Purpose: Cross-cultural education is an integral and required part of undergraduate medical curricula. However, the teaching of cross-cultural care varies widely and methods of evaluation are lacking. We sought to better understand medical students' perspectives on their own cultural competency across the 4-year curriculum using a validated survey instrument.Methods:We conducted an annual Internet-based survey at Harvard Medical School with students in all 4 years of training, for four consecutive years. We used a tool previously validated with residents and slightly modified it for medical students, assessing their (1) preparedness, (2) skillfulness, and (3) perspectives on the educational curriculum and learning climate.Results: Of 2592 possible survey responses, we received 1561 (60% response rate). Fourth-year students had significantly higher scores than first-year students (p<0.001) for all but one preparedness item (caring for transgender patients) and all but one skillfulness item (identifying ability to read/write English). Less than 50% of students felt adequately prepared/skilled by their fourth year on 8 of 11 preparedness items and 5 of 10 skillfulness items. Lack of practical experience caring for diverse patients was the most frequently cited challenge.Conclusions: While students reported that preparedness and skillfulness to care for culturally diverse patients seem to increase with training, fourth-year students still felt inadequately prepared and skilled in many important aspects of cross-cultural care. Medical schools can use this tool with students to self-assess cultural competency and to help guide enhancements to their curricula focusing on cross-cultural care.
BACKGROUND:As patient populations become increasingly diverse, we need to be able to measure residents' preparedness and skillfulness to provide cross-cultural care.OBJECTIVE: To develop a measure that assesses residents' perceived readiness and abilities to provide cross-cultural care.DESIGN: Survey items were developed based on an extensive literature review, interviews with experts, and seven focus groups and ten individual interviews, as part of a larger national mailed survey effort of graduating residents in seven specialties. Reliability and weighted principal components analyses were performed with items that assessed perceived preparedness and skillfulness to provide cross-cultural care. Construct validity was assessed.PARTICIPANTS: A total of 2,047 of 3,435 eligible residents participated (response rate=60%). MEASUREMENTS AND MAIN RESULTS:The final scale consisted of 18 items and 3 components (general cross-cultural preparedness, general cross-cultural skillfulness, and cross-cultural language preparedness and skillfulness), and yielded a Cronbach's alpha=0.92. Construct validity was supported; the scale total was inversely correlated with a measure of helplessness when providing care to patients of a different culture (p<0.001). CONCLUSIONS:We developed a three-component cross-cultural preparedness and skillfulness scale that was internally consistent and demonstrated construct validity. This measure can be used to evaluate residents' perceived effectiveness of cross-cultural medical training programs and could be used in future work to validate residents' self assessments with objective assessments.
Medical Education 2010: 44: 613–620 Objectives In an effort to provide preventive advice, this paper aims to acknowledge what has not worked with regard to cultural competency initiatives. A successful cultural competency training initiative should have lasting impact on its participants in terms of long‐term, ideally permanent changes to attitudes, knowledge and skills resulting in the provision of optimum care, regardless of a patient’s cultural background. Legal mandates mean there is an assumed need for cultural competency curricula and training programmes for medical students and postgraduate medical trainees. However, policy and practice have bypassed ‘proof’ that such programmes are effective and result in better patient care. Often only positive results are reported, which may minimise the difficulties involved in programme implementation. Methods Utilising the example of a cultural competency initiative introduced into a postgraduate general surgery training programme, this paper discusses mistakes that were made during the implementation phase, particularly with regard to underestimating potential resistance by the trainees. Also presented are the lessons learned and efforts that were made to mitigate the problems that arose. None of what is discussed in this paper is new. However, the literature often does not discuss in detail the difficulties that can be or have been faced and how these obstacles can be adequately mitigated. Conclusions The glow of cultural competency training initiatives is fading in the light of higher expectations for an evidence base prior to acknowledgement that their introduction has had a positive impact. For these initiatives to advance, there needs to be a clear understanding of terms utilised, buy‐in and a long‐term commitment at both individual and organisational levels, and use of standardised and validated tools to measure outcomes. An understanding of potential pitfalls can help to advance cultural competency training to the next level, namely, a solid evidence base that justifies both an individual’s and an institution’s investment in this effort.
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.
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