From “Lists of Traits” to “Open-Mindedness”: Emerging Issues in Cultural Competence Education

Abstract

The incorporation of "culture" into U.S. biomedicine has been increasing at a rapid pace over the last several decades. Advocates for "cultural competence" point to changing patient demographics and growing health disparities as they call for improved educational efforts that train health providers to care for patients from a variety of backgrounds. Medical anthropologists have long been critical of the approach to "culture" that emerges in cultural competence efforts, identifying an essentialized, static notion of culture that is conflated with racial and ethnic categories and seen to exist primarily among exotic "Others." With this approach, culture can become a "list of traits" associated with various racial and ethnic groups that must be mastered by health providers and applied to patients as necessary. This article uses an ethnographic examination of cultural competence training to highlight recent efforts to develop more nuanced approaches to teaching culture. I argue that much of contemporary cultural competence education has rejected the "list of traits" approach and instead aims to produce a new kind of health provider who is "open-minded," willing to learn about difference, and treats each patient as an individual. This shift, however, can ultimately reinforce behavioral understandings of culture and draw attention away from the social conditions and power differentials that underlie health inequalities.

A Model of Decision-Making Based on Critical Thinking

“…Bu açıdan açık fikirlilik, birinin inançlarından bağımsız olarak düşünme yeteneğini geliştiren önemli bir özelliktir (Rodriguez, 2011). Olsen (2005Olsen ( , 2006, Jenks (2011) ve Adler'in (2005 çalışmalarında açık fikirlilik, daha çok çoğulculuk, fakirlik, yolsuzluk, farklılık ve çok kültürlülük gibi meselelerde ön plana çıkmaktadır. Ayrıca ahlaki eğitimde bir yaklaşım olarak açık fikirlilik (Hare, 1987), başka insanların düşüncelerini anlama yeteneği olan empati (Cosme, Pepino ve Brown, 2010) ile yakından ilişkilidir.…”

Cultural Competence in Action: “Lifting the Hood” on Four Case Studies in Medical Education

“…Other anthropological critiques raise other important concerns including, for instance, lack of attention to the culture of biomedicine in cultural competence efforts (Carpenter-Song et al 2007;Fox 2005) and inattention to the structural factors that often play much weightier a role than cultural factors in affecting health circumstances and health outcomes (Jenks 2011;Metzl 2009Metzl , 2012.…”

The Appeal and Problems of a Cultural Competence Approach to Reducing Racial Disparities

“…The oft-repeated warning that not all patients will conform to these traits may do little to challenge taken-for-granted assumptions." 6 In addition, we can still find the description of racial groups' "cultures" in some, but not all, cultural competence textbooks. 7 , 8 The conflict between the application and avoidance of culture to explain racial inequality leads to a pernicious problem for those who employ cultural competence: while critics warn that teaching cultural generalizations of racial groups reinforces stereotypes, racial inequality as cultural difference resonates with common understanding of the social world.…”

“…3 The question is an important one, but communicating this to providers under the rubric of culture is difficult. 6 Starting with cultural difference-a starting point presumed by its name, cultural competence-avoids whites' collective responsibility for policies and behavior that result in the disadvantage of other racial groups. Because of whites' well-documented discomfort discussing white privilege and racism, 5 cultural competence programs often gloss over it.…”

“…Because of whites' well-documented discomfort discussing white privilege and racism, 5 cultural competence programs often gloss over it. 6 Research on whites' racial thinking suggests that takeaway messages would be about individual and "cultural differences" among minority race patients rather than the effects of bias on care, 10 even in those cultural competence programs that describe the effects of racism. Again, we must be alert to Saha and colleagues' findings being used to support cultural competence programs that do not address white privilege as Saha et al do.…”