Cultural competence and the culture of medicine.
29 Sep 2005-The New England Journal of Medicine (Massachusetts Medical Society)-Vol. 353, Iss: 13, pp 1316-1319
TL;DR: Renee Fox writes that most considerations of cultural competence neither identify nor explore the culture of medical training grounds.
Abstract: The phrase “cultural competence” arises often in discussions about improving medical education and health care in the United States. Renee Fox writes that most considerations of cultural competence neither identify nor explore the culture of medical training grounds.
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TL;DR: In this paper, the authors argue that the perceived distinction between the objectivity of science and the subjectivity of culture is itself a social fact (a common perception) and attribute the absence of awareness of the cultural dimensions of scientific practice to this distinction, especially for macrocultures and large societies.
517 citations
TL;DR: The findings strongly suggest that students' reflective narratives are a rich source of information about the elements of both the informal and hidden curricula, in which medical students learn to become physicians.
Abstract: PurposeThe aim of this study was to use medical students' critical incident narratives to deepen understanding of the informal and hidden curricula.MethodThe authors conducted a thematic analysis of 272 stories of events recorded by 135 third-year medical students that “taught them something
268 citations
TL;DR: Medical schools and oncology training can teach communication skills and cultural competence, while fostering in all students and young doctors those attitudes of humility, empathy, curiosity, respect, sensitivity, and awareness that are needed to deliver effective and culturally sensitive cancer care.
Abstract: Cultural competence in oncology requires the acquisition of specific knowledge, clinical skills, and attitudes that facilitate effective cross-cultural negotiation in the clinical setting, thus, leading to improved therapeutic outcomes and decreased disparities in cancer care Cultural competence in oncology entails a basic knowledge of different cultural attitudes and practices of communication of the truth and of decision-making styles throughout the world Cultural competence always presupposes oncology professionals' awareness of their own cultural beliefs and values To be able to communicate with cancer patients in culturally sensitive ways, oncologists should have knowledge of the concept of culture in its complexity and of the risks of racism, classism, sexism, ageism, and stereotyping that must be avoided in clinical practice Oncologists should develop a sense of appreciation for differences in health care values, based on the recognition that no culture can claim hegemony over others and that cultures are evolving under their reciprocal influence on each other Medical schools and oncology training can teach communication skills and cultural competence, while fostering in all students and young doctors those attitudes of humility, empathy, curiosity, respect, sensitivity, and awareness that are needed to deliver effective and culturally sensitive cancer care
183 citations
Cites background from "Cultural competence and the culture..."
...In addition, it involves the provision of a methodology to understand the western culture of medicine and its possible biases and prejudices [23, 42]....
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TL;DR: This paper highlights the lack of progress made in the health sciences to explain differences between population groups, and identifies 10 key barriers in research impeding progress in more effectively and rapidly realizing equity in health outcomes.
127 citations
TL;DR: The authors propose that the awareness of specific information pertaining to ethnicity and race enhances cross-cultural communication and ways to improve the cultural competence of physicians and other health care providers by providing a historical and social context for illness in another culture.
Abstract: Achieving cultural competence in the care of a patient who is a member of an ethnic or racial minority is a multifaceted project involving specific cultural knowledge as well as more general skills and attitude adjustments to advance cross-cultural communication in the clinical encounter. Using the important example of the African American patient, the authors examine relevant historical and cultural information as it relates to providing culturally competent health care. The authors identify key influences, including the legacy of slavery, Jim Crow discrimination, the Tuskegee syphilis study, religion's interaction with health care, the use of home remedies, distrust, racial concordance and discordance, and health literacy. The authors propose that the awareness of specific information pertaining to ethnicity and race enhances cross-cultural communication and ways to improve the cultural competence of physicians and other health care providers by providing a historical and social context for illness in another culture. Cultural education, modular in nature, can be geared to the specific populations served by groups of physicians and provider organizations. Educational methods should include both information about relevant social group history as well as some experiential component to emotively communicate particular cultural needs. The authors describe particular techniques that help bridge the cross-cultural clinical communication gaps that are created by patients' mistrust, lack of cultural understanding, differing paradigms for illness, and health illiteracy.
120 citations
References
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TL;DR: The Spirit Catches You and You Fall Down is a profound and lovely book that should be read on several levels, and be read as a metaphor for the care of all patients, for the lessons of Lia's story apply, in many ways, to every patient.
Abstract: The Spirit Catches You and You Fall Down is a profound and lovely book that should be read on several levels. It is, of course, the story of the illness of one Hmong patient who has been inserted into the American medical culture. Illness aside, it is the story also of the cultural clash and the consequences of that clash for her care and the care of her family. Interspersed with these stories are chapters of Hmong history, ancient and contemporary, particularly of the Hmong during the last few decades. Beyond all of these dimensions, read the book as a metaphor for the care of all patients, for the lessons of Lia’s story apply, in many ways, to every patient. Broadly speaking, The Spirit Catches You And You Fall Down tells a great deal about what it’s like to be a patient and what it’s like to be a physician, the physicianpatient relationship, language and communication, uncertainty, personal and professional values, and what can go wrong in the medical transaction. As you read the book, think about a series of five steps which characterize each medical encounter as an opportunity to learn and to add to one’s experience: the story—what really happened and how the patient experienced it; the medical history, the abbreviated, edited and reshaped version of the story, what physicians use to deliberate, reason and communicate; the issues, critical diagnostic and treatment questions raised by the story and the history; the doctor-patient relationship, which becomes the vehicle for care; and the question, “What did I learn?” the most important step in the physician’s professional growth. The questions raised in this Guide should help you to focus your reading.
508 citations
TL;DR: The similarity of the reports' objectives and reforms results not only from a similar body of problems, but also from the reaffirmation of similar values.
Abstract: Objectives. —To identify the values and agendas underlying reports advocating the reform of medical education and to account for their similarity and repeated promulgation. Data Sources. —Major reports regarding undergraduate medical education reform published between 1910 and 1993 were identified through a manual bibliographic search. Study Selection. —Nineteen of a total of 24 reports met the two inclusion criteria: they directly addressed undergraduate medical education and contained a coherent body of recommendations. Data Extraction. —Content analysis of 19 reports. Data Synthesis. —All the reports articulate a specifically social vision of the medical profession, in which medical schools are seen as serving society. The reports are remarkably consistent regarding the objectives of reform and the specific reforms proposed. Core objectives of reform include the following: (1) to better serve the public interest, (2) to address physician workforce needs, (3) to cope with burgeoning medical knowledge, and (4) to increase the emphasis on generalism. Proposed reforms have tended to suggest changes in manner of teaching, content of teaching, faculty development, and organizational factors. Reforms such as increasing generalist training, increasing ambulatory care exposure, providing social science courses, teaching lifelong and self-learning skills, rewarding teaching, clarifying the school mission, and centralizing curriculum control have appeared almost continuously since 1910. Conclusion. —The similarity of the reports' objectives and reforms results not only from a similar body of problems, but also from the reaffirmation of similar values. The reports have two implicit agendas that transcend the reform of medical education: the affirmation of the social nature of the medical profession and self-regulation of the profession. These agendas help account for the reports' similarity and their repeated promulgation. ( JAMA . 1995;274:706-711)
145 citations
Journal Article•
TL;DR: The majority of U.S. medical schools currently focus heavily on the relatively new, interdisciplinary field of bioethics to further this objective as mentioned in this paper, despite the fact that bioeth ics is only some thirty years old, both these patterns are asso ciated with a century-long history of recurrent, markedly simi lar attempts to reform American medical education.
Abstract: American medical educators presently espouse, and are pedagogically committed to, the goal of fostering medi cal students' ability to integrate biom?dical, social-sci entific, and moral ways of perceiving, thinking, and under standing into the diagnostic, therapeutic, prognostic, and car ing roles for which they are preparing a new generation of physicians. The majority of U.S. medical schools currently re lies heavily on the relatively new, interdisciplinary field of bioethics to further this objective. Despite the fact that bioeth ics is only some thirty years old, both these patterns are asso ciated with a century-long history of recurrent, markedly simi lar attempts to reform American medical education. The foci and leitmotifs of these attempts are articulated in the twenty four reports advocating improvements in medical education successively issued since the publication of the famed 1910 Flexner Report, which radically altered medical education in the United States.1 As physician and sociologist Nicholas A. Christakis has pointed out in a content analysis of these reports, every one of them proposed that the amount of \"social science\" offered in the curriculum be increased, though, as he observes, \"what is considered to be 'social science' has changed over the years.\" For example, he notes in passing, \"the early 1980s
36 citations
Journal Article•
19 citations