Boost Focus on Cross-Cultural Issues in Residency Training

Family medicine educators do a better job of incorporating cultural competency into residency training curricula than their peers in other medical specialties and subspecialties, but they still need to improve if future family physicians are to meet patients' needs, says a May 2007 Commonwealth Fund report.

"Resident Physicians' Preparedness to Provide Cross-Cultural Care: Implications for Clinical Care and Medical Education Policy," (PDF file: 24 pages / 224 KB. More about PDFs.) found that resident physicians received minimal formalized cultural competency training and, therefore, did not think they were well prepared to care for patients from different cultural, ethnic, national or religious backgrounds. The report calls for curricula that incorporate cultural issues throughout didactic and clinical experiences.

Researchers analyzed responses from 2,047 residents representing internal medicine, surgery, pediatrics, OB/Gyn, emergency medicine, psychiatry and family medicine; all were completing their last year of training. The residents' responses indicated that less than half of them thought they were "well prepared" or "very well prepared" to care for patients from a different cultural, racial or ethnic group; however, only 8 percent rated themselves as "very unprepared" or "somewhat unprepared" to care for such patients, when asked in a general sense.

When asked about specific characteristics likely to arise in cross-cultural situations,

Family physicians fared better than their counterparts, however. "Most answers varied by specialty, but the differences were not large," said the authors. "An exception was family physicians, who were significantly less likely to feel unprepared than residents in other specialties."

Cultural competency is crucial to erasing health care disparities, according to the Institutes of Medicine seminal publication, Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. The IOM report says that poor communication, patients' lack of English skills, and physicians' misunderstandings about their patients' religious or cultural belief systems hinder the quality of care given to minority groups.

Residents surveyed for the Commonwealth Fund report agreed. "Residents felt that poor handling of patients' cross-cultural issues often had negative consequences for clinical care, including longer office visits, patient noncompliance, delays obtaining informed consent, ordering of unnecessary tests and lower overall quality of care," the authors wrote.

Meanwhile, the U.S. population grows increasingly diverse. Today, more than 100 million people identify themselves as members of a racial, ethnic or national minority, according to the U.S. Census Bureau.

"About one in three U.S. residents is a minority," said Census Bureau Director Louis Kincannon in a May 17 news release about the growth of U.S. minority populations. Hispanics constitute the largest group, with 44.3 million, followed by 40.2 million African-Americans, 14.9 million Asians, 4.5 million American Indians and Alaska natives, and 1 million native Hawaiians or Pacific Islanders.

At the same time, the number of U.S. residents identifying themselves as members of a religious minority has grown. Today, between 6 million and 7 million U.S. residents are Muslim, some 7 million are Jewish, and 100,000 are Buddhist.

"As the United States population grows increasingly diverse, the delivery of quality health care to all patients, regardless of age, ethnicity and language proficiency, is becoming more of a challenge," said the Commonwealth Fund report's authors.

To meet the challenge, the authors recommend that