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Preparing Doctors for a Multicultural World
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... Individual medical schools can use this definition to determine population groups underrepresented in their geographic areas (2). 2 Rates were computed using the data sources indicated. be debated (25). More discussion and research are needed to determine the most effective methods of cultural competence training and the desired outcomes for that training. ...
... Cultural competence has many definitions, and most agencies or organizations have their own perspective of what cultural competence should be (23,24). Although most medical schools provide some type of cultural competence instruction, training varies in content and in method of educational delivery (25). Some schools require cultural competency training, some have elective courses, and some incorporate cultural issues into course content (33). ...
... However, the limitations of some methods of incorporating cultural competence into medical training curricula are also apparent. As Michael Whitcomb, Editor of Academic Medicine, states, "it is not yet clear how best to teach students how to begin acquiring the knowledge, skills, and attitudes they need" to develop relationships with culturally diverse patients (25). ...
Physicians and other health care workers are increasingly being called upon to bridge the cultural differences that may exist between themselves and their patients. Adequate cross-cultural education is essential if existing health care disparities are to be reduced. We conducted a needs assessment to identify gaps in the cultural competence/sensitivity components of the undergraduate medical school curriculum at Case Western Reserve University School of Medicine. The 2011 study was designed (1) to assess how first and second year medical school students perceive the adequacy of the medical school curriculum with respect to issues of diversity and (2) the extent to which first and second year medical students believe that an understanding of issues relating to patient culture are important to the provision of effective patient care. Student perspectives were assessed through a web-based anonymous survey of all first year (n = 167) and all second year (n = 166) medical school students, two focus groups (total n = 14) and a Problem-based Case Inquiry Group exercise (n = 6), both with second year students. A substantial proportion of participating first and second year medical students do not believe that self-reflection regarding one's own cultural biases is important to one's performance as a physician, do not view an understanding of diverse patient cultural beliefs as important or very important in the provision of effective patient care, and are uncomfortable with and unsure about how to approach culture-related issues arising in patient care. The inclusion of specified elements-increased contact with diverse patients, more comprehensive resources, increased opportunities to practice communication skills and engage in self-reflection-may be critical to heighten student awareness of and comfort in interacting with diverse populations. Our findings are relevant to the development of medical school curricula designed to improve physician understanding of and responsiveness to diverse patient populations and efforts to reduce health disparities.
... The last few years have seen an increasing call for greater diversity in healthcare leadership and greater sensitivity to the needs of minority and marginalized communities in the healthcare system. [15][16][17] Just as music and musicians have pushed the boundaries in the past and demonstrated how society can celebrate rather than shun difference, we hypothesize that aspects of this music for our healthcare project can pave the way for similar nonmusical initiatives that aim to increase diversity and amplify minority and marginalized voices in health care. While we acknowledge that music provides a unique container for an intercultural process such as this, we also hypothesize that much of what we learned and much of what we did to achieve MMD | 2022 | 15 | 3 | Page 150 success is transferable to other intercultural endeavors according to the following framework. ...
In mid-2018, the authors[1] were contracted by the YYZ Foundation[2] to create a new collection of intercultural recordings designed to support palliative care patients and their caregivers. At the onset of this project, a commitment was made to not only create the musical recordings but also a pre-production and research process that would foster an equitable and meaningful intercultural collaboration. It is this process that will be explored in detail in this paper. The authors propose that this process could help to inspire further equitable and inclusive intercultural collaborative practices in both musical and non-musical settings such as health care as several aspects of this collaborative process may be useful for other initiatives that require cultural sensitivity and intercultural collaboration. [1] Names have been redacted for the purposes of submission to the journal, names will be put back in for final published version. [2] Names have been redacted for the purposes of submission to the journal, names will be put back in for final published version.
Background: In the existing literature, there are many guidelines regarding cultural competencies for healthcare professionals and many instruments aiming to measure cultural competence. However, there is no consensus on which core cultural competencies are necessary for healthcare professionals. Aim and Methods: This study employed the PRISMA 2020 statement to systematically review Delphi studies and identify the core cultural competencies on which experts, who have been working with diverse populations in the fields of healthcare and allied healthcare, have reached a consensus. For this purpose, we searched, retrieved, and reviewed all Delphi studies conducted between 2000 and 2022 in the databases Scopus, PubMed, CINAHL, Medline, and PsycInfo and coded and synthesised the results qualitatively. Results: The systematic search resulted in 15 Delphi studies that met eligibility criteria and in which 443 experts from 37 different countries around the globe had participated. The review of these Delphi studies showed that the core competencies necessary for healthcare professionals to ensure that they provide culturally congruent care were: Reflect, Educate, Show Interest and Praise, Empathise, and Collaborate for Therapy. Discussion and Conclusion: These competencies make the abbreviation and word RESPECT, which symbolically places emphasis on respect as the overarching behaviour for working effectively with diversity. The study also provides a new, comprehensive definition of the cultural competence of healthcare professionals and opens new directions in formulating standardised guidelines and research in cultural competence in healthcare and allied healthcare.
The importance of cultural competence in health care has been more acknowledged since modern societies are becoming increasingly multi-cultural. Research evidence shows that cultural competence is associated with improved skills and patient satisfaction, and it also seems to have a positive impact on adherence to therapy. Based on this evidence, the acknowledged importance of cultural competence and its poor integration into medical curricula, we present a pyramid model for building cultural competence into medical curricula whereby medical students can enhance their skills through acquiring, applying and activating knowledge.
Cross-cultural undergraduate medical education in North America lacks conceptual clarity. Consequently, school curricula are unsystematic, nonuniform, and fragmented. This article provides a literature review about available conceptual models of cross-cultural medical education. The clarification of these models may inform the development of effective educational programs to enable students to provide better quality care to patients from diverse sociocultural backgrounds.
The approaches to cross-cultural health education can be organized under the rubric of two specific conceptual models: cultural competence and critical culturalism. The variation in the conception of culture adopted in these two models results in differences in all curricular components: learning outcomes, content, educational strategies, teaching methods, student assessment, and program evaluation.
Medical schools could benefit from more theoretical guidance on the learning outcomes, content, and educational strategies provided to them by governing and licensing bodies. More student assessments and program evaluations are needed in order to appraise the effectiveness of cross-cultural undergraduate medical education.
Our study describes a faculty development program to encourage the integration of racial, cultural, ethnic, and socioeconomic factors such as obesity, inability to pay for essential medications, the use of alternative medicine, dietary preferences, and alcoholism in a gastrointestinal pathophysiology course.
We designed a 1-hour faculty development session with longitudinal reinforcement of concepts. The session focused on showing the relevance of racial, ethnic, cultural, and socioeconomic factors to gastrointestinal diseases, and encouraged tutors to take an active and pivotal role in discussion of these factors. The study outcome was student responses to course evaluation questions concerning the teaching of cultural and ethnic issues in the course as a whole and by individual tutorials in 2004 (pre-faculty development) and in 2006 to 2008 (post-faculty development).
Between 2004 and 2008, the proportion of students reporting that "Issues of culture and ethnicity as they affect topics in this course were addressed" increased significantly (P = .000). From 2006 to 2008, compared with 2004, there was a significant increase in the number of tutors who "frequently" taught culturally competent care according to 60% or greater of their tutorial students (P = .003). The tutor's age, gender, prior tutor experience, rank, and specialty did not significantly impact results.
An innovative faculty development session that encourages tutors to discuss racial, cultural, ethnic, and socioeconomic issues relevant to both care of the whole patient and to the pathophysiology of illness is both effective and applicable to other preclinical and clinical courses.
This descriptive study was intended to identify actual actions, steps and processes of Children with Special Health Care Needs (CSHCN) programs to develop, implement, sustain and assess culturally and linguistically competent policies, structures and practices.
An online 52-item mixed format survey of Maternal and Child Health (MCH) CSHCN directors was conducted. In April 2003 and May 2004, 59 directors were solicited to participate in the survey and 42 (86%) responded. Standard quantitative and qualitative analyses of the data were conducted to address key questions linked to the study's overall objective.
Findings indicated that almost all respondents are implementing some actions to provide culturally and linguistically competent services including adapting service practices, addressing workforce diversity, providing language access, engaging communities and including requirements in contracts. These individual actions were less often supported by processes such as self-assessment and creating an ongoing structure to systematically address cultural and linguistic competence. Programs are challenged to implement cultural and linguistic competence by state agency organization and budget restrictions.
The results of the study indicate a continued need for support within state MCH CSHCN programs in order to maintain or enhance the systematic incorporation of culturally and linguistically competent efforts.
Cultural competence curricula have proliferated throughout medical education. Awareness of the moral underpinnings of this movement can clarify the purpose of such curricula for educators and trainees and serve as a way to evaluate the relationship between the ethics of cultural competence and normative Western medical ethics. Though rarely stated explicitly, the essential principles of cultural competence are (1) acknowledgement of the importance of culture in people's lives, (2) respect for cultural differences, and (3) minimization of any negative consequences of cultural differences. Culturally competent clinicians promote these principles by learning about culture, embracing pluralism, and proactive accommodation. Generally, culturally competent care will advance patient autonomy and justice. In this sense, cultural competence and Western medical ethics are mutually supportive movements. However, Western bioethics and the personal ethical commitments of many medical trainees will place limits on the extent to which they will endorse pluralism and accommodation. Specifically, if the values of cultural competence are thought to embrace ethical relativity, inexorable conflicts will be created. The author presents his view of the ethics of cultural competence and places the concepts of cultural competence in the context of Western moral theory. Clarity about the ethics of cultural competence can help educators promote and evaluate trainees' integration of their own moral intuitions, Western medical ethics, and the ethics of cultural competence.
The Institute of Medicine report, Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care, claims that medical studies document a systematic causal relationship between race and disparities in health inputs and outcomes among individuals of different races. This article argues that the majority of studies are not powerful enough to establish a causal link, since they do not sufficiently control for differences among patients that happen to correlate with race, and it outlines a powerful audit study that could isolate any effect of race on health care decisions. Even if there are race-based disparities in health inputs, evaluations of welfare and policy prescriptions should be based on health outcomes, since the relationship between care and health is, at least in some cases, weak.
Cultural competence has become an important concern for contemporary health care delivery, with ethical and legal implications. Numerous educational approaches have been developed to orient clinicians, and standards and position statements promoting cultural competence have been published by both the American Medical Association and the American Nurses Association. Although a number of health care regulatory agencies have developed standards or recommendations, clinical application to patient care has been challenging. These challenges include the abstract nature of the concept, essentializing culture to race or ethnicity, and the attempts to associate culture with health disparities. To make cultural competence relevant to clinical practice, we linked a cultural competency continuum that identifies the levels of cultural competency (cultural destructiveness, cultural incapacity, cultural blindness, cultural precompetence, and cultural proficiency) to well-established values in health care. This situates cultural competence and proficiency in alignment with patient-centered care. A model integrating the cultural competency continuum with the components of evidence-based care (i.e., best research practice, clinical expertise, and patient's values and circumstances) is presented.
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