Medical Education With Multicultural Perspectives: Cultivating Culturally Competent Future Physicians

Introduction

It is the purpose of this chapter to present potentially useful methods of integrating multicultural sensitive intentional processes in undergraduate medical education with the aim of developing future physicians who are both scientifically and multicultural competent. This chapter addresses the unique challenges and offers solutions experienced in achieving cultural competency within the realm of undergraduate medical education. The authors have identified the following areas to be integral to establishing adequate cultural awareness and sensitivity:

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  Lecture presentations which integrate multicultural patient examples as well as epidemiologically relevant disease processes that have race specific associations, and how to discuss those associations in the context of that patient’s perspective.

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  Examination questions and quiz assessments that utilize multicultural patient types with a variety of acute, chronic and neoplastic disease entities relevant to the organ system being addressed.

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  Standardized patient experiences that are intentionally organized to be inclusive of patient actors from diverse backgrounds.

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  Enhanced opportunities for Early Clinical Experiences in the local community via free clinics, outreach programs and encouragement of foreign medical mission involvement where the medical students are immersed in another culture and required to perform level competent history, physical exam, assessment and treatment plan.

Medicine in the U.S. has advanced over the past 20 years in ways that have forced healthcare professionals to continually rely upon multidisciplinary approaches to managing acute, chronic and neoplastic diseases in a diverse patient population. Cultivating a teamwork perspective in diagnosing and treating patients with a disciplinary “holistic” view, presents a unique opportunity for those same teams to foster appreciation for the vastly different ways in which we relate to and communicate medical results/information with patients of cultures different than our own. It is at times assumed that medical professionals should “know how to communicate” with their patients, and yet even within the confines of a physician-patient relationship within the same race or culture there are drastically varying patient experiences which at times are reflected in poor satisfaction surveys and hence can even negatively affect reimbursements from insurance companies.

As the United States becomes more multicultural, physicians face the challenge of providing culturally sensitive and appropriate health care to patients with differing health beliefs and values. While a few schools are providing cultural-sensitivity training in response to the changing patient population, the pervasiveness of such training has not been thoroughly reported (Lum & Korenman, 1994). In 1991-92, 126 U.S. medical schools were surveyed regarding their implementation and plans for future implementation of cultural-sensitivity training. That study surmised that only 13 of the responding schools offered cultural-sensitivity courses to their students, and all but one of these courses were optional. These 13 schools reported a greater perceived likelihood that their students would have contact with African-American patients (t = 2.88, p < .05). Despite the few courses offered and the common perception that recent graduates were only “somewhat prepared” to provide culturally sensitive clinical services, only 33 schools were planning to implement new courses (Lum & Korenman, 1994). The results of that study essentially acknowledge the need for more multicultural sensitive training.