Cultural Competency Curriculum Research Articles

Physical Therapists' Perceptions of Preparedness to Engage in Culturally Competent Practice Upon Graduation: A Qualitative Research Study.

Entry-level Doctor of Physical Therapy (DPT) graduates are not demographically diverse compared with the population of the United States. The curriculum must provide depth, breadth, and opportunity to develop culturally competent providers. The purpose of this qualitative study was to examine perceptions of novice/advanced beginner and experienced physical therapists (PTs) as to how well prepared they felt by their PT education to act as culturally competent providers and compare methods of cultural competence education received. Findings can inform whether cultural competence curriculum standards in PT education are viewed as effective or if changes to curriculum may be needed. Research has highlighted measured or perceived changes in perceptions, attitudes, and behaviors of cultural competence with clinical exposure and experience for PT students. Studies that examine or compare practicing PT perceptions of the effectiveness of entry-level cultural competence education are limited, as is evidence supporting specific cultural competence curriculum methodology. Thirteen licensed PTs participated in the study. In this phenomenological qualitative study, subjects participated in semi-structured interviews. Data were coded and analyzed using a constant comparative approach. Three themes emerged: 1) clinical practice and life experiences had greater influence on perceptions of preparedness, 2) suggestions to improve cultural competence curriculum, and 3) experiential learning was valued and contributed to culturally competent practice. Entry-level DPT programs may consider exposing students to diverse patient populations through diverse clinical rotation opportunities, community outreach, and interactive learning early in the curriculum. Incorporating student experiences with different social, cultural, or ethnic groups may promote a greater perceived value of cultural competence curriculum and improve PTs' perceptions of preparedness to practice culturally competent care. Programs may also examine the direct and indirect influence clinical instructors have on developing DPT students' cultural competence during clinical rotations.

Employing Indigenous methodologies to transform dental and medical education

Indigenous people in Australia experience considerably more dental and medical ill-health than non-Indigenous people. Cultural competence of dental and medical teams is crucial in the delivery of services to address these health disparities. Traditionally, cultural training has been incorporated later in health education curricula, resulting in students perceiving Indigenous health to be less important, relevant or useful in their future careers. Higher education institutions struggle to incorporate Indigenous culture into curricula to improve educational outcomes for Indigenous peoples and to increase cultural competence of staff and students. This study explores how a team of Indigenous and non-Indigenous researchers navigated the cultural interface to develop an Indigenous curricula model for dental and, potentially, medical programs in Australia. A team of Indigenous and non-Indigenous oral health, dental and social science researchers, together with a Cultural Competence Curriculum Review Reference Group comprising Indigenous and non-Indigenous members, successfully navigated the cultural interface. Collaborations between the reference group and research team at each phase of this research ensured authentication and validity of the data. This study highlights the importance of employing Indigenous methodologies when conducting Indigenous research to improve dental and medical health outcomes for Indigenous peoples.

A novel emergency medicine cultural competency curriculum addressing health care disparities.

Effective cultural competency (CC) training for future health professionals is an important first step towards improving healthcare disparities (HCD). The Accreditation Council for Graduate Medical Education (ACGME) now requires that institutions train residents and faculty members in CC relevant to the patient population they serve. Using Kern's Model, we created and implemented a novel CC curriculum tailored to specific program needs in an emergency medicine residency program. At the end of the curriculum, respondents reported having a better understanding of the importance of CC for their practice (p=0.004) and of how a patient's personal and historical context affects treatment (p=0.002). They also reported an increase in the frequency of practicing strategies to reduce bias in themselves (p < 0.001) and others (p < 0.001), as well as comfort interacting with and treating patients from different backgrounds (p < 0.001). Lastly, they reported improved preparedness to collaborate with communities to address HCD (p=0.004) and to identify community leaders to do so (p < 0.001). The challenges of CC training demonstrate the need for a standard yet adaptable framework. We have designed, implemented, and evaluated a novel curriculum tailored to the specific needs of our EM residency program. The curriculum improved participants' attitudes, preparedness, and self-reported behaviors regarding CC and HCD. This framework represents an example of a successful model to meet ACGME requirements.

Systemic racism in academic medicine: A systematic review of interventions

Purpose: The purpose of this systematic review is to identify and evaluate systemic racism interventions in academic medicine. Methods: Studies were identified through the use of the PubMed database, using the keywords ‘systemic racism’ and ‘academic medicine’. Of the 18 publications generated, 6 highlighted systemic racism interventions. Results: Ultimately, 6 studies were selected in this review including multiple interventions: virtual training modules, a department wide cultural competency curriculum, a hospital-wide breastfeeding initiative, and a fellowship program for underrepresented minorities interested in surgery. Conclusion: The findings of this systematic review indicate a dearth of systemic racism interventions. While the data is limited, there is some evidence that department/hospital-wide commitments, virtual curricula, and programming/mentorship directed at underrepresented minorities (URM) in medicine may be effective tools in combating systemic racism.

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.

A Consideration for Intersectional Framing Within Physiological Training

ObjectivesPrevious scholars have identified the need to increase diversity in medical education in terms of diversifying the student base, cultural competency curricula, and increasing health equity (Awosogba et al 2015; Sharma 2019; Hordjik 2019; Muntinga et al 2016). Establishing an intersectional theoretical framework, and other feminist theoretical frameworks, within medical education has been put forth, however literature indicates there are many obstacles in optimizing this implementation (Sharma 2019). In line with Bentabos et al (2014), we argue that much can be gained from addressing health equity at the biomedical undergraduate level, as healthcare is an institution of workers beyond the medical field (e.g. clinical research). Further, we posit that, given AAMC data points (AAMC Diversity in Medicine: Facts and Figures 2019), addressing diversity at the medical education level addresses the problem too late. Finally, the traditional medical education environment likely does not provide space to adequately develop a critical framing of cultural competency (Moore 2007; Muntinga et al 2016). As such, the purpose is to demonstrate how intersectional framing embedded within the Health Disparities track of a Biomedical Research Certificate provides a multidimensional analytical tool able to equip health &amp; care workers, including future medical students to: (1) Increase a diversity minded environment in medical education. (2) Apply reflective and reflexive tools to professional and graduate biomedical aimed curricula thus impacting the organizational discourse overall.MethodsThematic analysis applied to Intersectional Methodology to identify the interaction of curricula content and scaffolded collaborative learning through the Research‐Intensive Community (RIC) Model (Desai et al 2008). The major themes we seek to identify and reflect upon are the Guideposts of Intersectionality laid out by Collins and Bilge (2016). The research question we seek to answer is: how does intersectional curricula within the RIC model interact to create a reflexive lens that can identify and act on inequity at the micro, macro and meso level. Practical Implications:The framework provided here can supply a starting point of implementation that goes beyond an additive framework or simple gesture to intercategorization.

When Privilege and Oppression Become “Real” in the Life of Emerging Social Workers

ABSTRACT In today’s society, it is of utmost importance to deliver services with compassion, understanding, and cultural competence. Students’ awareness of personal cultural backgrounds, issues, and biases is essential to enhance their ability to serve others, particularly marginalized populations. This study demonstrates how students understood the impact of discrimination and oppression on their personal development and preparation for delivery of social work services to diverse clientele. The goal of this research was to learn more about students’ readiness for practice with heterogeneous client populations by assessing their changes in thought and behavior necessary for culturally competent and responsive social work practice in a pluralistic society. While this research informs the role of social work education in preparing culturally competent practitioners, there remains a significant gap in the literature regarding how best to teach students about privilege and oppression. This study used existing pre and post data from the “Oppression & Diversity/ Social Justice Scale” to assess students’ understanding of power, privilege and oppression both at the beginning and at the end of a semester. Results may be used to plan and develop future cultural competence curricula.

Implicit Bias and Caring for Diverse Populations: Pediatric Trainee Attitudes and Gaps in Training.

The objective of this study was to determine the attitudes, skill level, and preferred educational interventions of pediatric residents related to implicit bias and caring for diverse patient populations. A cross-sectional survey of pediatric residents at a single, large urban residency program was utilized. Surveys were completed by 88 (55%) residents who were 69% female and 35% non-White or mixed race. Almost all residents felt that it was very or extremely important to receive training on health disparities, diverse patient populations, and implicit bias. Self-assessment of skill level revealed that residents felt confident in areas often covered by cultural competency curricula, such as interpreter use, but were less confident in other areas. The top 3 areas identified for further training included implicit bias, working with transgender and gender nonconforming patients, and weight bias. For the majority of diversity and bias-related skills, prior training was significantly correlated with higher skill level (P < .05).

Impact of an LGBTQ Cultural Competence Training Program for Providers on Knowledge, Attitudes, Self-Efficacy, and Intensions

ABSTRACT This paper describes the development and implementation of a robust lesbian, gay, bisexual, transgender, and queer (LGBTQ) cultural competence curriculum for training health and human service providers across New York State. Between 2013–2018, The National LGBT Cancer Network developed and published Best Practices in Creating and Delivering LGBTQ Cultural Competency Trainings for Health and Social Service Agencies and designed a training curriculum. They also conducted Train the Trainer sessions, and evaluated pre- and post- curriculum knowledge, attitudes, self-efficacy and intentions of individuals who attended educational sessions conducted by the certified trainers. Most respondents improved from pretest to posttest, with significant improvements in knowledge, attitudes, self-efficacy and intentions. An increase in self-efficacy was significantly associated with pre- to posttest improvement in respondent intention. Future research should focus on what components specifically bolster self-efficacy and intention. Increasing the number of health and human service providers who are trained to address the needs of this population is an important step toward providing culturally competent care.

From Listening to Action: Academic Surgical Departmental Response to Social Injustice Through Curricular Development.

The aim of this study was to describe the development and evaluation of a structured department wide cultural competency curriculum. Despite numerous organizational policies and statements, social injustice and bias still exist. Our department committed to assist individuals of the entire department to develop foundational knowledge and skills to combat implicit bias and systemic racism through the creation of a cultural competency curriculum. The purpose of this manuscript is to detail our curriculum and the evaluation of its effectiveness. Using a well-established curriculum development framework, a cultural competency curriculum was developed focusing on knowledge, skills and attitudes at the individual level, for all members of the department. The curriculum was implemented through 6-hour-long sessions over a 9-week period. Effectiveness was assessed through a post curriculum survey. Twenty percent of the respondents had experienced bias based on race, ethnicity, or sexual orientation in the past 12 months, whereas 30% had experienced bias based on sex. Seventy-one percent independently explored related topics. The curriculum was overall well received and generally achieved the goals and objectives. Using a standard curriculum development framework, an effective department-wide cultural competency curriculum can be developed and implemented.

Religiosity and stigma toward patients with mental illness among undergraduate university students

There is a dearth of research that investigates the relationship between religiosity and stigma of mental illnesses by the context of Jordanian culture. So, this study aimed to describe the relationship between religiosity and stigma against mental illnesses as described by undergraduate university students in Jordan. This study design was descriptive correlations study among 338 University Students, undergraduate students in Jordan. The findings indicate there is a significant correlation (r = - 0.154, p < 0.05) between stigma toward patient with mental illnesses and religiosity. The higher religiosity score is associated with more negativity toward stigma of patient with mental illnesses. Also, the findings indicated there was a significant difference between medical and non-medical student's specialty area and stigma toward patients with mental illnesses (t = 111.14, p = 0.01). Non-medical students reported more stigma for patients with mental illnesses. Stigma against patient with mental illnesses should be addressed at different levels. Cultural competency curriculum should be established for medical and non-medical students to assure more acceptance attitudes and avoidance of stigma against patients with mental illnesses.

Appalachian Culture &amp; History, An Important Lesson for Incoming Medical Students

INTRODUCTION There is an expectation that medical students will be exposed to and gain cultural competence prior to graduation. It is prudent to ensure that cultural competence education starts early in the medical school curriculum. METHODS A 90-minute educational session ("Appalachian Culture and History") was created at the West Virginia University School of Medicine as a part of the cultural competency curriculum to better introduce and orient new medical school matriculates to the culture and history of both the state and Appalachia. Students anonymously completed on-line evaluations at the conclusion of the session to rate the quality of the presentation on a five-point scale which ranged from 1 (" very dissatisfied ") to S ("extremely satisfied "). RESULTS Students rated the session at a mean of 4.52, 4.37, and 4,53 in 2018, 2019, and 2020 respectively. Positive comments were generated by in-state and out-of-state students. DISCUSSION Matriculating students have been overwhelmingly satisfied with the Appalachian Culture and History educational session based upon anonymous evaluations. CONCLUSIONS As the majority of medical students have positively appraised the Appalachian Culture and History educational session, there is reason to believe they will be better prepared to learn from and care for patients from Appalachia.

Building Cultural Competence through Intentional Pedagogy in an Undergraduate Dietetics Program

Describe a successful example of a cultural competence curriculum for use with dietetics students.

Abstract A005: “Nobody will tell you. You've got to ask!” Race-based differences in patient-provider communication efficacy and social support between Black and White women with breast cancer

Abstract Purpose: The purpose of this qualitative research study was to explore patient perceptions of patient-centered communication from oncology care providers among Black and White women taking an adjuvant endocrine therapy (AET) medication to treat breast cancer. Methods: Four 90-minute focus groups were conducted from December 2017 to January 2018 in Memphis, TN, a Mid-South region of the United States with significant Black-White breast cancer mortality disparities. Focus groups were stratified by race (Black and White) and patient length on AET (i.e., &amp;lt; 6 month AET use or &amp;gt; 6 month AET use) (N=28). They were moderated by a race-concordant moderator, using a semistructured interview guide, and audio recorded, transcribed verbatim, coded according to conventions of value-based coding, and analyzed by emergent themes. Participants were compensated with a notebook and $40 merchant gift card. Results In our study, race-based differences in participants' perceptions of information provision and patient-centered patient-provider communication emerged. Black women were more likely than White women to report being proactive and assertive in requesting information related to AETs. Yet, Black women were less likely than White women to report having their informational needs met by providers, namely treatment length, AET symptom management, and effects of AET on pre-existing chronic conditions. One Black participant said, “Nobody will tell you about it [her lab reports]. You've got to ask! If you don't, you won't get any answers.” White women in our study were more likely to report receiving social support from health care providers and praise longstanding relationships. Conversely, Black women in our study shared personal stories of disempowered, paternalistic interactions with providers and frequently mentioned the importance of changing providers to increase their comfort. As such, they were more likely than White women to report relying on their faith in God and nonmedical social support networks to manage symptoms and adhere to prescribed AET regimens. In addition, unlike White women in our sample, Black women said they had no problem discussing sensitive topics, like sexual dysfunction and menopause, with providers but believed those discussions made their providers feel uncomfortable. Conclusion: Race-based differences in patient-provider communication may contribute to unmet informational and social support needs among Black women with breast cancer during the AET phase. Findings from our study suggest that Black women, compared to White women, experience poorer patient-provider communication and patient-centered cancer care. Implications: Study results have implications for cancer care in diverse clinical settings. Communication skills training programs should include cultural competency curricula and help oncologists identify and address social support challenges facing Black female patients during the adjuvant phase of breast cancer treatment. Citation Format: Janeane N. Anderson, Ryan Blue, J. Carolyn Graff, Rebecca A. Krukowski, Ilana Graetz. “Nobody will tell you. You've got to ask!” Race-based differences in patient-provider communication efficacy and social support between Black and White women with breast cancer [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr A005.

Conscripted curriculum: The experiences of minority genetic counseling students.

While the lack of racial and ethnic diversity in the genetic counseling profession has been discussed for decades, little attention has been paid to the training experiences of under-represented minorities. Under-represented minority graduate students in other disciplines have been reported to experience microaggressions and feelings of isolation during training, and they are often informally enlisted to educate classmates about issues related to race. In 2019, sociologist Lauren Olsen coined the term conscripted curriculum to describe the utilization of minority medical students to elucidate issues of race or ethnicity for their classmates. The conscripted curriculum arises when these topics are taught in a small-group discussion format that relies on students sharing their individual experiences to educate their classmates. In classrooms with limited diversity, the expectation to contribute falls disproportionately on students from non-majority groups. In this qualitative study, we conducted videoconference focus groups with 32 recent graduates of genetic counseling training programs who identified as racial or ethnic minorities. We present the results of two thematic categories that emerged from that study: the participants' perspectives on the cultural competency curriculum in their training programs and the participants' feelings of being pressed into service as spokespeople for their cultural groups. Participants described the cultural competency training as occurring primarily in a small-group discussion format in which students were expected to share their personal experiences. During these discussions, minority students, especially those in less-diverse class cohorts, felt obliged to contribute their perspectives in order to educate non-minority classmates about issues of race and ethnicity, leading to feelings of frustration and exhaustion. The results reflect a conscripted curriculum as described by Olsen (2019). Journal of Health and Social Behavior, 60(1), 55-68, in which minority students bear the burden of educating their classmates about the social basis of race. Genetic counseling training programs should critically examine their cultural competency curriculum to create a more equitable training environment.

Integrating Cultural Awareness into Medical Gross Anatomy Instruction.

Medical students need to understand how culture and patient management relate in order to provide optimal care to a diverse society. Multiple studies call for more cultural training in medical education. Some studies show that well-intentioned cultural competency curriculum can reinforce stereotypes, yet it is essential for educators to discuss varying identities with our students in their training in order to avoid the implication that white is the default patient identity. Our study evaluates a pilot, novel approach for integrating cultural content into the biomedical sciences, specifically gross anatomy. Clinical vignette practice questions were developed as tools to help students expand their anatomical knowledge and cultural and socioeconomic awareness, taking special consideration to avoid stereotypical presentations. We evaluated class of 2021 students' self-reported cultural awareness and ability to utilize culturally relevant information through completion of a survey in fall 2017 (pre) and winter 2017 (post). The students were surveyed on their ability to recognize and/or integrate culturally relevant information. Twenty-one students (n = 21) participated. There was significant improvement in the overall cultural awareness score between the pre- and post-surveys (pre mean = 3.54, while post mean = 3.81; p = 0.016). The most dramatic domains that students became aware of included incorporating culturally relevant information into a treatment plan and communicating with sensitivity and respect when caring for patients. Culturally informed curriculum does not need to be limited to the humanities courses in medical education. Direct integration into biomedical sciences is a novel approach to help students gain exposure to biomedical and cultural content simultaneously.

STIRRING THE MELTING POT: INTRODUCTION OF PRACTICE-BASED MODULE TO THE CULTURAL COMPETENCY EXERCISE FOR CHILD AND ADOLESCENT PSYCHIATRY TRAINEES

The Workshop is designed to show participants how to utilize a cultural competency curriculum module using simulated cases at their academic or practical settings. By understanding the need for a unique approach to culture-based training and the need to introduce a module of videotaped interviews to child and adolescent psychiatry, we aim to identify difficulties for trainees to explore such multiple cultural aspects as religion/spirituality, nativity status, gender identity, race/ethnicity, and sexual orientation.

Explicitly Addressing Implicit Bias in a Cultural Competence Curriculum for Pediatric Trainees

This article was migrated. The article was not marked as recommended. Background:Medical providers must learn to communicate effectively and demonstrate sensitivity to an increasingly diverse patient population. Implicit bias can contribute to stereotyping and miscommunication. Traditional cultural competence curricula that focus on memorizing lists of customs, beliefs and behaviors may inadvertently increase stereotyping. Methods: We created a workshop designed to introduce the concepts of implicit bias, health disparities, and individuated care to pediatric trainees. We surveyed participants on perceived preparedness for cross-cultural care prior to and immediately following the workshop. We delivered the workshop twice per year from 2011-14 to a convenience sample of pediatric residents on elective rotations (PGY-1-3) as well as to pediatric subspecialty fellows during their core curriculum. Results: Fifty-four residents and 21 fellows participated. All completed the pre-workshop survey; 52 completed the post-workshop survey. Ninety-four percent found the workshop useful. At baseline, 92% felt prepared to care for patients from different cultures. This did not change significantly. In aggregate, trainees reported increased skillfulness in assessing the patient's understanding of illness (83% to 92%, p= 0.04) and identifying cultural customs that might affect clinical care (69% to 90%, p=0.01). Discussion: The workshop was feasible and well received. Although it did not change trainees' perceived preparedness in caring for patients from different cultures, it did improve perceived skillfulness in specific areas important to providing individuated care. Learners may overestimate their preparedness to provide culturally competent care at baseline, which reinforces the need for objective assessment of skills and patient important outcomes around similar interventions in the future.

A Multimodal Approach to Teaching Cultural Competency in the Doctor of Pharmacy Curriculum

Objective. To assess first-year pharmacy students' grades and preferred teaching styles within a multimodal teaching approach for developing cultural competency during a required Pharmaceutical Care I course. Methods. A lecture, two active-learning exercises (global bead and trading places), and an in-class quiz were used to teach students about cultural competency in preparation for a practicum. A four-hour practicum consisting of videos, structured discussion, counseling, and a survey were used in this multimodal approach. Student quiz and practicum grades and survey results were analyzed. Reflection responses were collected. Results. Students scored an average of 86.1% on the in-class quiz and 92.6% on the practicum. Average rankings on the Trading Places exercise demonstrated a change in students' individual biases. Students perceived the practicum, lecture, and Worlds Apart videos to be the most useful elements of the cultural competency curriculum. Conclusion. The practicum and lecture were the teaching methods most preferred by students for conveying cultural competency; however, students agreed that all of the teaching methods used helped them to achieve the desired learning objectives. Students' grades improved from the quiz to the practicum, which may indicate enhanced cultural knowledge via a multimodal teaching approach.

Social work students’ perceptions of obesity

ABSTRACTResearch indicates that mental health and medical professionals often hold negative views of overweight or obese people. Little is known about weight prejudice among social work students. In order to address this gap in the literature, this study examines the attitudes of Bachelor of social work and Master of social work students (n = 250) toward persons who are overweight and/or obese. Consistent with the literature, findings indicate generally those with higher body mass index scores are more likely to believe that obesity is beyond their control. Further, although age was correlated with Beliefs About Obese People scores, it was not a significant predictor. Implications for social work social justice and cultural competency curriculum are discussed.