Journal of General Internal Medicine

, Volume 25, Supplement 2, pp 164–168 | Cite as

Teaching Cultural Diversity: Current Status in U.K., U.S., and Canadian Medical Schools

  • Nisha DograEmail author
  • Sylvia Reitmanova
  • Olivia Carter-Pokras


In this paper we present the current state of cultural diversity education for undergraduate medical students in three English-speaking countries: the United Kingdom (U.K.), United States (U.S.) and Canada. We review key documents that have shaped cultural diversity education in each country and compare and contrast current issues. It is beyond the scope of this paper to discuss the varied terminology that is immediately evident. Suffice it to say that there are many terms (e.g. cultural awareness, competence, sensitivity, sensibility, diversity and critical cultural diversity) used in different contexts with different meanings. The major issues that all three countries face include a lack of conceptual clarity, and fragmented and variable programs to teach cultural diversity. Faculty and staff support and development, and ambivalence from both staff and students continue to be a challenge. We suggest that greater international collaboration may help provide some solutions.

Key Words

cultural competency diversity education medical undergraduate 



All three authors have contributed to the writing of the paper. Drs. Carter-Pokras and Dogra gratefully acknowledge funding from the National Heart Lung and Blood Institute (NHLBI K07HL079255). This paper stems from an earlier workshop: “International perspectives on cultural competence training: assessment and evaluation of cultural competence education in the U.K., U.S. and Canada: Discussion of Theory and Practice” held at the 12th International Ottawa Conference on Clinical Competence in New York City on May 23, 2006.

Conflict of Interest Statement

Ethical approval was not sought for this review and there is no conflict of interest for any of the authors.


  1. 1.
    The Henry J Kaiser Family Foundation. Compendium of Cultural Competence Initiatives in Health Care. California: The Henry J Kaiser Family Foundation; 2003.Google Scholar
  2. 2.
    Dogra N. Cultural Competence or cultural sensibility? A comparison of two ideal type models to teach cultural diversity to medical students. International Journal of Medicine. 2003;5(4):223–31.Google Scholar
  3. 3.
    Gustafson DL. Are sensitivity and tolerance enough? Comparing two theoretical approaches to caring for newcomer women with mental health problems. In: Guruge S, Collins E, eds. Working with Immigrant Women. Issues and Strategies for Mental Health Professionals. Toronto: Centre for Addiction and Mental Health; 2008:39–63.Google Scholar
  4. 4.
    Dunnell, K. Diversity and different experiences in the U.K. National Statistician’s Annual Article on Society. London: Office of National Statistics; 2008. Available at: Accessed October 19, 2009.
  5. 5.
    General Medical Council. Tomorrow’s Doctors. London: General Medical Council; 1993.Google Scholar
  6. 6.
    Dogra N, Williams R. Applying policy and evidence in developing cultural diversity teaching in undergraduate medical education in the U.K. Evidence & Policy. 2006;2(4):463–77.Google Scholar
  7. 7.
    NHS Institute of Innovation and Improvement. Medical Leadership Competency Framework: Enhancing engagement in medical leadership. University of Warwick: NHS Institute of Innovation and Improvement; 2008.Google Scholar
  8. 8.
    Race Relations Amendment Act. London: HMSO; 2000.Google Scholar
  9. 9.
    Conning S, Hooper A, Turner M. Reports of new ideas in medical education: Educating tomorrow’s doctors for today’s world: introducing a new diversity course for year 2 medical students in a community-based setting. Med Educ. 2001;35(11):1071–90.CrossRefGoogle Scholar
  10. 10.
    Dogra N. The development and evaluation of a programme to teach cultural diversity to medical undergraduate students. Med Educ. 2001;35(3):232–41.CrossRefPubMedGoogle Scholar
  11. 11.
    Dogra N, Conning S, Gill PS, Spencer J, Turner M. Teaching of cultural diversity in medical schools in the United Kingdom and Republic of Ireland: cross sectional questionnaire survey. BMJ. 2005;330(7488):403–4.CrossRefPubMedGoogle Scholar
  12. 12.
    Bentley P, Jovanovic A, Sharma P. Cultural diversity training for U.K. healthcare professionals: a comprehensive nationwide cross-sectional survey. Clin Med. 2008;8(5):493–7.PubMedGoogle Scholar
  13. 13.
    Roberts JH, Sanders T, Wass V. Students’ perceptions of race, ethnicity and culture at two U.K. medical schools: a qualitative study. Med Educ. 2008;42:45–52.PubMedGoogle Scholar
  14. 14.
    Dogra N, Giordano J, France N. Cultural diversity teaching and issues of uncertainty: the findings of a qualitative study. BMC Med Educ. 2007;7:8.CrossRefPubMedGoogle Scholar
  15. 15.
    Dogra N, Karnik N. A comparison between U.K. and U.S. medical student attitudes towards cultural diversity. Med Teach. 2004;26(8):703–8.CrossRefPubMedGoogle Scholar
  16. 16.
    U.S. Department of Health and Human Services. Report of the Secretary's Task Force on Black & Minority Health, Volume I: Executive Summary. Washington: U.S. Government Printing Office; 1985. August.Google Scholar
  17. 17.
    Physicians for Human Rights. The Right to Equal Treatment: An action plan to end racial and ethnic disparities in clinical diagnosis and treatment in the United States. A report by the Panel on Racial and Ethnic Disparities in Medical Care convened by Physicians for Human Rights. September 2003. Available at: Accessed October 19, 2009.
  18. 18.
    Smedley BD, Stith AY, Nelson AR, eds. Unequal treatment: confronting racial and ethnic disparities in health. Washington DC: National Academies Press; 2002.Google Scholar
  19. 19.
    Office of Minority Health. National Standards for Culturally and Linguistically Appropriate Services in Health Care. U.S. Department of Health and Human Services; March 2001. Available at: Accessed October 19, 2009.
  20. 20.
    Salas-Lopez D, Holmes L, Mouzon DM, Soto-Greene M. Cultural competency in New Jersey: evolution from planning to law. J Health Care Poor Underserved. 2007;18:34–43.CrossRefGoogle Scholar
  21. 21.
    Liaison Committee on Medical Education. Functions and Structure of a Medical School: Standards for Accreditation of Medical Education Programs Leading to the M.D. degree; 2007. Available at: Accessed October 19, 2009.
  22. 22.
    Association of American Medical College (AAMC) Tool for Assessing Cultural Competency Training. Available at: Accessed October 19, 2009.
  23. 23.
    Accreditation Council for Graduate Medical Education. Common Program Requirements; February 2002.Google Scholar
  24. 24.
    American Medical Association. Minority Affairs Consortium. Policy Compendium; October 2007. Available at: Accessed October 19, 2009.
  25. 25.
    Smith WR, Betancourt JR, Wynia MK, et al. Recommendations for Teaching about Racial and Ethnic Disparities in Health and Health Care. Ann Intern Med. 2007;147(9):654–65.PubMedGoogle Scholar
  26. 26.
    Wyatt GE, Bass BA, Powell GJ. A survey of ethnic and sociocultural issues in medical school education. Med Educ. 1978;53(8):627–32.Google Scholar
  27. 27.
    Lum CK, Korenman SG. Cultural-sensitivity training in U.S. medical schools. Acad Med. 1994;69(3):239–41.CrossRefPubMedGoogle Scholar
  28. 28.
    Louden RF, Anderson PM, Paranjit S, Greenfield SM. Educating medical students for work in culturally diverse societies. JAMA. 1999;282(9):875–80.CrossRefGoogle Scholar
  29. 29.
    Flores G, Gee D, Kastner B. The teaching of cultural issues in U.S. and Canadian medical schools. Acad Med. 2000;75(5):451–5.CrossRefPubMedGoogle Scholar
  30. 30.
    Pena Dolhun E, Munoz C, Grumbach K. Cross-cultural education in U.S. medical schools: development of an assessment tool. Acad Med. 2003;78(6):615–2.CrossRefPubMedGoogle Scholar
  31. 31.
    Lie D, Boker J, Cleveland E. Using the tool for assessing cultural competence training (TACCT) to measure faculty and medical student perceptions of cultural competence instruction in the first three years of the curriculum. Acad Med. 2006;81(6):557–64.CrossRefPubMedGoogle Scholar
  32. 32.
    Rapp DE. Integrating cultural competency into the undergraduate medical curriculum. Med Educ. 2006;40:704–10.CrossRefPubMedGoogle Scholar
  33. 33.
    Tervalon M. Components of culture in health for medical students' education. Acad Med. 2003;78(6):570–6.CrossRefPubMedGoogle Scholar
  34. 34.
    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.CrossRefPubMedGoogle Scholar
  35. 35.
    Kripalani S, Bussey-Jones J, Katz MG, Genao I. A prescription for cultural competence in medical education. J Gen Intern Med. 2006;21:1116–20.CrossRefPubMedGoogle Scholar
  36. 36.
    Health Canada. Social Accountability. A Vision for Canadian Medical Schools. Ottawa: Health Canada; 2002.Google Scholar
  37. 37.
    Azad N, Chery S, Dollin J, Power B. Cultural Sensitivity Training in Canadian Undergraduate Medical Schools. Acad Med. 2002;77(3):222–8.CrossRefPubMedGoogle Scholar
  38. 38.
    Gustafson DL, Reitmanova S. How are we "doing" cultural diversity? A look across English Canadian undergraduate medical school programs. Medical Teacher. In press.Google Scholar
  39. 39.
    Frank B, MacLeod A. Beyond the ‘four Ds of Multiculturalism’: taking difference into account in medical education. Med Educ. 2005;39(12):1178–9.CrossRefPubMedGoogle Scholar
  40. 40.
    Dogra N. The learning and teaching of cultural diversity in undergraduate medical education in the UK [dissertation]. Leicester: University of Leicester; 2004.Google Scholar
  41. 41.
    De Leon Siantz ML. Leading Change in Diversity and Cultural Competence. J Prof Nurs. 2008;24(3):167–71.CrossRefPubMedGoogle Scholar
  42. 42.
    Association of American Medical Colleges. Canadian Medical School Graduate Questionnaire. Division of Medical Education; 2007.Google Scholar
  43. 43.
    Murray-Garcia JL, Garcia JA. The institutional context of multicultural education: what is your institutional curriculum? Acad Med. 2008;87(7):646–52.CrossRefGoogle Scholar
  44. 44.
    Huang G, Reynolds R, Candler C. Virtual patient simulation at U.S. and Canadian medical schools. Acad Med. 2007;82(5):446–51.CrossRefPubMedGoogle Scholar
  45. 45.
    Dogra N, Wass V. Can we assess students’ awareness of cultural diversity? A qualitative study of stakeholders’ views. Med Educ. 2006;40(7):682–90.CrossRefPubMedGoogle Scholar
  46. 46.
    Association of American Medical Colleges. Graduate Questionnaire: Student Survey on Priorities in Medical Education. Division of Medical Education; 2008.Google Scholar
  47. 47.
    Dogra N. The views of medical education stakeholders on guidelines for cultural diversity teaching. Med Teach. 2007;29(2–3):e41–6.CrossRefPubMedGoogle Scholar

Copyright information

© Society of General Internal Medicine 2009

Authors and Affiliations

  • Nisha Dogra
    • 1
    Email author
  • Sylvia Reitmanova
    • 2
  • Olivia Carter-Pokras
    • 3
  1. 1.Greenwood Institute of Child HealthUniversity of LeicesterLeicesterUK
  2. 2.Division of Community Health and HumanitiesMemorial University of NewfoundlandSt. John’sCanada
  3. 3.Department of Epidemiology and BiostatisticsUniversity of Maryland College Park School of Public HealthCollege ParkUSA

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