Cultural Competency Interventions During Medical School: a Scoping Review and Narrative Synthesis
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Washington University School of Medicine, St. Louis, MO, USA; 2Department of Emergency Medicine, Washington University School of Medicine, Campus Box 8072, St. Louis, MO, USA; 3Division of Nephrology, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA.
Many medical accreditation bodies agree that medical students should be trained to care for diverse patient populations. However, the teaching methods that medical schools employ to accomplish this goal vary widely. The purpose of this work is to summarize current cultural competency teaching for medical students and their evaluation methods. A scoping review was completed by searching the databases PubMed, Scopus, MedEdPORTAL, and MEDLINE for the search terms “medical education” and “cultural competency” or “cultural competence.” Results were summarized using a narrative synthesis technique. One hundred fifty-four articles on cultural competency interventions for medical students were systematically identified from the literature and categorized by teaching methods, length of intervention, and content. Fifty-six articles had a general focus, and ninety-eight articles were focused on specific populations including race/ethnicity, global health, socioeconomic status, language, immigration status, disability, spirituality at the end of life, rurality, and lesbian, gay, bisexual, transgender, and queer. About 54% of interventions used lectures as a teaching modality, 45% of the interventions described were mandatory, and 9.7% of interventions were not formally evaluated. The authors advocate for expansion and more rigorous analysis of teaching methods, teaching philosophies, and outcome evaluations with randomized controlled trials that compare the relative effectiveness of general and population-specific cultural competency interventions. KEY WORDS: cultural competence; cultural humility; culture; medical education; diversity. J Gen Intern Med DOI: 10.1007/s11606-019-05417-5 © Society of General Internal Medicine 2019
INTRODUCTION
Research has shown that perceived sociocultural differences can affect communication and decision making and are directly linked to patient satisfaction, treatment plan adherence, and overall care quality.1–4 “Cultural competency” and “cultural Received February 22, 2019 Revised July 15, 2019 Accepted September 16, 2019
humility” have emerged as approaches to addressing these differences in the healthcare system. Cultural competency has been defined as “a set of congruent behaviors, attitudes, and policies that come together in a system, agency, or among professionals and enable… (providers) to work effectively in cross-cultural situations.”5,6 Some argue that cultural competency is an unfeasible goal and that it is unrealistic to set this as a standard for health professionals. Others propose that providers should strive for cultural humility, a set of skills focused on continuous learning and self-reflection on one’s interactions with individuals from cultures different from their own.7 As cultural comp
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