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DAs the Moderna Covid-19 vaccine has begun to be administered, reports have found significant racial disparities among those being vaccinated in the UK and the U.S. More specifically, CNN, has found that Black and Latino Americans are receiving it at lower rates than their white counterparts. However, it is worth nothing that the reality of communities of color being hit harder by a pandemic is not new knowledge. For example, according to an ABC article, prior U.S. Administrations had anticipated that disparities would be felt along economic and racial lines. Officials from both the Obama and Bush administrations confirm that plans had been created to decrease the impacts of pandemics on minority communities.
Despite these plans and current administration actions, communities of color have suffered losses at increased rates. This is due to the pre-existing inequalities in the healthcare system and a higher percentage of them are employed in what have been called ‘essential jobs’. These vulnerabilities translate into numbers:
- The White population is receiving the vaccine at more than 2x the rate of the Black population (CNN)
- The White population is receiving the vaccine at more than 2.5x the rate of the Hispanic population (CNN)
- The Black or African American community is experiencing COVID-19 deaths at more than 2.5x the rate of the White community (Statista)
- Other minority groups are experiencing COVID-19 deaths at heightened rates (Statista)
Understanding the importance of lessening these statistics, Profs. Robin Arnsperger Selzer (University of Cincinnati, USA), Rohan Srivastava (University of Cincinnati, USA) and Alexis Huckleberry (Vanderbilt University, USA) discuss how cross-cultural pre-med training programs help set the foundation for more equitable access to healthcare in their chapter “Using the Intercultural Development Inventory (IDI) With First-Year, Pre-Med Students: Impacting the Human Side of Healthcare” sourced from the Handbook of Research on the Efficacy of Training Programs and Systems in Medical Education.
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Alexis de Tocqueville said about American society in the early 19th century that Americans tend to transform almost every important political question into a legal one. The major issues of American political life, perhaps even more so today than in Tocqueville’s time, frequently find their way into court. Contemporary issues such as same-sex marriage, abortion, gun rights, religious freedom, and a host of others have found their way into courtrooms. There can be little doubt that courts have played and continue to play a major role in shaping and influencing political and social life in the United States.
Judicial policymaking raises questions in the minds of many people as to whether it is fair for judges, rather than elected representatives, to make certain types of decisions and, even more important, whether judges are competent to decide on complex issues of public policy. Other critics maintain the major problem with contemporary courts is not that judges are engaged in policymaking but that the policy made is unjust (Tushnet, 1979).
POTENTIAL SOLUTION: IMPLEMENTING CROSS-CULTURAL ASSESSMENTS
Implementation of a cross-cultural assessment tool during the medical education journey can help establish a baseline for developmental growth and be an effective way to promote critical reflection related to diverse patient care. Yet many training programs omit these tools, even though employers consistently state they need employees with excellent soft skills like the ability to adapt, communicate, collaborate, and problem-solve across differences. In fact, intercultural awareness is ranked as #4 in the top 10 work skills needed for the future (Institute for the Future, 2011). However, most people do not receive any formal training or education to become interculturally effective. These skills are now more essential than soft (Blumenstyk, 2019). Students must obtain them during their undergraduate education to sustain the pipeline into medical school and then succeed in the workplace afterwards. With medical schools placing a growing emphasis on soft skills, some form of baseline assessment is necessary.
Cross-cultural assessments typically measure cultural competence. Cultural competence is defined as “having the knowledge, understanding, and skills about a diverse cultural group that allows the health care provider to provide acceptable cultural care” (Giger et al., 2007, p. 100). There are numerous cross-cultural assessments, including but not limited to, Cultural Intelligence (CQ), Inclusive Behaviors Inventory (IBI), Harvard’s Implicit Association Test (IAT), and the Intercultural Development Inventory® (IDI®). Situational judgment tests, like the Computer-Based Assessment for Sampling Personal Characteristics (CASPer®), are also used in some medical school admissions and assess soft skills related to cultural understanding such as communication, empathy, equity, and ethics. This being said, the American Council of Education’s working group on intercultural learning was charged with researching 20 assessment instruments and concluded that the IDI® was 1 of only 2 assessments that met their standards (Intercultural Development Inventory®, 2019). Moreover, The Society for Education, Training, and Research found that the IDI® was the most widely used assessment tool by professionals in the intercultural field (IDI®, 2019). According to the IDI®’s website, there are over 60 IDI®-related published articles and 80 PhD dissertations completed using the tool.
For the purposes of this research study, authors used the term “cultural humility” with student participants rather than cultural competence because the word “competence” conveys there is an end point. However, actively engaging with cross-cultural learning is a lifelong process of reflection and self-critique that requires humility (Tervalon & Murray-Garcia, 1998)). Cultural humility involves critically reflecting on our limitations as an opportunity to develop rather than trying to become fully competent or an expert in someone else’s culture. This critique of cultural competence led to the discovery of the term, “intercultural competence.” Bhawuk & Bruslin (1992) said, “To be effective in another culture, people must be interested in other cultures, be sensitive enough to notice cultural differences, and then be willing to modify their behavior” (p. 416). Intercultural competence is defined as appropriate shifting of one’s mindset and behavior based on successful navigation and bridging of commonalities and differences to incorporate multiple perspectives into one’s worldview. It relates to one’s “capacity to generate perceptions and adapt behavior to cultural context” (IDI®, 2019). While the word competence is used, the emphasis is developmental in nature and places onus on the person for intentional growth. The IDI® measures intercultural competence and can help medical educators gain a better understanding of how to achieve diversity and inclusion goals. Corporations, non-profit, organizations, governmental organizations, primary/secondary schools, and colleges and universities use the IDI®. By examining intercultural competency from a developmental perspective, training can be targeted better based on where the individual or group is developmentally situated towards a deeper understanding of cultural differences.
UTILIZING THE IDI® AS A CROSS-CULTURAL ASSESSMENT TOOL
Contexting question 1: What is your experience across cultures?
Contexting question 2: What is most challenging for you in working with people from other cultures?
Contexting question 3: What are key goals, responsibilities or tasks you and/or your team have, if any, in which cultural differences need to be successfully navigated?
Contexting question 4: Please give examples of situations you were personally involved with or observed where cultural differences needed to be addressed within your organization, and: • The situation ended negatively—that is, was not successfully resolved. • The situation ended positively—that is, was successfully resolved.
The IDI® must be purchased and administered by a Qualified Administrator (QA). Qualified Administrators also have the ability to add up to six unique multiple-choice questions. One can become a QA by undertaking the Qualifying Seminar which requires taking the IDI® assessment, participating in a debrief, and completing other training materials including authorizing a licensing agreement to use the tool ethically and appropriately. Upon completion of the assessment, a customized, graphic IDI® profile report and an actionable intercultural development plan (IDP) with suggestions for growth are generated by the QA and distributed by email to the respondents. The QA also provides feedback in an individual or group debrief session. An IDI® profile report may not be distributed without feedback. The IDI® profile is confidential unless the respondent shares it.
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