Cultural competence has been defined as “the ability to understand and respond effectively to the cultural and linguistic needs of patients in the health care encounter” or “a set of attitudes, skills, behaviors, and policies that enable organizations and staff to work effectively in cross-cultural situations. It reflects the ability to acquire and use knowledge of the health-related beliefs, attitudes, practices, and communication patterns of clients and their families to improve services, strengthen programs, increase community participation, and close the gaps in health status among diverse population groups.” Cultural competency training recognizes both the individual patient-doctor relationship and population-based perspectives.
Despite published reports of disparities in health care for the uninsured, African American, and Hispanic population relative to Caucasians and those with private insurance, most graduates of U.S. internal residency programs have not received adequate training in culture competency at the start of their careers. Two specific accreditation standards (ED-21 and ED-22) now require the teaching of cross-cultural issues in medical schools, and states have begun to legislate inclusion of this teaching in continuing medical education (CME) for physicians to better address health care needs of the diverse U.S. population. An integrated, rather than stand alone, curricular strategy is considered the most effective way to deliver this training across the continuum of medical education. The Association of American Medical Colleges (AAMC) has provided a framework to isolate key domains and learning objectives that recognize under addressed issues within cultural competency teaching and to guide faculty. The AAMC recently revised six domains identified as: health disparities, bias and stereotyping, community strategies, cross-cultural communication skills, working with interpreters, and the culture of medicine, with the first three being least addressed by most schools. Attending faculty, fellows, or residents should integrate teaching in the 6 domains, take steps to assess teaching impact and improve future self-directed learning.
Most educational research supports the case-based, precepting approach as more effective than the formal lecture-based didactic method during clinical training. Despite limited time to provide didactic teaching, frequent direct contact with learners presents informal or hidden opportunities for “teachable moments” that inevitably occur throughout the workday. This chapter will focus on ways to integrate teaching into direct patient care activities and identify “teachable moments” that build on learners' existing knowledge and skills. Case studies will be used to (1) provide a framework to address cultural competency teaching, (2) identify potential missed opportunities for teaching, (3) demonstrate learner- and patient-centered strategies to integrate the teaching of cultural competence into the hospitalist rotation, (4) review methods for assessing and giving feedback to learners, and (5) provide resources to help faculty to improve the teaching of cross-cultural medicine.
Health disparities are differences in the prevalence, etiology, presentation of disease, and access to care that result in unequal outcomes for different groups of people. They can be attributed to the patient (attitudes, adherence, education, beliefs, and health literacy), the physician (lack of knowledge, bias, poor cultural skills) and ...