Advances in Health Sciences Education

, Volume 17, Issue 2, pp 269–278

Integrating cultural humility into health care professional education and training

Reflections

Abstract

As US populations become increasing diverse, healthcare professionals are facing a heightened challenge to provide cross-cultural care. To date, medical education around the world has developed specific curricula on cultural competence training in acknowledgement of the importance of culturally sensitive and grounded services. This article proposes to move forward by integrating the concept of cultural humility into current trainings, in which we believe, is vital in complementing the current model, and better prepare future professionals to address health challenges with culturally appropriate care. Based on the works of Chinese philosophers, cultural values and the contemporary Chinese immigrants’ experience, we hereby present the QIAN 謙 (Humbleness) curriculum: the importance of self-Questioning and critique, bi-directional cultural Immersion, mutually Active-listening, and the flexibility of Negotiation. The principles of the QIAN curriculum reside not only between the patient and the healthcare professional dyad, but also elicit the necessary support of family, health care system as well as the community at large. The QIAN curriculum could improve practice and enhance the exploration, comprehension and appreciation of the cultural orientations between healthcare professionals and patients which ultimately could improve patient satisfaction, patient-healthcare professional relationship, medical adherence and the reduction of health disparities. QIAN model is highly adaptable to other cultural and ethnic groups in multicultural societies around the globe. Incorporating its framework into the current medical education may enhance cross-cultural clinical encounters.

Keywords

Cultural competence Curriculum reform Patient-physician communication Physician education 

References

  1. Ames, R., & Hall, D. (1987). Thinking through Confucius. Albany: SUNY Press.Google Scholar
  2. Austerlic, S. (2009). Cultural humility and compassionate presence at the end of life. http://www.scu.edu/ethics/practicing/focusareas/medical/culturally-competent-care/chronic-to-critical-austerlic.html [On-line].
  3. Azad, N., Power, B., Dollin, J., & Chery, S. (2002). Cultural sensitivity training in Canadian medical schools. Academic Medicine, 77, 222–228.Google Scholar
  4. Blendon, R. J., Buhr, T., Cassidy, E. F., Perez, D. J., Hunt, K. A., Fleishfresser, C., et al. (2007). Disparities in health: Perspectives of a multi-ethnic, multi-racial America. Health Affairs, 26, 1437–1447.CrossRefGoogle Scholar
  5. Borkan, J. M., Culhane-Pera, K. A., & Goldman, R. E. (2008). Towards cultural humility in healthcare for culturally diverse Rhode Island. Medical Health Rhode Island, 91, 361–364.Google Scholar
  6. Brach, C., & Fraserirector, I. (2000). Can cultural competency reduce racial and ethnic health disparities? A review and conceptual model. Medical Care Research and Review, 57, 181–217.Google Scholar
  7. Brody, H., & Hunt, L. M. (2005). Moving beyond cultural stereotypes in end-of-life decision making. American Family Physician, 71, 429.Google Scholar
  8. Campinha-Bacote, J., Yahle, T., & Langenkamp, M. (1996). The challenge of cultural diversity for nurse educators. Journal of Continuing Education in Nursing, 27, 59–64.Google Scholar
  9. Chao, Y. R. (1976). Aspects of Chinese sociolinguistics: Essays by Yuen Ren Chao. Stanford: Stanford University Press.Google Scholar
  10. Chen, W. T. (1963). A source book in Chinese philosophy. Princeton: Princeton University Press.Google Scholar
  11. Chenowethm, L., Jeon, Y. H., Goff, M., & Burke, C. (2006). Cultural competency and nursing care: An Australian perspective. International Nursing Review, 53, 34–40.Google Scholar
  12. China News Service. (2009). 2008 world Chinese entrepreneurs development report China News Service.Google Scholar
  13. Collins, K. S., Hughes, D. L., Doty, M. M., Ives, B., Edwards, J. N., & Tenny, K. (2002). Diverse communities, common concerns: Assessing health care quality for minority Americans. The Commonwealth Fund.Google Scholar
  14. Cooper-Patrick, L., Gallo, J. J., & Gonzales, J. (1999). Race, gender, and partnership in the patient-physician relationship. JAMA, 282, 583–589.CrossRefGoogle Scholar
  15. Crandall, S. J., George, G., Marion, G., & Davis, S. (2003). Applying theory to the design of cultural competency training for medical students: A case study. Academic Medicine, 78, 588–594.CrossRefGoogle Scholar
  16. Cruess, S. R., Cruess, R. L., & Steinhart, Y. (2010). Linking the teaching of professionalism to the social contract: A call for cultural humility. Medical Teacher, 32, 357–359.CrossRefGoogle Scholar
  17. DeFrancis, J. (1984). The Chinese language: Fact and fantasy. Honolulu: University of Hawaii Press.Google Scholar
  18. Dogra, N., Reitmanova, S., & Carter-Pokras, O. (2010). Teaching cultural diversity: Current status in U.K., U.S., and Canadian medical schools. Journal of General Internal Medicine, 25, 164–168.CrossRefGoogle Scholar
  19. Flores, G., Gee, D., & Kastner, B. (2000). The teaching of cultural issues in U.S. and Canadian medical schools. Academic Medicine, 75, 451–455.Google Scholar
  20. Furman, G., & Dent, M. M. (2004). Cultural competency in medical education: A guidebook for schools. Department of Health and Human Services.Google Scholar
  21. Gervais, M., & Jovchelovitch, S. (1998). The health beliefs of the Chinese community in England: A qualitative research study. London: Health Education Authority.Google Scholar
  22. Guo, Z. (2000). Ginseng and aspirin: Health care alternatives for aging Chinese in New York. Ithaca, New York: Cornell University Press.Google Scholar
  23. Hunt, L. M. (2005). Beyond cultural competence: Applying humility to clinical settings. In G. Henderson, S. Estroff, L. Churchill, N. King, J. Oberlander, & R. Strauss (Eds.), The social medicine reader (pp. 133–136). Durkham: Duke University Press.Google Scholar
  24. Institute of Medicine. (2008). Retooling for an aging America: Building the health care workforce. Washington DC: The National Academics Press.Google Scholar
  25. Juarez, J. A., Marvel, K., Brezinski, K. L., Glazner, C., Towbin, M. M., & Lawton, S. (2006). Bridging the gap: A curriculum to teach residents cultural humility. Family Medicine, 38, 97–102.Google Scholar
  26. Kagawa Singer, M., & Kassim-Lakha, S. (2003). A strategy to reduce cross-cultural miscommunication and increase the likelihood of improving health outcomes. Academic Medicine, 78, 577–587.CrossRefGoogle Scholar
  27. Kleinman, A., Eisenberg, L., & Good, B. (1978). Culture, illness and care: Clinical lessons from anthropologic and cross-cultural research. Annals of Internal Medicine, 88, 251–256.Google Scholar
  28. Kripalani, S., Bussey-Jones, J., Katz, M. G., & Genao, I. (2006). A prescription for cultural competence in medical education. Journal of General Internal Medicine, 21, 1116–1120.CrossRefGoogle Scholar
  29. Kumagai, A. K., & Lypson, M. L. (2009). Beyond cultural competence: Critical consciousness, social justice, and multicultural education. Academic Medicine, 84, 782–787.CrossRefGoogle Scholar
  30. Lam, T. P., Lam, B., & Yu, Y. (2009). Medical education reform: The Asian experience. Academic Medicine, 84, 1313–1317.Google Scholar
  31. Lee, E. (2007). At America’s gates: Chinese immigration during the exclusion era: 1882–1943. North Carolina: The University of North Carolina Press.Google Scholar
  32. Levi, A. (2009). The ethics of nursing student international clinical experiences. Journal of Obstetric, Gynecologic, and Neonatal Nursing, 38, 94–99.CrossRefGoogle Scholar
  33. Lie, D., Carter-Pokras, O., & Cleveland, E. (2006). Tool for assessing cultural competence training (TACCT) resource guide American Association of Medical Colleges.Google Scholar
  34. Lindsay, C. (2007). The Chinese community in Canada. Ottawa, Canada: Minister of Industry.Google Scholar
  35. Liu, R., So, L., & Quan, H. (2007). Chinese and white Canadian satisfaction compliance with physicians. BMC Family Practice, 21, 8–11.Google Scholar
  36. Loudon, R. F., Anderson, P. M., Gill, P. S., & Greenfield, S. M. (1999). Educating medical students for work in culturally diverse societies. JAMA, 282, 875–880.Google Scholar
  37. McElroy, A., & Jezewski, M. A. (2003). Cultural variation in the experience of health and illness. In G. Albrecht, S. C. Scrimshaw, & R. Fitzpatrick (Eds.), Handbook of social studies in health and medicine. Beverly Hills: Sage.Google Scholar
  38. Miller, S. (2009). Cultural humility is the first step to becoming global care providers. Journal of Obstetric, Gynecologic, and Neonatal Nursing, 38, 92–93.CrossRefGoogle Scholar
  39. Murray-Garcia, J., & Garcia, J. A. (2008). The instructional context of multicultural education: What is your institutional curriculum? Academic Medicine, 83, 646–652.CrossRefGoogle Scholar
  40. National Bureau of Statistics of China. (2009). 1% of National Population Survey in 2005. National Bureau of Statistics of China, Ministry of Foreign Affairs of the People’s Republic of China [On-line]. Available: http://www.stats.gov.cn/tjgb/rkpcgb/qgrkpcgb/t20060316_402310923.htm.
  41. Ngo-Metzger, Q., Legedza, A. T., & Phillips, R. S. (2004). Asian Americans’ reports of their health care experiences—Results of a national survey. Journal of General Internal Medicine, 19, 111–119.CrossRefGoogle Scholar
  42. Pan, L. (1994). Sons of the yellow emperor: A history of the Chinese diaspora. New York: Kodansha Globe.Google Scholar
  43. Ramsey, S. R. (1989). The languages of China. Princeton: Princeton University Press.Google Scholar
  44. Rust, G., Kondwani, K., Martinez, R., Dansie, R., Wong, W., Fry-Johnson, Y., et al. (2006). A crash-course in cultural competence. Ethnicity and Disease, 16, 29–36.Google Scholar
  45. Shapiro, J., Lie, D., Gutierrez, D., & Zhuang, G. (2006). That never would have occured to me: A qualitative study of medical students’ views of a cultural competence curriculum. BMC Medical Education, 26, 6–31.Google Scholar
  46. Shinagawa, L. (2008). A portrait of Chinese Americans. Maryland: Asian American Studies Program, University of Maryland.Google Scholar
  47. Smedley, B. D., Stith, A. Y., & Nelson, A. R. (2003). Unequal treatment: Confronting racial and ethnic disparities in health care. Washington DC: National Academies Press.Google Scholar
  48. Tervalon, M., & Murray-Garcia, J. (1998). Cultural humility vs. cultural competence: A critical distinction in defining physician training outcomes in multicultural education. Journal of Health Care for the Poor and Underserved, 9.Google Scholar
  49. US Census Bureau. (2009). U.S pop clock projection. US Census Bureau [On-line]. Available: http://www.census.gov/population/www/popclockus.html.
  50. Vega, W. A. (2005). Higher stakes ahead for cultural competence. General Hospital Psychiatry, 27, 446–450.CrossRefGoogle Scholar
  51. Wang, J. (2006). His dominion and the yellow peril: Protestant missions to Chinese immigrants in Canada, 1859–1967. Ontario, Canada: Wilfrid Laurier University Press.Google Scholar
  52. Wear, D. (2003). Insurgent multiculturalism: Rethinking how and why we teach culture in medical education. Academic Medicine, 78, 549–554.CrossRefGoogle Scholar
  53. Wong, S. C. (1998). Language diversity: Problem or resource? In S. L. McKay & S. C. Wong (Eds.), A social and educational perspective on lanugauge minorities in the United States. New York: Newbury House.Google Scholar
  54. Xu, Y., & Wang, B. (2007). Ethnic minorities of ChinaJourney into China. China Intercontinental Press.Google Scholar
  55. Ying, Y. (1995). Cultural orientation and psychological well-being in Chinese Americans. American Journal of Community Psychology, 23, 893–911.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2010

Authors and Affiliations

  1. 1.Rush Institute for Health AgingChicagoUSA
  2. 2.Northwestern University Medical CenterChicagoUSA

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