Abstract
BackgroundAssessing the cultural competence of medical students that have completed the curriculum provides indications on the effectiveness of cultural competence training in that curriculum. However, existing measures for cultural competence mostly rely on self-perceived cultural competence. This paper describes the outcomes of an assessment of knowledge, reflection ability and self-reported culturally competent consultation behaviour, the relation between these assessments and self-perceived cultural competence, and the applicability of the results in the light of developing a cultural competence educational programme.Methods392 medical students, Youth Health Care (YHC) Physician Residents and their Physician Supervisors were invited to complete a web-based questionnaire that assessed three domains of cultural competence: 1) general knowledge of ethnic minority care provision and interpretation services; 2) reflection ability; and 3) culturally competent consultation behaviour. Additionally, respondents graded their overall self-perceived cultural competence on a 1–10 scale.Results86 medical students, 56 YHC Residents and 35 YHC Supervisors completed the questionnaire (overall response rate 41%; n= 177). On average, respondents scored low on general knowledge (mean 46% of maximum score) and knowledge of interpretation services (mean 55%) and much higher on reflection ability (80%). The respondents’ reports of their consultation behaviour reflected moderately adequate behaviour in exploring patients’ perspectives (mean 64%) and in interaction with low health literate patients (mean 60%) while the score on exploring patients’ social contexts was on average low (46%). YHC respondents scored higher than medical students on knowledge of interpretation services, exploring patients’ perspectives and exploring social contexts. The associations between self-perceived cultural competence and assessed knowledge, reflection ability and consultation behaviour were weak.ConclusionAssessing the cultural competence of medical students and physicians identified gaps in knowledge and culturally competent behaviour. Such data can be used to guide improvement efforts to the diversity content of educational curricula. Based on this study, improvements should focus on increasing knowledge and improving diversity-sensitive consultation behaviour and less on reflection skills. The weak association between overall self-perceived cultural competence and assessed knowledge, reflection ability and consultation behaviour supports the hypothesis that measures of sell-perceived competence are insufficient to assess actual cultural competence.
Highlights
Assessing the cultural competence of medical students that have completed the curriculum provides indications on the effectiveness of cultural competence training in that curriculum
Participants The study population consisted of three groups: medical students in the clinical phase of their education, Youth Health Care Physician Residents in training (YHC Residents) and Youth Health Care Physician Supervisors (YHC Supervisors)
The three cultural competence domains were: 1) General Knowledge: We developed eight multiple choice items to assess the ‘general knowledge of ethnic minority care provision’, and six multiple choice items to assess respondents’ ‘knowledge of interpretation services’
Summary
Assessing the cultural competence of medical students that have completed the curriculum provides indications on the effectiveness of cultural competence training in that curriculum. Existing measures for cultural competence mostly rely on self-perceived cultural competence. Patient populations in many western countries show increasing ethnic diversity. In the Netherlands, for example, around 20% of the population is from non-Dutch background and in the largest Dutch cities about 33% of the population is from non-Western ethnic background [1]. Competent care has been proposed as an important strategy to combat ethnic inequalities in quality of care [2,3]. Cultural competence programs focused on teaching beliefs and characteristics of specific cultural and ethnic groups. Over the years the concept of cultural competence has expanded beyond culture, and addresses a broad array of topics relevant to (ethnic) inequalities in healthcare quality [4,5]
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