Cultural Competency in the Trenches

A core mission of health professions schools is to educate and train a workforce that will be optimally prepared to provide health care and public health services for the diverse communities that they serve. It is important to create and develop a health care workforce who can understand and assist in the battle against health care disparities. For health care workers and health profession schools, cultural competence education and training has been identified as one solution to the problem. However to educate and properly train a culturally competent health care workforce is not an easy task. The literature on cultural competency is growing, with numerous studies that have focused on specific traits of cultural competency but unfortunately, a consensus on the best approach to achieve the desired outcomes has not been reached. A review of the literature on cultural competency reveals some common concerns regarding cultural competency, especially about how cultural competence education is incorporated in the classroom/clinical setting. What training and preparation does the instructor possess to qualify him or her to teach cultural competency? Was the instructor chosen because of gender or because he/she is from a racial or ethnic minority group which somehow makes him/her an expert? How much time should be devoted to cultural competency training in health professions? How do we accurately assess student learning of cultural competency? And finally, how do we as faculty committed to cultural competency get our colleagues to also participate in cultural training/education? These are key questions, concerns, and problems that many who teach cultural competency training have encountered. Therefore, a variety of approaches to cultural competency education and training have been developed within our schools.

Earlier this year, a joint expert panel convened by the Association of American Medical Colleges and the Association of Schools of Public Health released a report with recommendations for Schools of medicine and public health defining a set of appropriate competencies for learners in both disciplines to prepare culturally competent practitioners.¹ Unfortunately, these recommendations are not well known and furthermore only provide a general framework for the incorporation of cultural competency education. Similarly the American Dental Association's Commission on Dental Accreditation requires all dental and dental hygiene schools to incorporate diversity and cultural competency standards and evaluation methods into the school's program according to new accreditation standards.²

We would like to share our experiences as four African American health professions educators (a physician, a nurse, a dental hygienist, and a non-physician medical educator) who develop, teach, and assess cultural competency education and training to health professions students in our institution. We are all faculty members working in a predominately White university in the medical, dental and nursing school in the state of Kentucky with a health sciences campus located in a predominately urban African American area of the city. Although we are located in a downtown urban area, many of our students come from rural areas of Kentucky. Some come with very limited exposure or interactions with people of diverse backgrounds and beliefs.

Kentucky as a state is less diverse than the nation as a whole, with 89% of the population identified as White not Hispanic, 8% Black, 2% Hispanic, 1.2% Asian, two or more races 1.6. One in four residents of Kentucky live in a rural area (24%) compared with only 6% in U.S. Between the years 2000 and 2010, 63 counties in Kentucky saw a decrease in the number of Blacks.³ Kentucky has a higher rate of hate-crime incidents than the nation. Of all the Kentucky hate crimes, 92% were against African Americans.⁴

Regarding health outcomes and health factors, Kentucky typically ranks near the bottom of all 50 states. Kentucky is ranked 43rd in overall health status when assessing the determinants and outcomes of health. Kentucky ranks 22nd for deaths secondary to HIV/ AIDS, but HIV/AIDS is the 11th leading cause among African Americans (http://www.americashealthrankings.org/ky). The state...