Cross-Cultural Care Survey Research Articles

Perceptions of and preparedness for cross-cultural care: a survey of final-year medical students in Ireland

BackgroundMigration is increasing globally, and societies are becoming more diverse and multi-ethnic. Medical school curricula should prepare students to provide high-quality care to all individuals in the communities they serve. Previous research from North America and Asia has assessed the effectiveness of medical cultural competency training, and student preparedness for delivery of cross-cultural care. However, student preparedness has not been explored in the European context. The aim of this study was to investigate how prepared final-year medical students in the Republic of Ireland (ROI) feel to provide care to patients from other countries, cultures, and ethnicities. In addition, this study aims to explore students’ experiences and perceptions of cross-cultural care.MethodsFinal-year medical students attending all six medical schools within the ROI were invited to participate in this study. A modified version of the Harvard Cross-Cultural Care Survey (CCCS) was used to assess their preparedness, skill, training/education, and attitudes. The data were analysed using IBM SPSS Statistics 28.0, and Fisher’s Exact Test was employed to compare differences within self-identified ethnicity groups and gender.ResultsWhilst most respondents felt prepared to care for patients in general (80.5%), many felt unprepared to care for specific ethnic patient cohorts, including patients from a minority ethnic background (50.7%) and the Irish Traveller Community (46.8%). Only 20.8% of final-year students felt they had received training in cross-cultural care during their time in medical school. Most respondents agreed that they should be assessed specifically on skills in cultural competence whilst in medical school (83.2%).ConclusionsA large proportion of final-year medical students surveyed in Ireland feel inadequately prepared to care for ethnically diverse patients. Similarly, they report feeling unskilled in core areas of cross-cultural care, and a majority agree that they should be assessed on aspects of cultural competency. This study explores shortcomings in cultural competency training and confidence amongst Irish medical students. These findings have implications for future research and curricular change, with opportunities for the development of relevant educational initiatives in Irish medical schools.

The impact of a pharmacist-led cultural competence training on provider perceived preparedness and clinical care in patients with diabetes of Asian descent

BackgroundPatients of Asian descent are under-represented in the U.S. health care system and provider cultural competence is inadequate in addressing Asian health disparities. ObjectivesThe purpose of this study was to evaluate the impact of the pharmacist-led cultural competence training on provider self-perceived preparedness and diabetes-related health outcomes in patients of Asian descent. MethodsThis study is a cross-sectional followed by a quasi-experimental design conducted in 2 phases in a primary care clinic. Phase one evaluated the association of providers’ cross-cultural care survey (CCCS) scores with patients’ diabetic health indices: hemoglobin A1c (HbA1C), systolic blood pressure (SBP), diastolic blood pressure, and body mass index. Phase 2 examined the impact of pharmacist-led cultural competence training on providers’ cross-cultural competency using survey analysis as well as pre- and post-training diabetic health indices in patients of Asian descent. ResultsPhase 1 CCCS results showed baseline cross-cultural competence of the providers is inadequate (N = 9 providers). Furthermore, a significant negative correlation was found between providers’ CCCS score and patients’ HbA1C (N = 49, P = 0.04). Phase 2 showed that cultural competence training significantly reduced providers’ self-perceived “un-preparedness” to care for patients of alternative cultures (N = 30 providers). Average diabetic health indices for all patients (N = 95) before and after the training were not significantly different. In the subset of patients with uncontrolled diabetes (HbA1C ≥ 7), SBP and HbA1C were significantly reduced after the training (P = 0.032 and P = 0.039, respectively). ConclusionsPharmacist-led cultural competence training had a positive impact on provider self-assessment and diabetic clinical outcomes in uncontrolled patients.

Readiness of Medical Students to Care for Diverse Patients: A Validated Assessment of Cross-Cultural Preparedness, Skills, and Curriculum.

Effective cross-cultural care is foundational for mitigating health inequities and providing high-quality care to diverse populations. However, medical school teaching practices vary widely, and learners have limited opportunities to develop these critical skills. To understand the current state of cross-cultural education and to identify potential opportunities for improvement, we disseminated a validated survey instrument among medical students at a single institution. Learners across 4 years of medical school participated in the cross-cultural care assessment, using a tool previously validated with resident physicians and modified for medical students. The survey assessed medical student perspectives on (1) preparedness, (2) skillfulness, and (3) educational curriculum and learning environment. Cross-sectional data were analyzed by class year, comparing trends between school years. Of 700 possible survey responses, we received 260 (37% response rate). Fourth-year students had significantly higher scores than first-year students (p<0.05) for 7 of 12 preparedness items and 4 of 9 skillfulness items. Less than 50% of students indicated readiness to deliver cross-cultural care by their fourth year in 9 of 12 preparedness items and 6 of 9 skillfulness items. Respondents identified inadequate cross-cultural education as the primary barrier. Medical students reported a lack of readiness to provide cross-cultural care, with self-assessed deficiencies persisting through the fourth year of medical school. Medical educators can use data from the cross-cultural care survey to longitudinally assess students and enhance curricular exposures where deficiencies exist. Optimizing cross-cultural education has the potential to improve the learning environment and overall patient care.

Assessing medical students’ perception of cross-cultural competence at a private University in Karachi

BackgroundCross-cultural competence is widely regarded to play an important role in being able to deliver appropriate and effective health care to patients with different backgrounds, race, gender orientation and cultural beliefs. This study aims to assess how medical students feel about their comfort, knowledge, and skill level in handling a diverse patient population using a validated questionnaire.MethodsThis study was carried out over a period of three weeks from July 5th to July 26th of 2021, in the Aga Khan University Hospital, Karachi, Pakistan. All medical students who fulfilled the eligibility criteria and gave informed consent were included in the study. A modified version of the Harvard cross-cultural care survey was used to assess the medical students’ comfort, knowledge and skill level in a variety of circumstances related to patients with different backgrounds and cultures. Descriptive statistical analysis of the questionnaire items was carried out. We reported frequencies and percentages for gender and year of study. For the questionnaire items, we reported mean, assuming that our Likert scale had equivariant intervals. Furthermore, multivariate analysis between demographics and themes was carried out. A p-value of < 0.05 was taken as statistically significant.ResultsIt was found that students of year 5 considered themselves more knowledgeable, comfortable and skilled in dealing with patients of different backgrounds, religions and beliefs compared to students of year 1 and had a higher average score in all of these categories which was statistically significant. Additionally, students who believed it is extremely important to practice medicine with a diverse patient population also had the highest averages in perceived knowledge, comfort and skills in dealing with patients of different sociocultural backgrounds compared to students who believed it wasn’t important at all.ConclusionThis is a first of its kind study in a private medical university in Pakistan and highlights the students’ self-assessment of their competence when caring for patients from different backgrounds. This study can be used as a reference study in the region to carry out further studies and to assess and improve the gaps in medical training being provided.

Impact of Cultural Competency Training in Naturopathic Medical Students: Self-Assessed Changes in Awareness, Knowledge, Skills, and Attitudes

Introduction: Cultural competency training is a growing requirement in medical schools across North America. Although accredited naturopathic medical schools now include some elements of cultural competency training throughout their programs, no literature to date has evaluated the effect of cultural competency curriculum among naturopathic medical students. This study evaluated the impact of a cultural competency training program of 4th-year naturopathic medical students at an accredited naturopathic medical educational institution in North America. Methods: Pre- and post-training online surveys were completed by naturopathic medical students using a 1 to 5 numerical scale (least to most confident), self-evaluating their awareness, knowledge, skills, and willingness to change behaviours, with some survey items adapted from the short version of the Cross-Cultural Care Survey (Harvard). Descriptive statistics were calculated, and a paired two-sided Wilcoxon signed-rank test was used to examine changes between pre- and post-training responses. Results: Out of 134 students enrolled in the training, 46 participants completed both the pre- and post-training surveys and were included in the final analysis. There was a statistically significant increase in self-rated confidence from pre- to post-training across all individual survey items spanning improvements in cultural competency awareness, knowledge, skills, and attitudes among students who completed both surveys. Conclusions: Results from this study indicate that cultural competency training of naturopathic students may improve their subjective assessment of their awareness, knowledge, skills, and attitudes related to working with diversity in clinical practice. Future research would benefit from using validated assessment scales, reducing loss to follow up, and investigating factors such as social demographics, prior training, and lived experience amongst participants.

Assessing Asian Medical Students’ Readiness for Diversity: Localizing Measures of Cross-Cultural Care Competence

Phenomenon: There is now broad acceptance that the development of cross-cultural competence (CCC) supports the delivery of appropriate care to diverse groups and is an essential component in medical education worldwide. CCC training in East Asian contexts has been constrained by the fact that “cultural diversity” training globally has focused primarily on the needs of racial and ethnic communities, to the relative neglect of other groups. The present study explores Taiwanese students’ perceptions of CCC provision to identify gaps in local medical education and thus facilitate a more systematic delivery of CCC. Approach: Using an adapted and translated version of the Cross-Cultural Care Survey developed by Harvard Medical School, we collected 1567 student responses from four geographically-distributed Taiwanese medical schools between 2015 and 2017. In addition to student responses, we also collected 122 clinical teacher responses from two of the four medical schools that were surveyed to cross-examine the students’ self-perceived competence. The data were analyzed with SPSS and ANOVA was employed with student data to compare the differences among different stages. The analysis focuses on CCC in 4 stages of training: general education, basic pre-clinical and integrated clinical sciences, clerkship, and internship. Findings: The findings show that students felt unprepared to deal with health disparities and the needs of diverse groups and there was no evidence of an increased sense of preparedness in the development of relevant skills in the analyses of the pre-clinical to clinical stages of the curriculum. Similarly, teachers also perceived students across the different stages of training to be unprepared in dealing with the health disparities and needs of diverse groups. However, although findings from teachers’ responses parallel those from students, teachers tend to perceive students to be even more unprepared than they perceive themselves to be. The training for CCC appeared inadequate from both set of data and students perceive CCC training to be less explicitly evident in the medical program as it advances from the foundation stage to the pre-clinical stage. Insights: The study raises some crucial issues in terms of diversity and CCC training in medical education programs. The fact that increased awareness of health disparities and the needs of diverse groups fails to be aligned with a sense of preparedness and skillfulness confirms that CCC has not been explicitly and sufficiently addressed in the medical curriculum, particularly in the pre-clinical stage when the focus is on acquiring scientific and technical knowledge. This study shows how a questionnaire designed by and for an American medical institution situated in a highly diverse society can be adapted so that its findings serve as a baseline for medical education programs in Taiwan, and perhaps in other countries that are beginning to acknowledge hitherto “hidden” diversity. This study also has implications which indicate that CCC is crucial in the delivery of appropriate care by members of the medical profession to diverse patients.

Concordance of Resident and Patient Perceptions of Culturally Dexterous Patient Care Skills

Disparities in surgical care persist. To mitigate these disparities, we are implementing and testing the Provider Awareness and Cultural dexterity Toolkit for Surgeons (PACTS), a curriculum to improve surgical residents' cultural dexterity during clinical encounters. We analyzed baseline data to look for concordance between residents' self-perceived cultural dexterity skills and patients' perceptions of their skills. We hypothesized that residents would rate their skills in cultural dexterity higher than patients would perceive those skills. Prior to the implementation of the curriculum, surgical residents at 5 academic medical centers completed a self-assessment of their skills in culturally dexterous patient care using a modified version of the Cross-Cultural Care Survey. Randomly selected surgical inpatients at these centers completed a similar survey about the quality of culturally dexterous care provided by a surgery resident on their service. Likert scale responses for both assessments were classified as high (agree/strongly agree) or low (neutral/disagree/strongly disagree) competency. Resident and patient ratings of cultural dexterity were compared. Assessments were considered dexterous if 75% of responses were in the high category. Univariate and multivariate analysis was conducted using STATA 16. A total of 179 residents from 5 surgical residency programs completed self-assessments prior to receiving the PACTS curriculum, including 88 (49.2%) women and 97 (54.2%) junior residents (PGY 1-2s), of whom 54.7% were White, 19% were Asian, and 8.9% were Black/African American. A total of 494 patients with an average age of 55.1 years were surveyed, of whom 238 (48.2%) were female and 320 (64.8%) were White. Fifty percent of residents viewed themselves as culturally dexterous, while 57% of patients reported receiving culturally dexterous care; this difference was not statistically significant (p = 0.09). Residents who perceived themselves to be culturally dexterous were more likely to self-identify as non-White as compared to White (p < 0.05). On multivariate analysis, White patients were more likely to report highly dexterous care, whereas Black patients were more likely to report poorly dexterous care (p < 0.05). At baseline, half of patients reported receiving culturally dexterous care from surgical residents at 5 academic medical centers in the United States. This was consistent with residents' self-assessment of their cultural dexterity skills. White patients were more likely to report receiving culturally dexterous care as compared to non-White patients. Non-White residents were more likely to feel confident in their cultural dexterity skills. A novel curriculum has been designed to improve these interactions between patients and surgical residents.

Scoping Review of Economical, Efficient, and Effective Cultural Competency Measures

Identifying practical and effective tools to evaluate the efficacy of cultural competency (cc) training in medicine continues to be a challenge. Multiple measures of various lengths and stages of psychometric testing exist, but none have emerged as a "gold standard." This review attempts to identify cc measures with potential to economically, efficiently, and effectively provide insight regarding the value of cc training efforts to make it easier for wider audience utilization. A scoping review of 11 online reference databases/search engines initially yielded 9,626 items mentioning cc measures. After the initial review, focus was placed on measures that assessed cultural competence of medical students, residents, and/or attending physicians. Six measures were identified and reviewed: (1) Cross-Cultural Care Survey, (2) Cultural Competence Health Practitioner Assessment, (3) Cultural Humility Scale, (4) Health Beliefs Attitudes Survey, (5) Tool for Assessing Cultural Competency Training, and (6) the Tucker-Culturally Sensitive Health-Care Provider Inventory. Relevant literature documenting use and current psychometric assessments for each measure were noted. Each measure was found to be of value for its particular purpose but needs more strenuous reliability and validity testing. A commitment to include psychometric assessments should be an expected part of studies utilizing these measures.

Assessment of cross-cultural competency among dental interns: An exploratory study

Aims: The study aims to quantity the variation in dental interns' self perceived levels toward cultural competence. Settings and Design: A cross-sectional study was conducted among 84 dental interns from dental college during December 2019. Subjects and Methods: 84 dental interns were participated from college during the month of December for this study. Data were collected through interview using pretested and prevalidated form, consisting of demographic variables such as age, gender, and community with cross-cultural care survey that concerning about the ability to deliver diverse patient's care. Statistical Analysis Used: The statistical analysis was done using SPSS software, and mean, standard deviation, paired t-test and Analysis of Variance (ANOVA) test were applied for the analysis of the data, and the level of significance was set at P < 0.05. Results: It showed that males had significantly higher mean ± SD knowledge (3.29 ± 0.60), skill (3.55 ± 0.52), and attitude (3.32 ± 0.51) scores, respectively, as compared to females; however, while comparing the various domains on the basis of religion factor, the difference was not found statistically significant. Conclusions: The current study suggests that cultural competence knowledge, skill, and attitude of the study participants were inadequate. Hence, there is a need to conduct training programs for interns to enlighten them on the sensitive issue of cross-cultural competency in oral health services.

86. EARLY IMPACT OF A HEALTH EQUITY, DIVERSITY, AND INCLUSION CURRICULA ON RESIDENT KNOWLEDGE, ATTITUDES AND SKILL IN CROSS-CULTURAL CARE

Background GME programs that provide targeted training on the care of disadvantaged populations may result in improved cross-cultural care and decreased health disparities and patient discrimination. In 2018, the ACGME highlighted lack of formal education on knowledge and strategies to address health disparities as a national priority need. Currently, many residents do not receive training on structural competencies and biases that contribute to poor health, nor are they equipped with skills to advocate for patients who disproportionately experience inequity from structural and social determinants of health (SDOH). Design The HEDI curriculum at Cohen Children's Medical Center expands resident training to include sessions on: implicit bias, use of interpreters, health literacy, health disparities, community engagement, LGBTQ health, mistrust, racism, SDOH, cultural and structural competency. Prior to curriculum initiation, residents completed the validated Cross-Cultural Care Survey (CCCS). Trainees engage in monthly, interactive workshops and case-based simulations. Pre and post surveys assess resident knowledge, skill, and attitudes related to each session. Descriptive analyses and Fisher's Exact Test assess bivariate associations. Results Of the 49 residents who completed the CCCS, 67% felt unprepared to deliver cross-cultural care. 18% identified lack of experience and 30% reported inadequate training as barriers to delivering cross-cultural care. Attendance of at least 1 HEDI session was associated with a decrease in residents personal feeling of helplessness when caring for patients of different cultures (p Conclusion Early results from the HEDI curriculum show residents' improvement in preparedness and attitudes in providing cross-cultural care. Further research is warranted to examine whether curricular elements provide a long-term, sustained impact on resident knowledge, skills, and attitudes, which are necessary to combat and eliminate health disparities.

Canadian residents’ perceptions of cross-cultural care training in graduate medical school

The Royal College of Physicians and Surgeons of Canada specifies both respect for diversity as a requirement of professionalism and culturally sensitive provision of medical care. The purpose of the present study was to evaluate the perception of preparedness and attitudes of medical residents to deliver cross-cultural care. The Cross Cultural Care Survey was sent via e-mail to all Faculty of Medicine residents (approx. 450) in an academic health sciences centre. Comparisons were made between psychiatry residents, family medicine residents, and other residency groups with respect to training, preparedness, and skillfulness in delivering cross-cultural care. Seventy-three (16%) residents responded to the survey. Residents in psychiatry and family medicine reported significantly more training and formal evaluation regarding cross-cultural care than residents in other programs. However, there were no significant differences in self-reported preparedness and skillfulness. Residents in family medicine were more likely to report needing more practical experience working with diverse groups. Psychiatry residents were less likely to report inadequate cross-cultural training. While most residents reported feeling skillful and prepared to work with culturally diverse groups, they report receiving little additional instruction or formal evaluation on this topic, particularly in programs other than psychiatry and family medicine.

Undergraduate nursing students and cross-cultural care: A program evaluation

The purpose of this study was to evaluate baccalaureate nursing students' perspectives on their acquired cultural competency following the integration of a transcultural nursing thread throughout the curriculum. This research is as part of an ongoing program evaluation. A cross-sectional survey design utilizing The Residents Physicians' Preparedness to Provide Cross-Cultural Care Survey (Weissman et al., 2005). The instrument was adapted and used as the Nursing Education in Cross-Cultural Care Survey. This survey consisted of five sections: training, cross-cultural experiences, resources, specialty areas, and personal and professional characteristics. The setting for this research was a baccalaureate school of nursing at a small university in rural Hawaii. A convenience sample of 56 graduating senior nursing students over a 2-year period participated in the study. Students perceived themselves as somewhat prepared to provide cultural competent care. Limited exposure and utilization of interpreters, lack of role models and mentors, and unpreparedness to counsel different cultures in the area of terminal health were the lowest scoring subsections. Students learned best in the clinical setting compared to classroom setting. Nursing program evaluation needs to be systematic and ongoing. All programs need to determine whether program goals were met. This survey tool assisted faculty to evaluate the integration of the transcultural thread throughout the nursing curriculum. At the end of the nursing program, students were somewhat prepared to deliver cross-cultural care. Areas were identified for program improvement.

Cultural competency of health-care providers in a Swiss University Hospital: self-assessed cross-cultural skillfulness in a cross-sectional study

BackgroundAs the diversity of the European population evolves, measuring providers’ skillfulness in cross-cultural care and understanding what contextual factors may influence this is increasingly necessary. Given limited information about differences in cultural competency by provider role, we compared cross-cultural skillfulness between physicians and nurses working at a Swiss university hospital.MethodsA survey on cross-cultural care was mailed in November 2010 to front-line providers in Lausanne, Switzerland. This questionnaire included some questions from the previously validated Cross-Cultural Care Survey. We compared physicians’ and nurses’ mean composite scores and proportion of “3-good/4-very good” responses, for nine perceived skillfulness items (4-point Likert-scale) using the validated tool. We used linear regression to examine how provider role (physician vs. nurse) was associated with composite skillfulness scores, adjusting for demographics (gender, non-French dominant language), workplace (time at institution, work-unit “sensitized” to cultural-care), reported cultural-competence training, and cross-cultural care problem-awareness.ResultsOf 885 questionnaires, 368 (41.2%) returned the survey: 124 (33.6%) physicians and 244 (66.4%) nurses, reflecting institutional distribution of providers. Physicians had better mean composite scores for perceived skillfulness than nurses (2.7 vs. 2.5, p < 0.005), and significantly higher proportion of “good/very good” responses for 4/9 items. After adjusting for explanatory variables, physicians remained more likely to have higher skillfulness (β = 0.13, p = 0.05). Among all, higher skillfulness was associated with perception/awareness of problems in the following areas: inadequate cross-cultural training (β = 0.14, p = 0.01) and lack of practical experience caring for diverse populations (β = 0.11, p = 0.04). In stratified analyses among physicians alone, having French as a dominant language (β = −0.34, p < 0.005) was negatively correlated with skillfulness.ConclusionsOverall, there is much room for cultural competency improvement among providers. These results support the need for cross-cultural skills training with an inter-professional focus on nurses, education that attunes provider awareness to the local issues in cross-cultural care, and increased diversity efforts in the work force, particularly among physicians.

The Refinement of a Cultural Standardized Patient Examination For a General Surgery Residency Program

BackgroundRecent articles have documented the importance of cultural competency in surgery. Surgical residency programs have used the Objective Structured Clinical Examinations or cultural standardized patient examinations as a training tool. Past studies evaluating cultural competency have noted the importance of including an observational (control) arm, which would allow for a more objective assessment of a resident’s competency in this area. The purpose of our article is to present the results of a follow-up study to a pilot cultural standardized patient examination for surgery residents. MethodsAll first-year surgery residents were required to participate in the videotaped cultural SP examination as part of the general surgery residency curriculum. Two measures were used to assess resident performance. On the day of the examination, the Cross-Cultural Care Survey was administered. The examination was assessed by the residents themselves, faculty observers, and standardized patients, using a written checklist that was developed to evaluate residents on all 6 Accreditation Council for Graduate Medical Education competencies. ResultsThe current study includes 20 first-year surgery residents from academic years 2011 to 2012 and 2012 to 2013. The examination of pretest differences in groups found that students born outside of the United States had significantly higher scores on attitude (t = −2.68, df = 18, p = 0.02), but no statistically significant differences were found in skillfulness or knowledge or in the overall rating scale. For the overall rating scale, change from pretest to posttest was statistically significant (t = −2.25, df = 18, p = 0.04). Further analysis revealed that students who were born in the United States demonstrated a significant increase in ratings (t = −3.08, df = 10, p = 0.01) whereas students who were not born in the United States showed little change (t = −0.35, df = 7, p = 0.74). These results show that the means in attitude scales changed little for all groups, but both white and US-born students showed greater improvement on skillfulness and knowledge. ConclusionsTraining and measurement of cross-cultural health care skills remains challenging. However, studies like these provide a good starting point from which to build.

The Development of a Cultural Standardized Patient Examination for a General Surgery Residency Program

Cultural competency and cross-cultural care issues in surgery resident education are areas of recognized need. The Accreditation Council for Graduate Medical Education (ACGME) has developed 6 core competencies addressing training to provide high quality care. Of these, cultural training is addressed under 3: patient care, professionalism, and interpersonal and communication skills. Our study sought to develop a measurable tool-a cultural standardized patient (SP) examination-that integrates cross-cultural care issues within the core competencies. All first year surgery residents (PGY-1) were required to participate in the videotaped cultural SP examination as part of the general surgery residency curriculum. Two measures were utilized to assess resident performance. On the same day, we administered a Cross-Cultural Care Survey. The SP examination was assessed by trained surgery teaching faculty using a written checklist that was developed to evaluate residents on all 6 ACGME competencies. Of the 26 eligible participants over 2 years, we were able to analyze the pre- and post-test results for 24 residents. The post-test score of the "attitude toward cross-cultural care" subscale of the Cross-Cultural Care Survey was significantly lower than the pre-test score (p = 0.012; Wilcoxon signed-ranks test). There were significant differences by ethnicity on all 3 subscales of the Cross-Cultural Care Survey (attitude = p < 0.05, knowledge = p < 0.01, skills = p < 0.05) on the pre-test. However, only the knowledge subscale scores remained significantly different between ethnicities on the post-test (p < 0.01). After additional assessment, evaluation, and refinement, our goal is to incorporate cross-cultural health care training as a permanent part of our curriculum. Our hope is that efforts to provide training in cross-cultural healthcare leads to high quality care and positive outcomes for the patient. This will not only enhance our training program, but may also become a useful tool for other surgery residency programs.

Using the cross-cultural care survey to assess cultural competency in graduate medical education.

Cultural competency is an important part of medical policy and practice, yet the evidence base for the effectiveness of training in this area is weak. One reason is the lack of valid, reliable, and feasible tools to quantify measures of knowledge, skill, and attitudes before and/or after cultural training. Given that cultural competency is a critical aspect of "professionalism" and "interpersonal and communication skills," such a tool would aid in assessing the impact of such training in residency programs. The aim of this study is to enhance the feasibility and extend the validity of a tool to assess cultural competency in resident physicians. The work contributes to efforts to evaluate resident preparedness for working with diverse patient populations. Eighty-four residents (internal medicine, psychiatry, obstetrics-gynecology, and surgery) completed the Cross-Cultural Care Survey (CCCS) to assess their self-reported knowledge, skill, and attitudes regarding the provision of cross-cultural care. The study entailed descriptive analyses, factor analysis, internal consistency, and validity tests using bivariate correlations. Feasibility of using the CCCS was demonstrated with reduced survey completion time and ease of administration, and the survey reliably measures knowledge, skill, and attitudes for providing cross-cultural care. Resident characteristics and amount of postgraduate training relate differently to the 3 different subscales of the CCCS. Our study confirmed that the CCCS is a reliable and valid tool to assess baseline attitudes of cultural competency across specialties in residency programs. Implications of the subscale scores for designing training programs are discussed.