Skip to main content
SpringerLink
Log in

Culturally Sensitive Care: A Review of Models and Educational Methods

  • Chapter
Diversity and Inclusion in Quality Patient Care

Abstract

The disparities in health care outcomes between the majority population and cultural and racial minorities in the USA are a problem likely influenced by the lack of culturally competent care. Emergency medicine and other primary care specialties remain on the front lines of this struggle due to the nature of their open door practice. In order to provide culturally appropriate care, health care providers must recognize the factors impeding cultural awareness, seek to understand the biases and traditions in medical education potentially fueling this phenomenon, and create a health care community open to individuals’ “otherness,” thus leading to better communication of ideas and information between patients and their health care providers. This chapter highlights the rationale for and current problems in teaching cultural competency in physicians and examines several different models implemented to teach and promote cultural competency in the health care environment. However, the literature addressing the true efficacy of such programs in leading to long-lasting change and improvement in minority outcomes remains insufficient.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. US Department of Health and Human Services. With understanding and improving health and objectives for improving health. Healthy People 2010. 2010;2(2nd ed).

    Google Scholar 

  2. Vaccarino V, Rathore SS, Wenger NK, Frederick PD, Abramson JL, Barron HV, et al. Sex and racial differences in the management of acute myocardial infarction, 1994 through 2002. N Engl J Med. 2005;353(7):671–82.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  3. Todd KH, Samaroo N, Hoffman JR. Ethnicity as a risk factor for inadequate emergency department analgesia. JAMA. 1993;269(12):1537–9.

    Article  CAS  PubMed  Google Scholar 

  4. Todd KH, Deaton C, D’Adamo AP, Goe L. Ethnicity and analgesic practice. Ann Emerg Med. 2000;35(1):11–6.

    Article  CAS  PubMed  Google Scholar 

  5. Lowe RA, Chhaya S, Nasci K, Gavin LJ, Shaw K, Zwanger ML, et al. Effect of ethnicity on denial of authorization for emergency department care by managed care gatekeepers. Acad Emerg Med. 2001;8(3):259–66.

    Article  CAS  PubMed  Google Scholar 

  6. Rand CS, Butz AM, Kolodner K, Huss K, Eggleston P, Malveaux F. Emergency department visits by urban African American children with asthma. J Allergy Clin Immunol. 2000;105(1 Pt 1):83–90.

    Article  CAS  PubMed  Google Scholar 

  7. Weissman JS, Betancourt J, Campbell EG, Park ER, Kim M, Clarridge B. Resident physicians’ preparedness to provide cross-cultural care. JAMA. 2005;294(9):1058–67.

    Article  CAS  PubMed  Google Scholar 

  8. Greysen SR, Siegel B, Sears V, Solomon A, Jones K, Bradley EH. Residents’ awareness of racial and ethnic disparities in cardiovascular care. J Grad Med Educ. 2011;3(3):417–20. doi:10.4300/JGME-D-10-00190.1.

    Article  PubMed Central  PubMed  Google Scholar 

  9. Kripalani S, Bussey-Jones J, Katz MG, Genao I. A prescription for cultural competence in medical education. J Gen Intern Med. 2006;21(10):1116–20.

    Article  PubMed Central  PubMed  Google Scholar 

  10. Office for Minority Health. Assuring cultural competence in healthcare: recommendations for national standards and an outcomes-focused research agenda. 2006. Available from: http://minorityhealth.hhs.gov/Assets/pdf/checked/Assuring_Cultural_Competence_in_Health_Care-1999.pdf.

  11. Liaison Committee on Medical Education. Accreditation standards. 2006. Available from: http://www.lcme.org/publications/2015-16-functions-and-structure-with-appendix.pdf

  12. Fadiman A. The spirit catches you and you fall down: a Hmong child, her American doctors, and the collision of two cultures. New York: Farrar, Straus, and Giroux; 1997.

    Google Scholar 

  13. Kaiser Permanente National Diversity Council and the Kaiser Permanente National Diversity Department. Multicultural caring: a guide to cultural competence for Kaiser Permanente health professionals. Oakland, CA: Kaiser Permanente; 2000.

    Google Scholar 

  14. Gordon J. Assessing students’ personal and professional development using portfolios and interviews. Med Educ. 2003;37(4):335–40.

    Article  PubMed  Google Scholar 

  15. Crampton P, Dowell A, Parkin C, Thompson C. Combating effects of racism through a cultural immersion medical education program. Acad Med. 2003;78(6):595–8.

    Article  PubMed  Google Scholar 

  16. Kamaka ML. Cultural immersion in a cultural competency curriculum. Acad Med. 2001;76(5):512.

    Article  CAS  PubMed  Google Scholar 

  17. Godkin M, Ferguson W, Diop D. A required interclerkship on multiculturalism for third-year medical students. Acad Med. 2002;77(5):469.

    Article  PubMed  Google Scholar 

  18. Campbell A, Sullivan M, Sherman R, Magee WP. The medical mission and modern cultural competency training. J Am Coll Surg. 2011;212(1):124–9.

    Article  PubMed  Google Scholar 

  19. Shapiro J, Lie D. Using literature to help physician-learners understand and manage “difficult” patients. Acad Med. 2000;75(7):765–8.

    Article  CAS  PubMed  Google Scholar 

  20. Hatem CJ. Teaching approaches that reflect and promote professionalism. Acad Med. 2003;78(7):709–13.

    Article  PubMed  Google Scholar 

  21. Esfandiari A, Drew CR, Wilkerson L, Gill G, Drew CR. An international health/tropical medicine elective. Acad Med. 2001;76(5):516.

    Article  CAS  PubMed  Google Scholar 

  22. Takayama JI, Chandran C, Pearl DB. A one-month cultural competency rotation for pediatrics residents. Acad Med. 2001;76(5):514–5.

    Article  CAS  PubMed  Google Scholar 

  23. Brainin-Rodriquez JE. A course about culture and gender in the clinical setting for third-year students. Acad Med. 2001;76(5):512–3.

    Article  CAS  PubMed  Google Scholar 

  24. Altshuler L, Kachur E. A culture OSCE: teaching residents to bridge different worlds. Acad Med. 2001;76(5):514.

    Article  CAS  PubMed  Google Scholar 

  25. Park ER, Chun MB, Betancourt JR, Green AR, Weissman JS. Measuring residents’ perceived preparedness and skillfulness to deliver cross-cultural care. J Gen Intern Med. 2009;24(9):1053–6.

    Article  PubMed Central  PubMed  Google Scholar 

  26. Hochberg MS, Berman RS, Kalet al, Zabar SR, Gillespie C, Pachter HL. The professionalism curriculum as a cultural change agent in surgical residency education. Am J Surg. 2012;203(1):14–20.

    Article  PubMed  Google Scholar 

  27. Goleman MJ. Teaching pediatrics residents to communicate with patients across differences. Acad Med. 2001;76(5):515–6.

    Article  CAS  PubMed  Google Scholar 

  28. Núñez AE. Transforming cultural competence into cross-cultural efficacy in women’s health education. Acad Med. 2000;75(11):1071–80.

    Article  PubMed  Google Scholar 

  29. Kagawa-Singer M, Kassim-Lakha S. A strategy to reduce cross-cultural miscommunication and increase the likelihood of improving health outcomes. Acad Med. 2003;78(6):577–87.

    Article  PubMed  Google Scholar 

  30. Rosen J, Spatz ES, Gaaserud AM, Abramovitch H, Weinreb B, Wenger NS, et al. A new approach to developing cross-cultural communication skills. Med Teach. 2004;26(2):126–32.

    Article  PubMed  Google Scholar 

  31. Musolino GM, Burkhalter ST, Crookston B, et al. Understanding and eliminating disparities in health care: development and assessment of cultural competence for interdisciplinary health professionals at The University of Utah-a 3-year investigation. J Phys Ther Educ. 2010;24(1):25–36.

    Google Scholar 

  32. Carpenter D-AL, Kamaka ML. Kaulukukui, MK. An innovative approach to developing a cultural competency curriculum; efforts at the John A. Burns School of Medicine, Department of Native Hawaiian Health. Hawaii Med J. 2011;70(11):15–9.

    PubMed Central  PubMed  Google Scholar 

  33. Crandall SJ, George G, Marion GS, Davis S. Applying theory to the design of cultural competency training for medical students: a case study. Acad Med. 2003;78(6):588–94.

    Article  PubMed  Google Scholar 

  34. Hobgood CD, Riviello RJ, Jouriles N, Hamilton G. Assessment of communication and interpersonal skills competencies. Acad Emerg Med. 2002;9(11):1257–69.

    Article  PubMed  Google Scholar 

  35. DelVecchio-Good M-J. American medicine: the quest for competence. Berkeley: University of California Press; 1995.

    Book  Google Scholar 

  36. Inui TS. A flag in the wind: educating for professionalism in medicine. Washington, DC: Association of American Medical Colleges; 2003.

    Google Scholar 

  37. American Association of Medical Colleges. Cultural competence education for medical students: assessing and revising curriculum. 2005. Available from: https://www.aamc.org/download/54338/data/culturalcomped.pdf

  38. Reynolds PP. Reaffirming professionalism through the education community. Ann Intern Med. 1994;120(7):609–14.

    Article  CAS  PubMed  Google Scholar 

  39. Stuart MR, Lieberman JR. The fifteen-minute hour: applied psychotherapy for the primary care physician. New York: Praeger; 1993.

    Google Scholar 

  40. Dobbie AE, Medrano M, Tysinger J, Olney C. The BELIEF Instrument: a preclinical teaching tool to elicit patients’ health beliefs. Fam Med. 2003;35(5):316–9.

    PubMed  Google Scholar 

  41. Carrillo JE, Green AR, Betancourt JR. Cross-cultural primary care: a patient-based approach. Ann Intern Med. 1999;130(10):829–34.

    Article  CAS  PubMed  Google Scholar 

  42. Betancourt JR, Carrillo JE, Green AR. Hypertension in multicultural and minority populations: linking communication to compliance. Curr Hypertens Rep. 1999;1(6):482–8.

    Article  CAS  PubMed  Google Scholar 

  43. Levin SJ, Like RC, Gottlieb JE. ETHNIC: a framework for culturally competent ethical practice. Patient Care. 2000;34(9):188–9.

    Google Scholar 

  44. Kleinman A, Eisenberg L, Good B. Culture, illness, and care: clinical lessons from anthropologic and cross-cultural research. Ann Intern Med. 1978;88(2):251–8.

    Article  CAS  PubMed  Google Scholar 

  45. Berlin Jr EAFW. A teaching framework for cross-cultural health care. Application in family practice. West J Med. 1983;139(6):934–8.

    CAS  PubMed Central  PubMed  Google Scholar 

  46. Flores G. Culture and the patient-physician relationship: achieving cultural competency in health care. J Pediatr. 2000;136(1):14–23.

    Article  CAS  PubMed  Google Scholar 

  47. Green AR, Betancourt JR, Carrillo JE. Integrating social factors into cross-cultural medical education. Acad Med. 2002;77(3):193–7.

    Article  PubMed  Google Scholar 

  48. Michalopoulou G, Falzarano P, Arfken C, Rosenberg D. Implementing Ask Me 3 to improve African American patient satisfaction and perceptions of physician cultural competency. J Cult Divers. 2010;17(2):62–7.

    PubMed  Google Scholar 

  49. Wilkes M, Raven BH. Understanding social influence in medical education. Acad Med. 2002;77(6):481–8.

    Article  PubMed  Google Scholar 

  50. ACGME/American Board of Medical Specialties Joint Initiative. Toolbox of Assessment Methods: a product of the joint initiative. 2000;1.1. Available from: https://www.partners.org/Assets/Documents/Graduate-Medical-Education/ToolTable.pdf

Download references

Author information

Authors and Affiliations

  1. Department of Emergency Medicine, Indiana State University School of Medicine, Eskenazi Health, Indianapolis, IN, USA

    Antoine Leflore M.D.

  2. University of Louisiana School of Medicine, Louisville, KY, USA

    Susan Sawning M.S.S.W.

  3. Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN, USA

    Cherri Hobgood M.D.

Authors
  1. Antoine Leflore M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Susan Sawning M.S.S.W.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Cherri Hobgood M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Cherri Hobgood M.D. .

Editor information

Editors and Affiliations

  1. Professor of Emergency Medicine University of Virginia School of Medicine Department of Emergency Medicine, Vice President and Chief Officer for Diversity and Equity, Charlottesville, Virginia, USA

    Marcus L. Martin

  2. Assistant Dean Clinical Education & Student Affairs Emory University School of Medicine, Professor of Emergency Medicine Vice Chair – Administrative Affairs, Atlanta, Georgia, USA

    Sheryl L. Heron

  3. Director of Diversity Department of Medicine Section of Emergency Medicine Louisiana State University Health Sciences Center - New Orleans, Professor of Emergency Medicine Director of Research, New Orleans, Louisiana, USA

    Lisa Moreno-Walton

  4. University of Virginia Hospital, Charlottesville, Virginia, USA

    Anna Walker Jones

Rights and permissions

Reprints and permissions

Copyright information

© 2016 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Leflore, A., Sawning, S., Hobgood, C. (2016). Culturally Sensitive Care: A Review of Models and Educational Methods. In: Martin, M., Heron, S., Moreno-Walton, L., Jones, A. (eds) Diversity and Inclusion in Quality Patient Care. Springer, Cham. https://doi.org/10.1007/978-3-319-22840-2_5

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-22840-2_5

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-22839-6

  • Online ISBN: 978-3-319-22840-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation