An Acceptance and Commitment Training (ACT) Framework for Teaching Cultural Humility: A Guide for Translating ACT from a Therapeutic Context into a Medical Education Curriculum

Abstract

The objective of this project was to train future physicians to work effectively and thoughtfully with diverse populations by teaching them to employ Acceptance and Commitment Training (ACT) skills to increase cultural humility, with the goal of improving attitudes, knowledge, and beliefs about working with diverse patients. We developed ACT for cultural humility online interactive modules as part of an elective course to teach Medical Spanish to 4th-year medical students. Pre-and post-pilot data pertaining to the cultural humility training modules on the Work-Related Acceptance and Action questionnaire, Multidimensional Cultural Humility Scale, knowledge, attitudes, and beliefs were analyzed using paired samples t-tests and Wilcoxon signed-rank tests. We also included descriptive data pertaining to overall satisfaction with the cultural humility modules and intent to apply the material learned to patient care. Our data showed a significant increase in the cultural humility of our participants as well as an increase in psychological flexibility, a higher favorability rating toward various ethnicities, improvements in attitude, and positive changes in beliefs and knowledge following completion of the modules. The modules were well received by the medical students, with high social validity ratings. The ACT for cultural humility curriculum has great potential to enhance medical education in diversity, equity, and inclusion by increasing both the understanding and the cultural humility of medical students and future professionals to work with diverse populations. The current paper provides a framework that can be used by other programs to shape the education of the future medical workforce to help promote culturally humble care.

Integrating Cultural Humility into Medical Education Using a Structured and Interactive Workshop

“…Psychological inflexibility is characterized by behaviors such as experiential avoidance, attachment to a conceptualized self, rigid adherence to one’s thoughts and emotions as literal truths (cognitive and emotional fusion), lack of clarity regarding personal values, dominance of past and future-related thoughts, and actions that are misaligned with one’s values, manifesting as either impulsivity or passivity. 13 Lombardero et al used ACT skills for cultural humility virtual interactive modules as part of an elective course to teach Medical Spanish to 4th-year medical students and reported a significant increase in the cultural humility and in psychological flexibility of the participants. 13 In comparison, our study that was in-person and in addition to medical students we included both residents and faculty.…”

“…While this shift holds promise for mitigating healthcare disparities, scant empirical guidance is available to assist medical educators in imparting cultural humility competencies within the medical curriculum confidently and effectively. 13 Furthermore, the Accreditation Council for Graduate Medical Education (ACGME) mandates that physician residents be trained to respect and be responsive to a diverse population, while Liaison Committee on Medical Education (LCME) requires similar training. 14 , 15 Consequently, medical educators have begun to advocate for humility trainings.…”

Health Equity and Policy Considerations for Pediatric and Adult Congenital Heart Disease Care among Minoritized Populations in the United States

“…While guidance for cultural humility training in clinical cardiology does not exist, the Joint Commission and the literature offer suggestions on approaching it [81,[88][89][90]. Topics covered include implicit bias, recognition of privilege, communication with patients from diverse backgrounds, and principles to address social determinants of health [91,92].…”

“…Program effectiveness has been measured through surveys, debriefing, or journaling [93]. While data have not investigated if cultural humility training directly impacts patient outcomes, trained providers report improved comfort with caring for diverse patients and increased awareness of their biases and attitudes that may affect care [88][89][90]94,95]. Providers participating in immersion programs have also enhanced sociocultural skills related to the patient-doctor relationship and communication [96,97].…”

Developing a transgender and non‐binary inclusive obstetrics and gynaecology undergraduate medical curriculum in Aotearoa/New Zealand: Where are we at, and where do we need to be?

“…At the time of writing there has been no formal development of a TGD inclusive obstetrics, gynaecology and reproductive medicine undergraduate medical curriculum in ANZ. However, based on the information presented in the preceding and other literature, there are some clear priorities and foundations to consider: a curriculum that is designed with Māori and Pacifica, TGD and takatāpui representatives 16 norm criticism, cultural humility, and self‐reflective practice 17 incorporation of trauma‐informed education 18 the use of anatomical language and images that are consistently gender‐inclusive 19 where possible, language that is self‐determined by TGD, and gender‐inclusive language, eg through a more gender neutral approach (eg people) and/or through a gender additive approach (eg women and pregnant people) 20 provision of appropriate opportunity for medical students to interact with TGD patients appropriate formative assessment, eg through developed OSCE (Objective Structured Clinical Examination) where cases and stems used for OSCE assessments are diversified to include non‐binary, transgender and gender diverse simulated patients appropriate learning resources. The current New Zealand textbook used for the advanced learning in medicine obstetrics and gynaecology use only female gendered language, with the terms ‘women’ and ‘maternal’ throughout the text.…”