A prescription for cultural competence in medical education

Abstract

Cultural competence programs have proliferated in U.S. medical schools in response to increasing national diversity, as well as mandates from accrediting bodies. Although such training programs share common goals of improving physician-patient communication and reducing health disparities, they often differ in their content, emphasis, setting, and duration. Moreover, training in cross-cultural medicine may be absent from students' clinical rotations, when it might be most relevant and memorable. In this article, the authors recommend a number of elements to strengthen cultural competency education in medical schools. This ''prescription for cultural competence'' is intended to promote an active and integrated approach to multicultural issues throughout medical school training.KEY WORDS: cultural competency; medical education; disparities. DOI: 10.1111/j. 1525-1497.2006.00557.x J GEN INTERN MED 2006 21:1116-1120 M edical education has witnessed a steady increase in efforts to train physicians to provide high-quality, culturally competent care. Training in cultural competence has risen to the forefront of medical education in part because the United States is becoming increasingly diverse. Ethnic minorities now comprise about 30% of the population, and demographic trends show that they will become the majority by the year 2050.1,2 In addition, greater appreciation exists for the impact of culture on health care and health disparities. 3,4Health seeking behaviors are affected by cultural mores. Some patients may delay seeking care due to perceived cultural insensitivity, 5 concern that they will receive a lower quality of care, 6 or the perception that they have been treated unfairly because of race or ethnic background. 7,8 Furthermore, health disparities have been widely recognized, with racial differences in treatment persisting after adjustment for insurance status, income level, and health status. 9-13Published research suggests cultural competence may improve physician-patient communication and collaboration, increase patient satisfaction, and enhance adherence, thereby improving clinical outcomes and reducing health disparities. 3,4,7,8,[14][15][16][17][18] In this manuscript, we describe current approaches to cultural competence education. Based on features of successful programs and drawing on established educational principles, we propose several elements that may improve cultural competence training in medical education. Current Approaches to Cultural Competence EducationConceptual Approach. Three major conceptual approaches have emerged for teaching cultural competence, focusing on knowledge, attitudes, and skills, respectively. 24 Knowledgebased programs (the multicultural/categorical approach) focus on information, such as definitions about culture and related concepts, social determinants of health, and variations in disease incidence and prevalence. These programs may also identify common ethno-medical beliefs and practices thought to influence the patient-physician relationship and medical outcom...

Teaching Cultural Diversity: Current Status in U.K., U.S., and Canadian Medical Schools

“…medical schools generally include cultural competency education within required courses 32 . However, few medical schools have achieved longitudinal integration of issues of culture into 4-year curricula 33,34 instead concentrating in the first or second years of medical school, often in a didactic or case-based format 35 .…”

National Survey of Medical Spanish Curriculum in U.S. Medical Schools

“…The topic of medical education on cultural competency or sensitivity has already been well explored in the literature. [12][13][14] In addition, Spanish is the official language in 21 countries on four different continents, each with vastly different cultures. Thus, addressing cultural competency or sensitivity education was beyond the scope of our survey.…”

Cultural Competency Training Requirements in Graduate Medical Education

“…While the manner in which cultural training should best be provided varies in the literature, the need to acknowledge the potential impact of cultural factors is widely supported. 3,9,[11][12][13] A seminal 2005 study by Weissman et al 14 found that the majority of residents (96%) recognized the importance of cultural issues in health care and that 92% of them felt prepared to address general culturally related care issues; however, with regard to specific components of culturally sensitive approaches to care, only 75% responded affirmatively. An overly generic approach (ie, lack of explicit cultural training) may underestimate the diversity of the Objective We reviewed Accreditation Council for Graduate Medical Education (ACGME) program requirements and relevant documents from the ACGME website to evaluate competency requirements across specialties.…”