Doctors Must Learn 'Cultural Humility'

Marlene Busko

Disclosures

March 05, 2018

Clinicians in the United States and elsewhere are treating an increasingly diverse patient population, so in addition to learning about the science of medicine, young doctors and residents need to understand how a patient's beliefs, values, and behaviors might affect their illness.[1]

That is, they need to be trained in "cultural competency," or "an understanding of different cultures and how this affects people's attitudes toward healthcare and toward illness," Barbara L. McAneny, MD, an oncologist from Albuquerque, New Mexico, and president-elect of the American Medical Association (AMA), told Medscape. "Culture" encompasses more than race and ethnicity, she emphasized. It includes religion, socioeconomic factors, education, gender identity, and all "the factors that make us all [unique] individuals."

David Hunt, an attorney and president of Critical Measures, which deals with workplace diversity and unbiased healthcare, told Medscape that "what we're talking about is clinical competence across cultures," or the ability to deliver equitable healthcare, free of disparities based on individual patient characteristics.

Medical schools have been training students in cultural competency since about 2000, and accrediting bodies have also required that residency programs train residents in this skill, Tonya L. Fancher, MD, MPH, associate dean of workforce innovation and community engagement and interim associate dean for student and resident diversity at the University of California, Davis, School of Medicine, told Medscape in an email.

Recently, Fancher coauthored a cultural competency module for AMA, which is designed to help residents meet Accreditation Council for Graduate Medical Education requirements in cultural competency.[2]

A Lifelong Learning Process

"I prefer the term 'cultural humility' to 'cultural competency' in healthcare delivery," Fancher said. "Competency implies that you reach a threshold where you become competent in learning about the 'other,' whereas humility implies that it's a lifelong process of learning and self-reflection," including awareness of your own unconscious biases.

Although it is not possible to be "competent" (or knowledgeable) about all of the many cultures that a clinician may encounter, she added, "it is possible to be humble in our approach to all patients" and make this a part of lifelong learning. Referencing a work by Melanie Tervalon, MD, and Jann Murray-García, MD, Fancher noted that "cultural humility incorporates a lifelong commitment to self-evaluation and self-critique, to redressing the power imbalances in the patient-physician dynamic."[3]

That seminal article "basically states that providers must view healthcare from the patient's point of view," Maria B.J. Chun, PhD, associate chair of administration and finance in the Department of Surgery at the University of Hawaii, Manoa, and lead author of a study on residents' perceptions of cross-cultural care training, explained to Medscape.[4] "Traditionally, patients would view the physician as the authority and not ask questions," she noted. "But now, there is a focus on patient-centered care where patients are encouraged to ask questions."

Cultural competency training is lifelong, she agreed. "It really needs to occur during premedical training, in medical school, during residency, and as professional development."

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