Doctors Must Learn 'Cultural Humility'

Marlene Busko


March 05, 2018

Family Medicine Has Need for More Training

In two small recent studies, medical residents reported that although they received some or very little training in cross-cultural care, they generally felt skilled and prepared to treat diverse patients; however, family medicine residents would like additional practical experience.

In the study by Chun and colleagues[4] of medical residents in Honolulu, Hawaii, 15 family medicine residents reported receiving more cross-cultural training than 20 surgery residents. On average, family medicine residents reported receiving "some" training, whereas surgery residents reported getting "very little" training to determine how a patient wants to be addressed; take a social history; assess how well a patient understands the causes of their illness; assess whether they mistrust doctors and/or the healthcare system; identify cultural customs; identify how decisions are made in the family; negotiate a treatment plan; and use a medical interpreter. Paradoxically, surgery residents were more likely than family medicine residents to report that they were skilled in providing cross-cultural care, although they received less training.

Similarly, Barinder Singh, MD, from Queen's University in Hamilton, Ontario, Canada, and his colleagues used the same survey and found that 73 residents in diverse residency programs at their institution generally felt that they were skilled and prepared to work with culturally diverse patients.[5] Residents in family medicine and psychiatry reported receiving the most training in this skill, but as in the study by Chun and colleagues,[4] residents in family medicine would have liked to receive additional practical experience.

"I think increasingly [residents] are more comfortable with cultural groups they typically encounter, but they have expressed some apprehension with groups that they have had limited exposure to," Chun said. "For example, for our residents and medical students in Hawaii, some were unsure of how to best care for some of the Pacific Islander patients, because they had not learned much about their culture."

"It is the AMA's position that as physicians, we have to teach our young physicians and ourselves how to come up with the lifestyle accommodations that will fit into a person's life, if we are going to be able to help them improve their health," McAneny summarized. "That's really the heart of it."


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