Student midwives’ understanding of anti-racist behaviours and cultural competency

Cultural competence in health care is designed to ensure that health professionals are able to provide quality health care to culturally and ethnically diverse populations. Cultural competence can be effective for improving health professionals’ knowledge, attitudes and skills and patient satisfaction. The impact of cultural competence education and training included in university-based professional training of health professionals is relatively unclear. This study aims to describe the characteristics and assess the methodological quality of published evaluations of cultural competence education and training interventions targeting university based health professionals in training. A systematic search of the cultural competence literature identified 16 published evaluations of cultural competence education and training interventions included in university based professional training of health professionals. Information on the characteristics and methodological quality of included studies was extracted using standardized assessment tools. Nine studies evaluated the integration of cultural competence into health or medical curriculum, four evaluated a cultural immersion experience, and three evaluated cultural awareness education and training. Positive outcomes commonly reported were improvements in students’ knowledge of cultural competence and attitudes towards Indigenous and culturally diverse peoples. The methodological quality of evaluations and the reporting of key methodological criteria were variable. Eleven studies conducted a quantitative and five studies a qualitative evaluation. Strengths of quantitative evaluations included adequate study designs and valid and reliable measurement instruments. Selection bias and poor attrition were the main limitations of quantitative evaluations. Qualitative evaluations were adequate on most methodological criteria but the reporting of ethical and some methodological issues was less than adequate. There is insufficient evidence to provide a strong basis for recommending the inclusion of specific cultural competence education and training strategies in the professional training of university based health professionals. Future evaluations should compare similar types of strategies, and extend their measurement of outcomes beyond those relating to the knowledge, attitudes and skills of health professionals, to those relating to health care outcomes of ethnically diverse peoples.

Diversity Within US Gastroenterology Physician Practices: The Pipeline, Cultural Competencies, and Gastroenterology Societies Approaches

core mission of health professions schools is to educate and train a workforce that will be optimally prepared to provide health care and public health services for the diverse communities that they serve. It is important to create and develop a health care workforce who can understand and assist in the battle against health care disparities. For health care workers and health profession schools, cultural competence education and training has been identified as one solution to the problem. However to educate and properly train a culturally competent health care workforce is not an easy task. The literature on cultural competency is growing, with numerous studies that have focused on specific traits of cultural competency but unfortunately, a consensus on the best approach to achieve the desired outcomes has not been reached. A review of the literature on cultural competency reveals some common concerns regarding cultural competency, especially about how cultural competence education is incorporated in the classroom/clinical setting. What training and preparation does the instructor possess to qualify him or her to teach cultural competency? Was the instructor chosen because of gender or because he/she is from a racial or ethnic minority group which somehow makes him/her an expert? How much time should be devoted to cultural competency training in health professions? How do we accurately assess student learning of cultural competency? And finally, how do we as faculty committed to cultural competency get our colleagues to also participate in cultural training/education? These are key ques- tions, concerns, and problems that many who teach cultural competency training have encountered. Therefore, a variety of approaches to cultural competency education and training have been developed within our schools. Earlier this year, a joint expert panel convened by the Association of American Medical Colleges and the Association of Schools of Public Health released a report with recommendations for Schools of medicine and public health defining a set of

Introduction: Cultural competency training, which includes understanding and respecting diverse religious beliefs and practices, is crucial for providing culturally sensitive patient care. In residency programs, a focus on this type of competency may not only enhance patient care but also promote mental health and wellness for resident trainees. The Accreditation Council for Graduate Medical Education (ACGME) suggests integrating this training into core competencies such as interpersonal and communication skills, patient care, and professionalism. Promoting inclusivity within residency training prepares residents to effectively care for patients from diverse backgrounds, enhancing their ability to provide personalized care. This research study seeks to track and analyze the evolution of cultural and religious support purported on Obstetrics and Gynecology residency websites over three years. Methods: In 2021 and 2024, a comprehensive evaluation of the websites of ACGME-accredited OB/GYN residency programs in the U.S. was conducted, focusing on data from the recently concluded interview cycles. A unique set of evaluation criteria was developed to assess the incorporation of cultural and religious diversity, as well as the integration of corresponding competency training into resident education. The process of devising the 18 key questions for the assessment involved rigorous formulation, validation, and refinement by a group of religiously and culturally diverse medical students. The collection of data was conducted by students from two larger medical schools, one in the Midwest and another in the South. The number of analyzed websites between the two time periods was noted to be discrepant due to the rise in accredited programs and/or improved website accessibility. Thus, instead of absolute numbers, percentages were utilized to optimize comparison. Data was also categorized based on geographical/administrative CREOG regions to facilitate easier understanding and regional comparison. The evaluation criteria included factors such as the program’s efforts in recruiting and respecting the needs of residents of diverse religious backgrounds, the presence of cultural, religious, and racial non-discrimination statements, and the program’s support towards residents’ religious obligations, among others. Results: A total of 577 OB/GYN residency program websites were analyzed: 285 in 2021 and 292 in 2024. There was a positive trend toward supporting cultural and religious competencies across all CREOG regions in OB/GYN residency programs. Programs expressing an interest in recruiting residents from diverse religious backgrounds nearly doubled from 12% to 26%. The percentage of residency programs providing formal cultural competency education to staff rose from 7% to 17%. Additionally, there were improvements in support for resident involvement in advocacy or policy issues related to cultural competency and an increase in programs allowing residents to opt out of practices conflicting with their beliefs. The proportion of residency programs implementing a holistic review of applications increased from 17% to 33%. Regional analysis highlighted significant shifts across different CREOG regions. Regions 1 and 3 showed a marked rise in the percentage of programs demonstrating interest in investment to recruit residents of diverse religious backgrounds, indicating increased acceptance of religious variety. Specifically, Region 1 saw an increase from 12% to 38%, while Region 3 jumped from 0% to 20%. Regions 2 and 4 experienced substantial growth in implementing formal cultural competency education, rising from 5% to 18% in Region 2 and from 9% to 46% in Region 4. Region 5 stood out overall in multiple areas, such as integrating cultural competency into the residents’ didactic curricula and supporting residents in researching religious and cultural diversity issues. Despite improvements in most areas, some criteria showed minimal progress. Support for residents with religious obligations remained static at 0% across all regions. Similarly, explicit policies addressing time off for religious holidays declined from 2% to 1%. In Regions 3 and 4, there was a decline in the percentage of programs addressing opportunities and procedures for reporting harassment on their websites, with Region 4 experiencing a significant drop from 16% to 1%. This decline suggests a potential lack of transparency and support for residents facing such cultural issues. Lastly, specialized cultural mentorship programs to accommodate International Medical Graduates remained largely absent, with only 1% of programs offering such support in both cycles. Conclusion: Our study provides a comprehensive analysis of cultural and religious competencies in OB/GYN residency programs across the US, based on data from 2021 and 2024. The findings suggest a generally positive trend in the improvement of these competencies over the three years with significant progress noted in most areas. However, the regional analysis revealed varied trends across CREOG regions, showcasing the need for region-specific strategies. This research underscores the importance of continuous evaluation and enhancement of cultural and religious competency training in residency programs to ensure that future healthcare providers are well-equipped to deliver inclusive and respectful patient care.

To identify demographic, educational, and experiential factors associated with perceived self-efficacy in cultural competency (PSECC) for pediatric residents and faculty at a large, tertiary-care children's hospital and to identify key barriers to the delivery of culturally competent pediatric care. We conducted a cross-sectional assessment of cultural competency (CC) education, training, and skills using an online survey of residents and faculty at a large children's hospital. With our data analysis, we sought associations between PSECC skills, cross-cultural training or work experience, and demographic background. Participants were asked to identify and rank barriers to CC care and additional training they would like to see implemented. A total of 114 residents (55%) and 143 faculty (65%) who responded to the survey assessing PSECC. Residents were more likely to have had CC training than faculty. More than half of the residents and faculty had participated in an underserved-group clinical experience domestically or abroad. Those residents with underserved-group experience were more likely to be comfortable with interpreter use (P = .03) and culturally sensitive issues (P = .06). Faculty who participated in underserved-group care in the United States were more likely to believe that cultural bias affects care (P = .005). Both identified time constraints, language barriers, and lack of knowledge as chief barriers to acquiring CC, and both desired more training. Residents and faculty at a large children's hospital believe that they lack adequate CC training. Underserved-group clinical experiences both domestically and abroad are associated with perceived improved cross-cultural care skills. Increasing the extent and quality of CC education in both resident training and faculty development is needed.

Most US medical schools have instituted cultural competence education in the undergraduate curriculum. This training is intended to improve the quality of care that doctors, the majority of whom are White, deliver to ethnic and racial minority patients. Research into the outcomes of cultural competence training programmes reveals that they have been largely ineffective in improving doctors' skills. In varied curricular formats, programmes tend to teach group-specific cultural knowledge, despite the vast heterogeneity of racial and ethnic groups. This cultural essentialism diminishes training effectiveness. This paper proposes key curriculum content changes and suggests the inclusion of an intersectional framework in the cultural competence curriculum. This framework maintains that racial and ethnic minority groups hold multiple social statuses, called social locations, which interact with one another to uniquely shape the health views, needs and experiences of the individuals within the groups. Social locations include those defined by race, ethnicity, gender, social class and sexuality, which are experienced multiplicatively, not additively, within a particular social context. Cultural competence education must go beyond simplified cultural understandings to explore these more complex meanings. Doctors' ability to understand, communicate with and treat diverse groups can be vastly improved by applying an intersectional framework in academic research, self-awareness exercises and clinical training. Integrating an intersectional framework into cultural competency education can better prepare doctors for caring for racial and ethnic minority patients. This paper recommends curriculum elements for the classroom and clinical training that can improve doctor knowledge and skills for caring for diverse groups. Medical schools can use the proposed model to facilitate the development of new educational strategies and learning experiences. These improvements can lead to more equitable care and ultimately diminish disparities in health care. Although these recommendations are designed with US schools in mind, they may improve doctor understanding and care of marginal populations across the world.

Strategies for Incorporating Health Disparities and Cultural Competency Training into the Pharmacy Curriculum and Co-curriculum

Introduction: The hierarchy of the American medical system and it’s disconnect of recognition beyond the binary of sexual minorities has created systematic inequitable care because of lack of appropriate cultural competency training. Healthcare providers are not adequately taught appropriate cultural competencies in standardized academic training. Methods: Given an online survey of varied health care providers (N = 208), the research examined “culturally competent health care delivery” knowledge, stage of change; precontemplation, contemplation, preparation, action, maintenance; as per the work of Prochaska & DiClemente, (1983) for taking action to be culturally sensitive, culturally competent, culturally appropriate, and future training desirability. Results: The sample population reported a high self-rating for aligning with definition of cultural competency; prevalence of 6 to 10 hours of engagement in cultural competence training; rating 3.97 (SD = .741) of quality for cultural competence training; Pre-Survey Stage of Change (N = 208) mean was 4.32 between action and maintenance, but closest to action (SD = 1.21); and with 71.2% already in maintenance it is noted that the research captured providers who have received equitable training, offering equitable care. Conclusions: Affirmation for LGBT clients is a critical adaptive response for practitioners recognizing the overt social injustices that have occurred historically as personal injustices and responding in a positive and accepting manner can dramatically improve patient engagement. Training within the confines of a grounded evidenced based theory can support appropriate and culturally competent equitable care. Keywords: healthcare providers, cultural competency, lesbian, gay, bisexual, transgender (LGBT), stages of change, transtheoretical model

The Partnership of Dietetic Education and Practice (PDEP) has introduced two new competencies surrounding diversity and culture to the Integrated Competencies of Dietetic Education and Practice (ICDEP). Dietetic educators can consider utilizing critical pedagogies, such as culturally responsive pedagogy (CRP), to support their implementation. Currently, it is unknown how CRP can be applied to support cultural competency education and training for Canadian dietetic students. As such, this narrative literature review aims to address this gap through the following research questions: 1) What is the current state of cultural competency education and training for Canadian dietetic students?; 2) What are the key principles and strategies of CRP?; 3) How are other healthcare professionals implementing CRP in their curriculum?; 4) What are the barriers and supports needed to implement and sustain CRP?; and 5) What are the best practices and recommendations for using CRP in implementing cultural competency education and training for Canadian dietetic students? From the findings, seven recommendations for stakeholders to implement into practice were generated: 1) Implement policies that support the delivery of cultural competency; 2) Implement faculty development training on CRP; 3) Recruit ethnically diverse faculty and student population; 4) Engage in self-reflection on personal attitudes and beliefs; 5) Design culturally relevant curricula; 6) Implement group assignments; and 7) Create opportunities for engagement for social action. With effective implementation, we can expect Canadian dietetic students to improve their cultural competence. Developing culturally competent dietitians is essential to reducing racial and ethnic disparities in immigrant populations and supporting equitable healthcare.

The number of racially and culturally diverse patients in the medical practices of US physicians is increasing. It is unclear how well culturally and linguistically appropriate services (CLAS) standards have been integrated into physician practice. The objective of this study was to determine the prevalence of US-based physicians who received training in cultural competency and describe their behavior. This survey study utilized data from a supplement of the 2016 National Ambulatory Medical Care Survey (NAMCS). The NAMCS Supplement on CLAS for Office-based Physicians (National CLAS Physician Survey) is a nationally representative survey of ambulatory physicians. We determined the proportion and characteristics of physicians who reported receiving cultural competency training in medical school or in practice. The unweighted sample of 363 yielded a weighted sample of 290,109 physicians, 66.3% of whom reported that they had received cultural competence training at some point. Only 35.5% of the sample had ever heard of the CLAS standards, suggesting a low level of awareness of the standards. Further, only 18.7% reported that training in cultural competency is required for newly hired physicians who join their practice. There were no statistically significant differences between those who had been trained and those who had not in terms of self-reported consideration of race/ethnicity or culture in assessing patient needs, diagnosis, treatment and patient education (P>.05). Fewer than half of practicing physicians reported receiving cultural and linguistic competency training in medical school or residency. It is possible that cultural competence training is being seamlessly integrated into medical education.

Objectives. Although, culturally competent (CC) interventions aim to reduce health inequalities for ethnic minorities, they have been criticized on the grounds that they increase prejudice and stereotyping. It remains unclear whether CC interventions really can reduce health inequalities among ethnic minorities. The purpose of this review is to assess whether CC interventions in the management of Type 2 diabetes mellitus (T2DM) match the recommendations to reduce health inequalities.Design. We identified CC interventions relating to T2DM among ethnic minority patients in the literature published between 2005 and 2011. Data were analyzed according to an equity-oriented framework. Each study was given a score based on its congruence with the reduction of health inequalities amongst ethnic minorities.Results. We reviewed 137 papers and found 61 studies that met the inclusion criteria. Most interventions focused on the individual level and the modification of patients' health behavior. Very few addressed the sociopolitical level. A minority of the studies acknowledged the role of socioeconomic deprivation in ethnic health inequalities. Half of the studies contained no information about the socioeconomic status of the patients. The patients receiving the interventions were socioeconomically deprived. Only 10 studies compared ethnic minority groups to majority groups. Thirty-three studies had a very low average congruence score. The highest score of congruence was achieved by one study.Conclusion. Overall, CC interventions addressing T2DM are not congruent with the reduction of ethnic health inequalities. The future of CC interventions may involve going one step further and going back to basic tenets of cultural competence: the integration of difference, whatever its source, into the delivery of fair health care for patients.

Cultural competence education for health professionals.

Cultural competency can be understood as those learned skills which help us understand cultural differences and ease communication between people who have different ways of understanding health, sickness and the body. Recently, medical schools have begun to recognise a need for cultural competency training. However, few reports have been published that articulate and evaluate cultural competency in medical curricula. This study was performed in order to evaluate the current status of cultural competency training at a medical school in southern Sweden. We used a multimethod approach to curriculum evaluation. We reviewed the published list of learning objectives for the medical programme, interviewed curriculum directors and individual teachers for each term about course content and carried out focus group interviews with students in all stages of the medical programme. Cultural competency is a present but mostly hidden part of the curriculum. We found learning objectives about cultural competency. Teachers reported a total of 25 instances of teaching that had culture or cultural competency as the main theme or 1 of many themes. Students reported few specific learning instances where cultural competency was the main theme. Students and teachers considered cultural competency training to be integrated into the medical programme. Cultural competency was not assessed. This evaluation showed places in the curriculum where cultural competency is a present, absent or hidden part of the curriculum. The differences between the 3 perspectives on the curriculum lead us to propose curriculum changes. This study illustrates how triangulation with a multifactorial methodology leads to understanding of the current curriculum and changes for the future.

Cultural competence: A call to action

Partnership, reflection and patient focus: advancing cultural competency training relevance