Cultural Competence in Clinician Communication

Abstract

1. Cheryl Kodjo, MD, MPH* 1. *Assistant Professor of Pediatrics, Division of Adolescent Medicine, University of Rochester School of Medicine & Dentistry, Rochester, NY After completing this article, readers should be able to: 1. Define cultural competence. 2. Explain the need for cultural competence. 3. Describe the changing child demographics of the United States. 4. Discuss the process of becoming a more culturally competent clinician. 5. Review tools and techniques that help achieve cultural competence. Note: A clarification has been posted. Some have suggested that cultural competence cannot be taught or learned and that some clinicians are just more sensitive than others when it comes to issues of cultural differences. Indeed, in some instances, we preach to the choir, if you will, regarding attitudes toward cultural competence. However, certain skills can be imparted to help all clinicians, regardless of their attitudes. As Dr Joseph Betancourt concludes, we would not accept substandard competence in other areas of clinical medicine, and cultural competence should not be an exception.(1) Certain skills can be acquired, practiced, and honed on the journey of becoming a more culturally competent clinician. This article reviews the evolution and benefits of cultural competence in pediatric practice and gives examples of questions that can be asked to provide more comprehensive care to the patient and his or her family. Cultural competence can be assessed via several methods. For example, evaluations or satisfaction surveys from patients, families, and staff, otherwise known as 360-degree evaluations, in a busy pediatric practice can provide useful feedback that prompts change in behavior. Observation, one of the best tools for evaluating clinician behavior, can be performed by using either standardized or real patients. Observed role-playing with standardized patients can provide clinicians with formative feedback to improve their interviewing skills. Observation of interactions with actual patients or unidentified standardized patients, similar to the observation model used in education, captures actual clinician behavior when functioning under pressure. The Institute of Medicine issued its landmark report …