings are incorporated into the three-year primary care curriculum. RESULTS: During HRSA funding (1997 ± 2000) , 23 of 25 graduates chose primary care careers; of the two choosing fellowships, one was in geriatrics. The career development sessions were consistently rated very positively; 4.85 to 5.00 on a 5-point scale. In focus groups, residents also reported high satisfaction with these sessions, primary care rotations, continuity clinics and the mentorship program. CONCLUSION: While we have successfully promoted primary care career choices, we have been less successful in placing graduates in medically underserved areas.In attempt to increase graduates choosing careers in medically underserved areas, we are focusing recruitment efforts on students with documented interest in care of the medically underserved and supporting this interest throughout residency training. Due to the national trend of declining interest in primary care careers, these efforts will be extended to include categorical residents and medical students.