Cultural Competence Training:

Personal Journey, Corporate or

Legislative Mandate? Jeannette E. South-Paul, MD

Andrew W. Mathieson UPMC Professor and Chair of Family Medicine

University of Pittsburgh and UPMC

Rhonda Moore Johnson, MD, MPH

Medical Director

Health Equity & Quality Services

Highmark, Inc

Robert C. Like, MD, MS

Professor and Director , Center for Healthy Families and Cultural Diversity

Department of Family Medicine and Community Health

UMDNJ-Robert Wood Johnson Medical School

Not for quotation, duplication, or dissemination without permission of the authors © 2010.

The ideas and opinions expressed in this presentation are those of the authors and may not represent

those of any organizations with which they are employed or associated with.

All aspects of an

individual are

recognized as

contributing to

diversity

A Diverse Workforce Offers ...

Marketing Advantage

Insight and cultural

sensitivity, ability to tap

diverse markets

Creativity

More alternatives and

higher quality

solutions.

Cross-Cultural Skills Enhances global competency and

the capability to function in

diverse cultural environments

Nationality

Sexual

Orientation Culture

Class/

Status

Geographic

Location

Marital

Status Religious

Beliefs

Education

Professional

Experience

Family

Responsibilities Age

Race

Ethnicity Gender

Physical

Abilities

M. Schimer

NEOUCOM

The Diversity Kaleidoscope

Changes in College Entrance –

Race/Ethnicity

College Entrance

within 1 yr HS

Graduation

1972 1980 2001

White, non-Hisp 49.7 49.8 64.2

Af-Am 44.8 42.7 54.8

Hispanic 45.0 52.3 51.7

Max Difference

(%)

4.9 9.6 12.5

US Dept of Education (2002). Digest of Education Statistics, 2002. Washington, DC

Changes in College Entrance – Social

Class

College Entrance

within 2.5 y of HS

Graduation

1972 1992

Top ¼ SES 78.0 88.3

Middle ½ SES 43.1 63.0

Bottom ¼ SES 26.7 36.0

Max Diff (%) 51.3 52.3

US Dept of Education (2002). Digest of Education Statistics, 2002. Washington, DC

“Education is a treasure that no one can

ever take from you. A diverse classroom

is the first step toward educating yourself

to your fullest potential.”

Lauro F. Cavazos, PhD

Tufts University School of Medicine and

former US Secretary of Education

Preserving diversity in medical schools is important -

1. Student and faculty diversity is indispensable for quality medical education

2. Diversity of the physician workforce improves access to care for underserved populations

3. Diversity of the research workforce can accelerate advances in medical and public health research

4. Diversity among managers of health care is good business sense

Cohen JJ. JAMA 2003;289:1143-1149

ED-21: “Faculty & students must demonstrate an

understanding of the manner in which people of

diverse cultures & belief systems perceive health &

illness & respond to various symptoms, diseases, &

treatments.”

ED-22: “Medical students should learn to recognize

& appropriately address gender & cultural biases in

health care delivery, while considering first the

health of the patient.”

Liaison Committee on

Medical Education

LCME Accreditation Standards

http://www.lcme.org/functionslist.htm

New Diversity Standard IS-16: “Each medical school must have policies

and practices to achieve appropriate diversity

among its students, faculty, staff, and other

members of its academic community, and must

engage in ongoing, systematic, and focused

efforts to attract and retain students, faculty,

staff, and others from demographically diverse

backgrounds.”

Liaison Committee on

Medical Education

LCME Accreditation Standards

http://www.lcme.org/standard.htm

Standard IS-16 - New Annotation:

The LCME and CACMS believe that aspiring future physicians will

be best prepared for medical practice in a diverse society if they

learn in an environment characterized by, and supportive of,

diversity and inclusion. Such an environment will facilitate

physician training in:

• Basic principles of culturally competent health care

• Recognition of health care disparities and the

development of solutions to such burdens

• The importance of meeting the health care needs of

medically underserved populations

• The development of core professional attributes, such as

altruism and social accountability, needed to provide effective

care in a multi-dimensionally diverse society

Liaison Committee on

Medical Education

LCME Accreditation Standards

http://www.lcme.org/standard.htm

“The faculty and students must demonstrate

an understanding of the manner in which

people of diverse cultures and belief systems

perceive health and illness and respond to

various symptoms, diseases, and treatments.

Medical students should learn to recognize

and appropriately address gender and

cultural biases in health care delivery, while

considering first the health of the patient.”

LCME, 2000

Cultural Competence Education at the

University of Pittsburgh

1. Offer early and often

2. Offer across the educational continuum

3. Offer consideration of broad aspects of

culture

4. Offer across all clinical disciplines –

nursing, pharmacy, medicine, dentistry,

public health, allied health sciences

5. Include as many stakeholders as possible

Cultural Competence Education at the

University of Pittsburgh

MS1

Orientation – 3 days – survey knowledge and

attitudes

Behavior, Medicine, and Society Course

MS2

Research electives offered in the community

to evaluate culture laden issues of health

disparities

Cultural Competence Education at the

University of Pittsburgh

MS3

Family Medicine Clerkship

Cultural Competence/ Health Disparities

module – didactic, experiential, discussions,

video and movie modalities

MS4

Cultural Competence elective

Individual projects

Liaison with the community

Cultural Competence Education at the

University of Pittsburgh

Clinical Educator Training Program

Division of General Internal Medicine

Masters Level Course

16 hours in 8 sessions

Co-taught by family physician educator, public

health researcher and linguistics faculty

member

Cultural Competence Education at the

University of Pittsburgh

Residency Training Programs

103 programs

1300+ house officers

Comprehensive orientation program

Cultural Competence module

Family Medicine, GIM and Peds

Fellowships

4 hour module

Didactics and case studies

Cultural Competence Education at the

University of Pittsburgh

Nursing school courses – selected topics

Clinical Translational Science Institute

Community Oriented Speakers’ Bureau

Understanding the needs of an underserved

community

Tailoring research to respond to community

input and needs

Institutional Requirements for Effective

Cultural Competence Curricula

1. The institutional support of the leadership, faculty, and students,

2. Institutional and community resources committed to the curriculum,

3. Input of Community leaders in designing the curriculum and providing feedback,

4. Commitment to providing integrated educational interventions appropriate to the level of the learner,

5. Clearly defined evaluation process that includes accountability and evaluation (#faculty teaching the curriculum, #courses, and # hours?).