Developing the AAMC Competencies With Pre-Health Professional Students Through the Use of the Intercultural Development Inventory

Introduction

More than 40% of the United States population will be comprised of minorities by 2030; and 20% of the United States population does not currently speak English at home (Price, 2019). Health professions education literature has emphasized the need for cultural competence training programs to meet the needs of increasingly diverse patient populations (Jernigan et al., 2016). However, there is a dearth of literature related to the specific need for intercultural competence training. Intercultural competence is defined as “the capability to shift cultural perspective and appropriately adapt behavior to cultural differences and commonalities (Intercultural Development Inventory [IDI], 2012, para. 1).” In addition, training programs that focus on health equity have been recommended to understand social determinants of health as root causes of structurally embedded healthcare disparities (Tervalon & Murray-Garcia, 1998). Social determinants of health are defined as the “conditions in the environments in which people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks” (Office of Disease Prevention and Health Promotion, 2019, para. 1). Studies show that 80% of healthcare outcomes involve the influences of social determinants (Heath, 2019). When social determinants are not acknowledged; patients may feel a lack of respect from healthcare providers. Yet the question remains about how to best address these problems because intercultural competence is not simply acquired with experience, as many assume. The long-standing argument is that the science-heavy undergraduate pre-health curriculum is too full to incorporate this material. Wear et al. (2017) purport that the existing medical education curriculum inadequately addresses healthcare disparities. Furthermore, they maintain that a “silent curriculum” exists in which individual bias is invisible--and individual bias can affect health outcomes. The extant health professions education literature does not address these topics as they relate to pre-health professional students (Lin et al., 2013).

It is critical to outline the context for this research and book chapter to be written. This topic is of pressing importance in the wake of the health, racial, and economic crisis in the United States resulting from the COVID-19 global pandemic, the uprising of the Black Lives Matter movement after the murder of unarmed African Americans like Mr. George Floyd and Ms. Breonna Taylor by police officers and a contentious presidential election that led to the insurrection at the Capitol of the United States. These events highlighted the need for cultural self-awareness related to equity around the globe. “This learning can only happen if we can talk with people across all kinds of identities for authentic conversations about how the United States looks very different based on your position in it” (Verschelden, 2021, para. 12). In addition, hundreds of medical students have led the way with calls for more diversity in medical school by participating in White Coats for Black Lives at their institutions (Kirch, 2016). From an advising perspective, pre-health advising offices should not churn out students that lack awareness about how social justice intersects with healthcare. Health professions advisors should invite lasting change with students by pushing them out of their comfort zones (Barnes & Souza, 2019). Encouraging reflection on these topics early on in their college experience is one way to begin a lifelong process of introspection and self-awareness that will aid the enactment of social justice leadership in their future practice (Selzer, 2016).

Jones (2020) refers to the racial uprising and the COVID-19 health crisis as twin pandemics that caused a renewed focus on public and global health, the need for a new definition of medical professionalism that addresses systemic racism and the health inequities that show disproportionately high rates of African Americans dying from COVID-19. Razack (2021) has recently proposed the question about whether current constructs of professionalism prepare pre-health professional students to address these social justice inequities. The concept of medical professionalism has evolved to include conduct that protects “patient welfare, patient autonomy, and social justice” (DeAngelis, 2015, p. 1837). It is time for health professions education to make a paradigm shift and build upon implicit bias training to foster a social justice focus on systemic inequities.