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Teaching Cultural Competency:

A Review of the Literature Sunita Mutha MD1,2, Carol Allen MA1,

Cynthia Salinas MD3, Arnab Mukherjea MPH4

1The Network Program, Center for the Health Professions2Department of Medicine

3Department of Family and Community MedicineUniversity of California, San Francisco

4School of Public HealthUniversity of California, Berkeley

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BACKGROUNDCritical need to eliminate disparities in health care

among diverse populations in the U.S.  Reasons for disparities include attitudes and

knowledge of health care professionals associated with:stereotypes and biases lack of knowledge of cultural issuesineffective communication skills

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BACKGROUND

There are calls to improve clinicians’ ability to provide culturally competent care for all populations

 There is limited guidance for educators about the

structure, content and effectiveness of cultural competency curricula

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AIM OF REVIEW

To summarize what is currently known about the structure, content and effectiveness of cultural diversity education programs for a spectrum of health professionals at different levels of training.

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DEFINITIONCultural competency is “a set of behaviors, attitudes

and policies that enable effective work in cross-cultural situations.”

Definition broadened to include knowledge and communication skills that enhance clinicians’ ability to be aware of cultural differences and to provide appropriate care that is congruent with patients’ values, beliefs and expectations.

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DATA SOURCES

Pub Med search for articles published between 1966 to December 2001

Supplemented with review of references of index articles, as well as relevant reports and websites addressing cultural competency education

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SELECTION CRITERIA

Inclusion criteria:Articles written in EnglishDescribing curricula for students, residents or

cliniciansIn medicine, nursing, dentistry and pharmacyWith quantitative evaluation of learners’

attitudes, knowledge and skills

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SELECTION CRITERIAExclusion criteria:

Review articlesArticles focused solely on teaching

language skillsHealth professionals in fields other than

medicine, nursing, pharmacy and dentistryReporting only qualitative results or course

evaluations

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DATA EXTRACTION

122 articles read, 14 met inclusion criteriaData abstraction by 2 reviewers for each article

including:Participants (number, level & profession)Duration of curricular experienceEducational objectivesTeaching methods Evaluation results

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STUDY STRENGTHStrength of each study ranked on the basis of:

Study design Sample size Duration of educational experience Type of outcome measurements

Possible range from low (4 pts) to high (12 pts)

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FINDINGSStudy design

57% (8/14) were cohorts without controlsOne randomized control trial (RCT)

Populations included Medical students and residents (9/14 or 64%)Nurses and Nursing students (5/14 or 36%)

Experiences ranged from 3 hours to 2 yearsStudy strength ranged from 5 to 10 (scale: 4 –12)

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FINDINGS

Areas of curricular emphasisawareness of sociocultural factors on patients’

health beliefs, values and behaviorsknowledge of specific cultural issues including

social and historical factors shaping health behaviors, disease epidemiology, ethno-pharmacology and complementary health practices

Communication skills such as eliciting patients’ health beliefs, participatory decision-making, and working with medical interpreters.

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FINDINGS

Vast majority of learning objectives only addressed attitudinal change (11/14 or 79%)

50% (7/14) programs included knowledge-based objectives

A minority ( 4/14 or 29%) of programs focused on skill acquisition

Evaluations relied on self-administered surveysFew used existing measurement scales (e.g., Cultural

Self-Efficacy Scale)

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THERE IS A NEED FOR… Consensus about core competencies Clear and consistent learning objectives Assessment linking behavior change among

learners to patient satisfaction and health outcomes data

Objective measurements of program effectiveness Resources devoted to faculty development to

integrate core competencies into curricula