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TRAINING AND EDUCATION Ongoing training and education of health care professionals is a key recommendation for cultural and linguistic competency. A health care professional’s ability to appropriately assess and communicate with a client is critical to the quality of care and to successful treatment outcomes. As recognition of the importance of cultural and linguistic competency grows, there will be continued emphasis on education and training curricula for students, as well as continuing education opportunities for people already working in health care settings. The resources below provide tools, strategies, curricula and further links to education and training resources for organizations and medical schools addressing the training needs of current and future health care professionals. Association of American Medical Colleges. Cultural competence education for medical students. Washington, DC: Association of American Medical Colleges; 2005. Available at: http://www.aamc.org/meded/tacct/culturalcomped.pdf. Accessed December 17, 2005. This assessment tool was developed to help medical schools integrate cultural competency training into their curricula. Schools can self-administer the tool to identify the major domains of cultural competence and to monitor the educational experience of students. Beach MC, Price EG, Gary TL, Robinson KA, Gozu A, Palacio A, Smarth C, Jenckes MW, Feuerstein C, Bass EB, Powe NR, Cooper LA. Cultural competence: a systemic review of health care provider educational interventions. Medical Care. April 2005;43(4):356-373. This article is a systematic review of the literature for strategies most effective in improving the quality of care for racial and ethnic minorities. Prior to being chosen for review, articles were examined against criteria developed by the authors. Only 34 articles written between 1980 and June 2003 were eligible for review; these studies measured one or more of the following: provider knowledge, provider attitudes, provider skills, patient outcomes, outcomes associated with specific features of cultural competence training and the cost of cultural competence training. The results illustrated that cultural competence training had a beneficial effect on provider knowledge, attitude, skills and behaviors, and patient satisfaction. Which training strategy affected which types of outcomes, however, was difficult to determine, due to the variety of curriculum content and methods. The California Endowment. A manager’s guide to cultural competence education for health care professionals. Gilbert JM, ed. Woodland Hills, CA: California Endowment; 2003. Available at: http://www.calendow.org/reference/publications/pdf/cultural/TCE0217-2003_A_Managers_Gui.pdf. Accessed May 18, 2007. This guide was designed to help managers and administrators of health care organizations select a cultural competence trainer that best fits the needs of their practicing health care professionals. It complements and should be used with the Principles and recommended standards for the cultural competence of health care professionals (also listed in this annotated bibliography, immediately below). The California Endowment. Principles and recommended standards for the cultural competence education of health care professionals. Gilbert JM, ed. Woodland Hills, CA: California Endowment; 2003. Available at: http://www.calendow.org/reference/publications/pdf/cultural/TCE0215-2003_Principles_and.pdf. Accessed December 29, 2005. Developed by an expert panel with national input, this guide is one in a series of documents that provide guidance and resources to organizations about becoming more culturally competent. This document provides recommendations for cultural competency training content standards, methods for training and how to implement and evaluate programs. The California Endowment. Resources in cultural competence education for health care professionals. Gilbert JM, ed. Woodland Hills, CA: California Endowment; 2003. Available at: http://www.calendow.org/reference/publications/pdf/cultural/TCE0218-2003_Resources_in_C.pdf. Accessed May 21, 2007. This resource bibliography includes a vast array of data, tools, articles, curricula and other resources relevant to cultural competence education for health care professionals. It was compiled as part of a research and environmental scan for a project funded by The California Endowment. The bibliography also includes a listing of various guides to providing culturally competent care and a listing of organizational, personal and patient assessments that can be used for evaluating the level of cultural competence in service delivery and of individual care providers. Latin American Research and Service Agency (LARASA). Assessing and developing the cultural and linguistic competence of Medicaid providers serving Latinos in Colorado. Denver, CO: Centers for Medicare and Medicaid Services; 2002. This report describes a three-year project funded by the Health Resources and Services Administration to understand the degree to which the current Medicaid system in Colorado meets the linguistic and cultural needs of Latino participants and to identify strategies for improvement. Focus groups and one-on-one interviews were conducted with Spanish-speaking Medicaid patients and providers within both public and private managed care organizations. The findings highlighted the importance of increasing cultural and linguistic competency among providers through training, making systemic changes such as hiring representative staff, hiring interpreters, translating materials, creating a budget for cultural competency needs, expanding encounter times to accommodate patients with limited English proficiency, increasing continuity among patients and providers to build relationships and trust, and orienting patients to the system. Loudon RF, Anderson PM, Gill PS, Greenfield SM. Educating medical students for work in culturally diverse societies. Journal of the American Medical Association. 1999;282:875-880. This article reviews the literature on cultural diversity education programs for medical students. After a systematic search, articles about 17 programs (1967 to 1997) were chosen for review. Almost all of the programs were for medical students in their first or second year of training. The impetus for each program was related to perceptions of discrimination. Methods used to teach cultural diversity included: patient simulations, discussion of video vignettes, panels of community members presenting resources, development of language skills, visiting Mexico, role plays and clerkships. Most courses addressed attitudes and health beliefs, alternative healing systems and complementary medicine, demographics and language barriers. A majority of programs were optional and were evaluated via a student satisfaction questionnaire. National Alliance for Hispanic Health. A primer for cultural proficiency towards quality health services for Hispanics. Washington, DC: Estella Press; 2001. Available at: http://www.hispanichealth.org/pdf/primer.pdf. Accessed May 18, 2007. This short primer and its accompanying workbook were created as an outgrowth of Proyecto Informar, a 15-year initiative to improve communication between health care providers and their patients. The premise of the information is that cultural proficiency is critical to quality care. Quality health services for Hispanics rely not only on learning a specific set of skills, but also on developing proficiency in the art of listening to and communicating with patients and families from a holistic perspective. The primer discusses Hispanic culture and history, language issues, the cultural competency continuum and how providers can ensure that they and the systems within which they work do not inhibit access to care. Office of Minority Health. Teaching cultural competency in health care: a review of current concepts, policies and practices. Washington, DC: U.S. Department of Health and Human Services; 2002. Available at: http://www.omhrc.gov/assets/pdf/checked/em01garcia1.pdf. Accessed May 18, 2007. This report, a follow-up to the Office of Minority Health’s “National Standards for Culturally and Linguistically Appropriate Services (CLAS) in Health Care,” presents the findings of an “environmental scan” to inform the development of cultural competence curriculum modules for family physicians. Policy and research issues highlight the importance of culturally competent health care and training methods. The report discusses training practices and concepts of cultural competence as they relate to the three major themes of the CLAS standards. Lastly, it reviews sample curricula and analyzes their content, teaching techniques and assessment strategies. Shaya FT, Gbarayor CM. The case for cultural competence in health professions education. American Journal of Pharmaceutical Education [serial online]. 2006;70(6):1-6. Available at: http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=1803701&blobtype=pdf. Accessed May 18, 2007. This article advocates that schools of the health professions (e.g., medical schools, schools of pharmacy) should develop and implement or expand existing curricula to present the evidence of health disparities among racial and ethnic minorities and the importance of culturally competent care, as well as to provide more exposure to and communication with culturally-diverse populations. Tervalon M, Murray-Garcia J. Cultural humility versus cultural competence: a critical distinction in defining physician training outcomes in multicultural education. Journal of Health Care for the Poor and Underserved [serial online]. 1998;9(20):117-125. Available at: http://healthresearch.berkeley.edu/disparities/docs/CulturalHumility.pdf. Accessed May 21, 2007. This article proposes a distinction between cultural humility and cultural competence. Cultural humility incorporates a life-long commitment to self-evaluation and critique to counter the power imbalances inherent in the provider-patient dynamic. The culturally humble provider focuses on developing a mutually beneficial and non-paternalistic partnership with communities through advocacy and by practicing patient-focused care. Thom DH, Tirado MD, Woon TL, McBride MR. Development and evaluation of a cultural competency training curriculum. BMC Medical Education [serial online]. 2006;6:38. Available at: http://www.biomedcentral.com/1472-6920/6/38. Accessed: May 21, 2007. |
