INCREASING HEALTH PROFESSIONS STUDENTS' CULTURAL COMPETENCE

New strategies for integrating cultural competence into the education of health professions students are greatly needed, particularly cultural competence that deals with issues of the aging population. Ethnic, racial and cultural minority groups within the aging population are doubly disadvantaged; not only are there not enough health professionals trained in geriatrics, but aging individuals in minority groups suffer a disproportionate share of health disparities in terms of access, quality of care, and health outcomes (Lillie-Blanton and Hoffman, 2000; Mayberry et al., 1999). The Institute of Medicine advocates cultural competence training for all health professionals as a strategy to lessen the healthcare disparities affecting cultural minority groups (Smedley, Stith, and Nelson, 2003). 

The American Medical Association defines cultural competence as

The knowledge and interpersonal skills that allow providers to understand, appreciate, and work with individuals from cultures other than their own. Cultural competence involves an awareness and acceptance of cultural differences; self-awareness; knowledge of the patient’s culture; and adaptation of skills (Davis and Voegtle, 1994).

Cultural competence does not simply mean identifying when there is a need for interpreter services or knowing how certain medications or health disorders affect ethnic groups differently. Cultural competence is also about having those skills necessary to communicate effectively with persons from different cultures. It is about acknowledging our own biases and working to respect the beliefs and values of others, no matter how different or foreign they may seem. Most importantly, cultural competence is having the willingness to work with patients to agree upon a treatment plan that is acceptable within their system of values and beliefs.  Central to becoming culturally competent is learning to see strengths and value in diversity, despite the challenges this may pose to medical treatment within the mainstream Western approach.

Many of the core skills that Xakellis, et al. (2004) describe as necessary to becoming culturally competent in geriatric care can be achieved through engaging health professions students in oral history projects, including:

·        “Be familiar with culturally specific methods of showing respect to elders and nonverbal communication styles”

·        “Understand, elicit, and work with culturally related health beliefs that may not be congruent with dominant American culture (e.g., believing that disease states are caused by an imbalance in ying/yang or by karma from past lives)

·        “Be sensitive to critical cohort experiences shaping a patient’s world view and psyche (e.g. place and country of birth, major life experiences, histories of migration, war, torture or refuge status)”

·        “Understand the use of spiritual advisors and native healers” (Xakellis, et al. 2004).

Through the use of oral history, health professions students are provided the opportunity to learn, first hand, from representatives of the population they serve, about the various aspects of the local culture, traditions, and beliefs. Furthermore, they are able to have a positive, non-clinical experience with elders in the community, providing these students with a different frame of reference about aging that takes the focus away from illness and weakness, to reveal the wonderful strength, beauty, and wisdom of the individuals they interview.

References:

Davis, B.J., and Voegtle, K.H. 1994. Culturally Competent Health Care for Adolesents: A Guide for Primary Health Care   Providers. Chicago, IL: American Medical Association.

Lillie-Blanton, M., Hoffman, C. 2000. “Racial and Ethnic Disparities in Access to Medical Care,” Medical Care Research and Review, 57:5-10.

Mayberry, Robert M., Mili, Fatima, Vaid, Isam G.M., Samadi, Aziz, Ofili, Elizabeth, McNeal, Meryl S., Griffith, Patrick A., LaBrie, Ghania. 1999. “A Synthesis of the Literature: Racial and Ethnic Differences in Access to Medical Care,” The Henry J. Kaiser Family Foundation. Retrieved online 15 April, 2006 at: http://www.kff.org/minorityhealth/1526-index.cfm.

Smedley, Brian D., Stith, Adrienne Y., Nelson, Alan R., eds. 2003. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Washington, D.C.: The National Academic Press.

Xakellis, G., Brangman, S.A., Hinton, W.L., Jones, V.Y., Masterman, D., Pan, C.X., Rivero, J., Wallhagen, M., and Yeo, G. 2004. “Curricular Framework: Core Competencies in Multicultural Geriatric Care,” Journal of the American Geriatrics Society. 52: 137-142.