Abstract
The concept of cultural competence has become reified by inclusion as an accreditation standard in the US and Canada, in New Zealand it is demanded through an Act of Parliament, and it pervades discussion in Australian medical education discourse. However, there is evidence that medical graduates feel poorly prepared to deliver cross-cultural care (Weissman et al. in J Am Med Assoc 294(9):1058–1067, 2005) and many commentators have questioned the effectiveness of cultural competence curricula. In this paper we apply Hafferty’s taxonomy of curricula, the formal, informal and hidden curriculum (Hafferty in Acad Med 73(4):403–407, 1998), to cultural competence. Using an example across each of these curricular domains, we highlight the need for curricular congruence to support cultural competence development among learners. We argue that much of the focus on cultural competence has been in the realm of formal curricula, with existing informal and hidden curricula which may be at odds with the formal curriculum. The focus of the formal, informal and hidden curriculum, we contend, should be to address disparities in health care outcomes. In conclusion, we suggest that without congruence between formal, informal and hidden curricula, approaches to addressing disparity in health care outcomes in medical education may continue to represent reform without change.
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Acknowledgments
The authors would like to acknowledge our colleagues involved in the Educating for Equity project. See www.educating4equity.net for more details of the project and team members. This project is supported by funding from the National Health and Medical Research Council (Aust), Grant ID 634586 and the Health Research Council (NZ), Contract number 09/643b.
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David Paul was formerly, Deputy Director, Centre for Aboriginal Medical and Dental Health, University of Western Australia.
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Paul, D., Ewen, S.C. & Jones, R. Cultural competence in medical education: aligning the formal, informal and hidden curricula. Adv in Health Sci Educ 19, 751–758 (2014). https://doi.org/10.1007/s10459-014-9497-5
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DOI: https://doi.org/10.1007/s10459-014-9497-5