Diversity & Democracy: Civic Learning for Shared Futures
Diversity Innovations Research
Diversity Digest Volume 9, Number 2

Diversity Digest
Volume 9,
Number 2
(2006)

Download our print issue (PDF)
Campus-Community Connections
Intercultural Learning for Inclusive Excellence
Why Allen and Joan Bildner and the Bildner Family Foundation Funded a Statewide Diversity Initiative
Learning to Listen as We Lead
Institutional Models That Cultivate Comprehensive Change
Curricular Transformation
Where Worlds Converge
Curricular Transformation through Collaborative Teaching
Intercultural Learning in First-Year Seminars
Research
Designing Intercultural and Cross-cultural Spaces
Enhancing Collaborative Leadership of Faculty and Staff
Faculty-Driven Curricular Change
Diversity as Shared Practice
Dialogue Groups at Princeton University Library
Faculty Involvement
Epistles, Posters, and Pizza
Forging Campus-Community Connections
"Beyond Food"
Cross-cultural by Design
Student Experience
Something to Declare
Putting Student Voices in Public Spaces
Café Bergen
Institutional Leadership and Committment
Assessing Diversity Attitudes in First-Year Students
Infusing Cultural Competency into Health Professions Education

Infusing Cultural Competency into Health Professions Education: Best and Promising Practices

By Debbie Salas-Lopez, chief of the Division of Academic Medicine, Geriatrics, and Community Programs, and Maria Soto-Greene, vice dean, both from the University of Medicine and Dentistry of New Jersey, New Jersey Medical School; Catherine Bolder, associate vice president, affirmative action/equal employment opportunity, University of Medicine and Dentistry of New Jersey; and Robert C. Like, professor and director of the Center for Healthy Families and Cultural Diversity, University of Medicine and Dentistry of New Jersey–Robert Wood Johnson Medical School

Cultural competency training has gained attention as a potential strategy to improve quality of care and eliminate racial and ethnic health disparities. Cultural competence in health care is defined as “the ability of systems to provide care to patients with diverse values, beliefs, and behaviors, including tailoring delivery to meet patients’ social, cultural, and linguistic needs” (Betancourt, Green, and Carrillo 2002). The ultimate goal is to create a health-care system and workforce that can deliver the highest quality of care to every patient, regardless of race, ethnicity, cultural background, or English proficiency.

Cultural competency training is a critical area of interest to regulatory bodies such as the Liaison Committee on Medical Education and the Accreditation Counsel for Graduate Medical Education. In March 2005, New Jersey became the first state in the nation to require cultural competency training as a condition of physician licensure, as well as its inclusion in the curricula of the state’s medical schools. Arizona, California, Illinois, and New York currently have pending cultural competency legislation.

The University of Medicine and Dentistry of New Jersey (UMDNJ), the largest health sciences institution in the United States, is one of the academic institutions participating in the New Jersey Campus Diversity Initiative. The university received funding from the Bildner Family Foundation for a project entitled Developing Cultural Competency at UMDNJ. During this project, focus group interviews were conducted with administrators, faculty, staff, students, and community representatives about diversity-related issues in education, clinical care, research, and community service. The results are helping to inform educational efforts throughout UMDNJ. In particular, increasing organizational and clinical cultural competence and addressing health disparities have been identified as key goals in the university’s new strategic plan. UMDNJ–New Jersey Medical School, one of the university’s eight health sciences schools, has embarked on curriculum transformation and is highlighting cultural competency as a major module within the new “physician’s core” two-year sequence in the preclinical and subsequent clerkship years. Curriculum development has been guided by a variety of resource materials, and the experience of the Hispanic Center of Excellence. Faculty development workshops focusing on improving intercultural communication skills have also taken place.

The medical student course consists of six three-hour sessions focusing on a broad spectrum of core cultural competency topics (figure 1). Each session has a large-group didactic component incorporating a video or panel and uses small groups of ten students with a trained faculty facilitator for discussions. The curriculum continues into the second year, using a cross-cultural standardized patient exercise. Students receive a one-and-a-half hour core cultural competency session at the start of the third year, followed by a one-and-a-half hour clerkship specific session, which permit students to explore topics and issues that they may confront while completing a specific discipline (figure 2). Each session encourages safe interaction and involves discussions, self-reflective exercises, and/or role playing.

Figure 1. Cultural competency curriculum within the physician’s core course, UMDNJ–New Jersey Medical School
Issue Teaching Objective
Toward culturally sensitive health care Provides an overview of the importance of culturally sensitive health care on patient outcomes by defining and understanding culture, cultural competence, ethnicity, race, health disparities, and integrative and complementary medicine and their role in the doctor-patient relationship
Challenges to
cross-cultural communication
Identifies cultural differences affecting doctor-patient communication, offers solutions to bridging linguistic and cultural differences, and covers how to work with interpreters
Beliefs and culture: diverse approaches to health care Presents the impact of beliefs and culture on health-seeking behaviors
Integrating complementary and alternative medicine in health care Provides an understanding of the role of integrative and complementary medicine in patients’ healing traditions and systems
Health disparities and factors influencing health Provides an overview of disparities in health care and the impact of stereotyping, racism, and bias; includes examples of health disparities in our local community
Vulnerable populations Provides an understanding of the experience that people who are considered vulnerable or disenfranchised have with the medical community

 

Figure 2. Third-year clerkship-specific cultural competency sessions, UMDNJ–New Jersey Medical School
Clerkship Topics
General Learning
Objectives
Family Medicine • Eliciting patients’ perspectives on chronic disease
• Social stressors and support networks
• Cultural competency as a window into non-adherence
• Complementary/alternative therapies
• Understand that patients and health-care professionals often have different perspectives, values, and beliefs about health and illness that can lead to conflict, further complicated by language barriers
• Become familiar with issues and challenges important in caring for patients of different cultural backgrounds
• Think about each patient as an individual, rather than using stereotypes about groups
• Understand how discrimination and mistrust affect a patient’s interaction with physicians and the health-care system
• Refine communication and negotiation skills through ongoing instruction
OB/GYN • Lesbian health issues
• Female circumcision
• Acculturation on health beliefs
Pediatrics • Negotiating the unique triadic pediatric doctor-patient relationship in a diverse population
• The impact of family health beliefs on children’s health
Psychiatry • Five components of cultural formulation
• Cultural explanations of the individual’s illness and help-seeking experience
• Cultural aspects related to psychosocial environment and functioning
• Cultural elements of the relationship between the individual and the clinician
• Cultural assessment for diagnosis, treatment, and care
Surgery • Family decision making and withholding of information
• Language barriers and communications
• Acculturation on family dynamics/beliefs
Medicine • A focus on religious beliefs, spirituality, and negotiation

 

Evaluating the effectiveness of cultural competency training is the focus of ongoing research. What is the impact on patients? How are faculty and students that receive this training better prepared to take care of our diverse populations? Are we actually decreasing health disparities with cultural competency education?

All of these important questions remain to be answered over the next few years. In the meantime, our goal is to develop strategies through cultural competency education that build trust and promote social justice in alignment with quality health-care services.

Additional information about cultural competency and health disparities can be found at the UMDNJ Center for Cultural Competency Web site, www.umdnj.edu/culturalcompetency.

Acknowledgments

The authors would like to acknowledge the contributions of Dominga Padilla, MD, and Dawne Mouzon, MPH.

Reference

Betancourt J., A. Green, and E. Carrillo. 2002. Cultural competence in health care: Emerging frameworks and practical approaches. The Commonwealth Fund. www.cmwf.org/usr_doc/ betancourt_culturalcompetence_576.pdf. Accessed September 26, 2005.

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