A prescription for cultural competence in medical education.Edit

Kripalani S, Bussey-Jones J, Katz MG, Genao I.

J Gen Intern Med 2006 Oct; 21(10):1116-20.

This article describes the current approaches to cultural competence education and proposes several elements that may improve cultural competence training in medical education. There are three major conceptual approaches: 1) Knowledge-based – multicultural/categorical approach, 2) Attitude-based – cultural sensitivity/awareness approach, and 3) Skill-building – the cross-cultural approach.

The authors propose a “prescription for success in cultural competence education” as follows:

  1. Teach practical skills – instead of using the knowledge-based approach teaching preferred words, images, or approaches, physicians must learn to apply knowledge of socio-cultural issues at the individual level.
    1. Berlin and Fowkes’ LEARN guideline
      1. Listen to the patient’s perception
      2. Explain your own opinion
      3. Acknowledge and discuss differences and similarities
      4. Recommend treatment
      5. Negotiate an agreement
    2. RISK
      1. Assess a patient’s Resources, Identity, Skills, and Knowledge
  2. Use interactive educational methods – standardized patient encounters, role-play, and self-reflective journals help to reinforce practical skills learned.
  3. Provide direct faculty observation and feedback – either through direct observation or by reviewing videotapes, faculty observation and feedback is another way to reinforce and improve practical skills.
  4. Discuss cultural competence throughout clinical education – most curricula devote 1 week to cultural competence training. However, to improve competency, this education should be extended into medical rounds and other opportunities to discuss patients’ cultural background.
  5. Get buy-in from the top – seeking the support of medical school deans and a commitment from course directors will facilitate complete integration into the curriculum.
  6. Promote cultural diversity among medical students and at all levels of medical school faculty – with the lack of diversity in the health care leadership, there may be a limit to the adaptation of the system to meet the needs of the diverse population. By promoting more diversity among students and faculty, it helps emphasize the importance of cultural competency education.
  7. Involve an “Opinion Leader” as the physician champion – an opinion leader is an “educationally influential colleague who models appropriate behaviors” who plays a vital role in the diffusion into a larger community, based on the diffusion of innovations theory.
  8. Develop a cadre of dedicated faculty – not only should students be taught but faculty as well to ensure the continual teaching of cultural competency.
  9. Make it a “real science” – emphasize the research on health disparities and the value of cultural competence education.

Their recommendations are founded in adult learning theory and the diffusion of innovations model. Of these 9 suggestions, many are already employed by institutions throughout. Some would be more difficult to implement than others, and others may not have the same impact as others. Number 9 may not have the same impact as number 1.

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