Researchers and program developers in medical education presently face the challenge of implementing and evaluating curricula that teach medical students and house staff how to effectively and respectfully deliver health care to the increasingly diverse populations of the United States. Inherent in this challenge is clearly defining educational and training outcomes consistent with this imperative. The traditional notion of competence in clinical training as a detached mastery of a theoretically finite body of knowledge may not be appropriate for this area of physician education. Cultural humility is proposed as a more suitable goal in multicultural medical education. Cultural humility incorporates a lifelong commitment to self-evaluation and self-critique, to redressing the power imbalances in the patient-physician dynamic, and to developing mutually beneficial and nonpaternalistic clinical and advocacy partnerships with communities on behalf of individuals and defined populations.

Medical educators across the United States are addressing the topics of culture, race, language, behavior, and social status through the development of cross-cultural coursework. Dramatic demographic changes and nationwide attention to eliminating racial and ethnic health disparities make educating medical students about the importance of the effects of culture on health a 21st-century imperative. Despite the urgent need for including this topic material, few medical schools have achieved longitudinal integration of issues of culture into four-year curricula. The author makes the practical contribution of describing key themes and components of culture in health care for incorporation into undergraduate medical education. These include teaching the rationale for learning about culture in health care, "culture basics" (such as definitions, concepts, the basis of "culture" in the social sciences, relationship of culture to health and health care, and health systems as cultural systems), data on and concepts of health status (including demographics, epidemiology, health disparities, and the historical context), tools and skills for productive cross-cultural clinical encounters (such as interviewing skills and the use of interpreters); characteristics and origins of attitudes and behaviors of providers; community participation (including the use of expert teachers, community-school partnerships, and the community as a learning environment); and the nature of institutional culture and policies.

Dramatic global-migration patterns over recent decades have forever changed the racial, ethnic, social, and cultural makeup of the people of the United States. Simultaneously, the patterns of disease and risk factor distribution within the U.S. population are changing in ways that accentuate the role of lifestyle, behavior, and social and economic differences in the onset and outcomes of disease. Medical school curricula must prepare students to address these demographic realities. The University of California, San Francisco's (UCSF's) redesigned curriculum, launched in September 2001, integrates social, behavioral, and biomedical science education in an early and sustained way. The traditional undergraduate medical structure of two years of basic science plus two years of clinical rotations was replaced with a model divided into three stages spanning four years: the Essential Core, the Clinical Core, and Advanced Studies. The authors summarize the role of the social and behavioral sciences in the UCSF Essential Core-the first 16 months of instruction divided into integrated blocks, each centered on clinical cases. Basic thematic areas (e.g., behavior change, health disparities), content illustrations (e.g., Introduction to the Biopsychosocial Model, The Culture of Medicine), and process considerations (e.g., integration, content order, evaluations) are presented. Special challenges and limitations are also discussed.

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