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. |
