Resident Physicians’ Preparedness to Provide Cross-Cultural Care

Weissman, Joel S.; Betancourt, Joseph R.; Campbell, Eric G.; Park, Elyse R.; Kim, Minah; Clarridge, Brian; Blumenthal, David; Lee, Karen C.; Maina, Angela W.

doi:10.1001/jama.294.9.1058

Cited by 308 publications

(252 citation statements)

References 35 publications

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“…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.…”

Section: Introductionmentioning

confidence: 99%

Cultural Competency Training Requirements in Graduate Medical Education

Ambrose¹,

Lin²,

Chun³

2013

Journal of Graduate Medical Education

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Background Cultural competency is an important skill that prepares physicians to care for patients from diverse backgrounds. 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. Methods The program requirements for each specialty and its subspecialties were reviewed from December 2011 through February 2012. The review focused on the 3 competency domains relevant to culturally competent care: professionalism, interpersonal and communication skills, and patient care. Specialty and subspecialty requirements were assigned a score between 0 and 3 (from least specific to most specific). Given the lack of a standardized cultural competence rating system, the scoring was based on explicit mention of specific keywords. Results A majority of program requirements fell into the low- or no-specificity score (1 or 0). This included 21 core specialties (leading to primary board certification) program requirements (78%) and 101 subspecialty program requirements (79%). For all specialties, cultural competency elements did not gravitate toward any particular competency domain. Four of 5 primary care program requirements (pediatrics, obstetrics-gynecology, family medicine, and psychiatry) acquired the high-specificity score of 3, in comparison to only 1 of 22 specialty care program requirements (physical medicine and rehabilitation). Conclusions The degree of specificity, as judged by use of keywords in 3 competency domains, in ACGME requirements regarding cultural competency is highly variable across specialties and subspecialties. Greater specificity in requirements is expected to benefit the acquisition of cultural competency in residents, but this has not been empirically tested.

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Section: Introductionmentioning

confidence: 99%

Cultural Competency Training Requirements in Graduate Medical Education

Ambrose¹,

Lin²,

Chun³

2013

Journal of Graduate Medical Education

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“…Current residency also do not appear to meet expectations for person-centred, prevention-focused, and cost-effective care despite efforts to identify physician roles and attributes that are important to meet societal needs. [59][60][61][62][63] Finally, progression within residency may lead to transitions that leave residents less than optimally prepared for a new, more responsible and independent role in providing care. A recent systematic review supported the existence of a ''July effect'' with a higher incidence of errors and adverse events in the early months of the academic year, particularly in studies with higher-quality designs and larger samples.…”

Section: Transitions Across the Medical Education Continuummentioning

confidence: 99%

Review article: Closing the research gap at the interface of learning and clinical practice

Philibert

2011

Can J Anesth/J Can Anesth

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Purpose The dialogue at the interface of education and clinical practice highlights areas of critical importance to the development of new approaches for educating anesthesiologists. The purpose of this article is to examine the literature on education and acquisition of competence in three areas relevant to the interface of learning and clinical practice, with the aim to suggest a research agenda that adds to the evidence on preparing physicians for independent practice. The three areas are: 1) transitions across the continuum of education; 2) the effect of reductions in hours of clinical training on competence; and 3) efforts to incorporate the competencies and CanMEDS roles into teaching and evaluation. Principal findings Fifty-six articles relevant to one or more of the themes were identified in the review, including 21 studies of transitions (in, during, and after residency education), 19 studies on the effects of duty hour limits on residents' acquisition of competence, and 16 articles that assessed competency-based teaching and assessment in anesthesiology. Overall, the findings suggested a relative paucity of scientific evidence and a need for research and the development of new scientific theory. Studies generally treated one of the themes in isolation, while in actuality they interact to produce optimal as well as suboptimal learning situations, while medical education research often is limited by small samples, brief follow-up, and threats to validity. This suggests a ''research gap'' where editorials and commentaries have moved ahead of an evidence base for education. Promising areas for research include preparation for care deemed important by society, work to apply knowledge about the development of expertise in other disciplines to medicine, and ways to embed the competencies in teaching and evaluation more effectively. Conclusion Closing the research gap in medical education will require clear direction for future work. The starting point, at an institution or nationally, is dialogue within the specialty to achieve consensus on some of the most pressing questions.

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“…80 Surveys report that while nearly all residents believe that addressing cultural issues is moderately or very important, about one in five felt they were not prepared to care for individuals whose beliefs are at odds with Western medicine, new immigrants, or those whose religious beliefs affect treatment. 81 Proper patient engagement takes time, and many resident physicians who provide care for racial and ethnic minorities have expressed concern that time constraints and other pressures related to day-today medical practice do not facilitate cross-cultural communication and understanding. 82 Many residents also report that they lack professional mentorship in the area of cross-cultural care and receive little evaluation of skills.…”

Section: Cultural Competency Trainingmentioning

confidence: 99%

“…81 Proper patient engagement takes time, and many resident physicians who provide care for racial and ethnic minorities have expressed concern that time constraints and other pressures related to day-today medical practice do not facilitate cross-cultural communication and understanding. 82 Many residents also report that they lack professional mentorship in the area of cross-cultural care and receive little evaluation of skills. Other evidence suggests that existing cultural competency measures are insufficient to produce meaningful change among providers.…”

Section: Cultural Competency Trainingmentioning

confidence: 99%

Racial and Ethnic Disparities in Health Care

Nassar¹

2005

Ann Intern Med

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The Institute of Medicine defines disparities as "racial or ethnic differences in the quality of health care that are not due to access-related factors or clinical needs, preferences, and appropriateness of intervention." Racial and ethnic minorities tend to receive poorer quality care compared with nonminorities, even when access-related factors, such as insurance status and income, are controlled.The sources of racial and ethnic health care disparities include differences in geography, lack of access to adequate health coverage, communication difficulties between patient and provider, cultural barriers, provider stereotyping, and lack of access to providers. In addition, disparities in the health care system contribute to the overall disparities in health status that affect racial and ethnic minorities. Why is it Important to Correct These Disparities?The problem of racial and ethnic health care disparities is highlighted in various statistics:• Minorities have less access to health care than whites. The level of uninsurance for Hispanics is 34% compared with 13% among whites.• Native Americans and Native Alaskans more often lack prenatal care in the first trimester.• Nationally, minority women are more likely to avoid a doctor's visit due to cost.• Racial and ethnic minority Medicare beneficiaries diagnosed with dementia are 30% less likely than whites to use antidementia medications.ACP is strongly committed to advocating for increased access to quality health care for all, regardless of race, ethnicity, socioeconomic status, or other factors. Accordingly, the mission of ACP is "to enhance the quality and effectiveness of health care by fostering excellence and professionalism in the practice of medicine." The College believes that racial and ethnic disparities in health care are unacceptable and supports policies that increase access to health care for all, invest in preventive care, create a more diverse health care workforce, address social determinants of health, and expand research into the causes and solutions regarding racial and ethnic health disparities. Key Findings and Recommendations from the Paper ACP recommends the following:• Providing all legal residents with affordable health insurance is an essential part of eliminating racial and ethnic disparities in health care.• All patients, regardless of race, ethnic origin, gender, nationality, primary language, socioeconomic status, sexual orientation, cultural background, age, disability, or religion, deserve high-quality health care.• As our society increasingly becomes racially and ethnically diverse, physicians and other health care professionals need to acknowledge the cultural, informational, and linguistic needs of their patients. Health literacy among racial and ethnic minorities must be strengthened in a culturally and linguistically sensitive manner.• Physicians and other health care professionals must be sensitive to cultural diversity among patients and recognize that preconceived perceptions of minority patients may play a role in their...

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Resident Physicians’ Preparedness to Provide Cross-Cultural Care

Cited by 308 publications

References 35 publications

Cultural Competency Training Requirements in Graduate Medical Education

Cultural Competency Training Requirements in Graduate Medical Education

Review article: Closing the research gap at the interface of learning and clinical practice

Racial and Ethnic Disparities in Health Care

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