Enhancing cultural competence in medical education

A health system serving diverse populations requires health professionals who are competent in caring for patients and population groups who differ in e.g. age, gender, socio-economic status, migrant status, and ethnicity. Cultural competence (CC) among health professionals is viewed as one strategy to ensure equal access to healthcare across diverse groups and to ensure that patients receive care by their needs.1,2 However, many physicians are insufficiently prepared to meet the needs of increasingly diverse populations.3 In 2013, the EACEA ERASMUS Life Long Learning Programme funded the project Culturally Competent in Medical Education involving 13 partners from 11 countries.4 The project aimed to support the implementation of CC in medical curricula. First, a Delphi Study involving 34 experts was conducted to develop a framework of core cultural competencies for medical school teachers. The framework included learning objectives on knowledge (e.g., teachers should have knowledge of determinants of health), attitudes (e.g., teachers should be aware of their own ethnic and cultural backgrounds), and skills (e.g., teachers should have the ability to engage and motivate all students). The second stage of the project was a survey conducted to identify the strengths, gaps, and limitations of CC in the programmes of the 13 medical school project partners. Based on the Delphi study and survey findings, we created guidelines for the development and delivery of CC training at medical schools.4 The proposed guidelines were presented in September 2015 in Amsterdam at a workshop entitled: “How to integrate cultural competence in medical education”. A range of participants attended the workshop, including the project partners, deans and faculty members of Dutch medical schools, physicians, and students, to test the relevance and clarity of the proposal. Based on the workshop discussions, some of the wording of the guidelines was modified, but the document remained substantially unchanged. The proposed guidelines are presented as minimum requirements; they generally concur with the previously published literature on the subject5-7 but cover a broader range of issues. Culturally competent teachers Research shows that medical school teachers should be culturally competent to educate culturally competent physicians. Focus should, therefore, be placed on policies that recruit and build the capacity of culturally competent teachers. We suggest that the recruitment policies of the organisations ensure that teaching staff have the relevant qualifications and reflect the diversity of the community in which they work. This could be accomplished by explicitly stating in job advertisements for new staff that the recruiting organisation wishes to reflect the cultural diversity of society and therefore welcomes all qualified applicants. The advertisement should also state that if the applicant is not culturally competent, they should be willing to attend training in CC. This “condition” could be part of the formal contract. The advertisement should be distributed widely. We suggest that medical schools offer mandatory CC training for all teachers to enhance and strengthen teachers’ cultural competencies. It could be a specific CC course, or CC could be integrated into existing general teaching skills courses. Teachers’ CCs should also be evaluated, for example, by including questions about CC in student evaluations of the courses completed.