Impact of Interviews on Heterosexual Students' Expressions of Cultural Competency

The Institute of Medicine and the Council of Dental Accreditation (CODA) recommends that dental practitioners become culturally competent in response to healthcare disparity in the U.S. (Asch et al., 2006; Behar-Horenstein, Garvan, Moore, & Catalanotto, 2013; Dharamsi, Ho, Spadafora, & Woollard, 2011; Frist, 2005; Schoen & Doty, 2004). These skills are necessary to improve patient perceptions of quality and satisfaction, population health and to reduce healthcare costs (Berwick, Nolan, & Whittington, 2008). Increasing diversity and cultural competence are important educational goals as students need awareness of unconscious bias (Teal, Green, Gill & Crandall, 2012). In a previously published study, we analyzed documents among 80 pre-doctoral dental students and found linguistic differences using text analysis software in students' reflective writing assignments before and after interviewing an individual who was culturally different (Isaac, Behar-Horenstein, Lee, & Catalanotto, 2014). These interviews and reflective writing demonstrated the interventional strategy and provided, "increasing opportunities for contact" (Devine, Forscher, Austin, & Cox, 2012). Although there were significant increase in scores for each group (race, religion, SES/able-ness, gender, sexual orientation), the change was not significant for those students (male/female, majority/non- majority) who interviewed those of different sexual orientation (Isaac et al., 2014). For the current study, the researchers sought to explore the perceptions of these heterosexual students after conducting interviews with individuals unlike themselves. Dental curriculum typically lacks discussions of lesbian, gay, bisexual and transgender (LGBT) issues (Brondani & Paterson, 2011). One study reported that 88% of dental schools were neutral or negative about their program's preparation for treating LGBT patients (Anderson, Patterson, Temple, & Inglehart, 2009). In a study of 54 dental school administrators, only 61% reported that their dental school was "somewhat tolerant" or "very tolerant" of LGBT students and faculty (More, Whitehead, & Gonthier, 2004). This lack of tolerance extends to other healthcare professionals. In a cross-sectional study at the University of California-Davis, medical students reported discomfort towards gay men's "intimate behavior and homosexuality" in patients but also among their student peers as well (Matharu, Kravitz, McMahon, Wilson, & Fitzgerald, 2012, p. 1). A heteronormative society constructs and relies on assumptions of heterosexuality as normal (Kimmel, 2010). Although explicit homophobic behaviors are deemed socially and politically incorrect, heterosexism, the belief that heterosexuality is more "normal," permeates society and organizations (Berkman & Zinberg, 1997; Yep, 2002). This heterosexual bias remains "strategically invisible" (Yep, 2002), and because heterosexuality is the majority sexual orientation, heterosexual individuals experience privileges that LGBT individuals do not (Bieschke, 2002). The negative effects of homophobia, defined as negative feelings and actions toward homosexuality (Maher et al., 2009), ranges from psychological alienation, loss of status, discrimination, to violence (Evans & Broido, 2002; Herek & McLemore, 2013; Kimmel, 2010). This drives the need for competency training that transcends conceptual discussions with different pedagogical methods (Matharu et al., 2012). Research shows that particular demographic attributes align with individuals displaying sexual prejudice. For example, heterosexuals that have a low educational level, are older, live in rural areas, and exhibit high levels of conservative values are more prone to homophobia (Herek, Gillis, & Cogan, 2009; Herek & McLemore, 2013). Other research in college students found that older students, women, and European-Americans reported more awareness of heterosexist privilege (Simoni & Walters, 2001; Yep, 2002). …