As the Qatari population becomes more culturally diverse, concerns about the impact of this demographic trend have captured the attention of medical educators. Cultural differences between patients and healthcare providers create significant disparities within society.1 These disparities often arise because of the strong influence that culture has on the perceptions, interpretations, and expectations of the healthcare system. Moreover, there is now a clear consensus among medical educators that culturally competent healthcare cannot be attained without placing a significant emphasis on appropriate training during medical education. It is against this backdrop that this article focuses on the need to provide culturally competent healthcare in Qatar.
Cultural competence in healthcare involves an understanding of the “social and cultural influences on patients’ health beliefs and behaviors; considering how these factors interact at multiple levels of the healthcare delivery system… and devising interventions that take these issues into account to assure quality of healthcare delivery to diverse patient populations.”2 In essence, proponents of cultural competence appreciate the unsustainability of the current healthcare system because it is unable to address diverse healthcare needs effectively and efficiently in a multicultural society. Healthcare systems in general and medical educators in particular must integrate the sociocultural elements into traditional medical practice to achieve sustainability and effectiveness. Kripalani et al. contend that cultural competence is critical because of its ability to boost patient-physician communication and collaboration, enhance treatment adherence, and increase patient satisfaction.3 This not only contributes to a reduction in health inequalities but also improves clinical outcomes.
To ensure that benefits are gained from cultural competence, medical education has witnessed an influx of programs aimed at training medical practitioners on how to provide high-quality culturally competent care. The Liaison Committee on Medical Education and the Accreditation Council for Graduate Medical Education are at the forefront of efforts to integrate cultural competence into medical education.4 In addition, the National Standards for Culturally and Linguistically Appropriate Services in Healthcare (United States Department of Health and Human Services) also fosters cultural competency in medical education by providing a framework for the implementation of linguistically and culturally competent healthcare.5
Effective integration of cultural competence into medical education requires bridging the existing dichotomy between traditional medical disciplines and behavioral sciences in curricula, which leads students to focus on the former at the expense of the latter. Behavioral science, which incorporates cultural competence, is perceived to be less significant because of the less prominent role it is given in curricula. This dichotomy is echoed in the United States Medical Licensing Examination which places more emphasis on the mastery of the core sciences over the behavioral sciences.9 A possible solution to counterbalance this educational bias may be to implement assessment tools during undergraduate medical education that evaluate cultural competence. Medical schools could also consider requiring graduates to demonstrate cultural competence as a stand-alone competency prior to successful completion of their medical school training programs.
In addition to underscoring how cultural competence fits in to curricula, a paradigm shift in how it is taught is also necessary if we are to attain better results. For example, students using simulation10 to mimic real-life experiences during training demonstrate better knowledge, skill, and attitude outcomes. Other dynamic training methods such as community participation, self-reflection and self-awareness, clerkship activities, and role-play are crucial to fostering better outcomes in the area.11 This approach not only improves the knowledge and skills of students around cultural competency but also provides them with an opportunity to learn practical skills outside traditional teaching environments. Involvement within the community, for instance, builds an appreciation for cultural diversity and its influence on the administration and provision of healthcare. As a result, students gain a better understanding of the relevant issues and improve their attitude toward cultural diversity.
Over the last decade, it has become abundantly clear that cultural competence is essential to providing high-quality healthcare to patients. Medical educators have the ultimate responsibility to nurture cultural awareness and to provide the formal education necessary for medical students and residents to become experts in cultural competency. As educators, it is incumbent upon us as well to continuously demonstrate the value of cultural competence as a necessary and effective tool in caring for patients.
- Trivedi AN, Zaslavsky AM, Schneider EC, Ayanian JZ. Trends in the quality of care and racial disparities in Medicare managed care. N Engl J Med, 2005: 353:692-700.
- Betancourt JR, Green AR, Carrillo JE, Ananeh-Firempong O. Defining cultural competence: A practical framework for addressing racial/ethnic disparities in health and health care. Public Health Reports, 2003; 118: 287-292.
- Kriplani S, Bussey-Jones J, Katz MG, Genao I. A Prescription for Cultural Competence in Medical Education. J Gen Intern Med, 2006, 21(10) 1116-1120.
- Liaison Committee on Medical Education, Committee on the Accreditation of Canadian Medical Schools. The Role of Students in the Accreditation of Medical Education Programs in the U.S. and Canada. July 2010. Available at: http://www.lcme.org/roleofstudents1112.pdf
- Kelesidis N. A Racial Comparison of Sociocultural Factors and Oral Health Perceptions. Journal of Dental Hygiene, 2014: 88(1) 173-182.
- Horevitz E, Lawson J, Show JC-C. Examining Cultural Competence in Healthcare. Health Social Work, 2013.
- Betancourt JR. Cross-cultural medical education: Conceptual approaches and frameworks for evaluation. Academic Medicine, 2003: 78: 560-69.
- Ferguson W & Keller D. Creating culturally competent faculty: A model curriculum. Academic Medicine, 2003: 78:1221-8.
- Crandall SJ, George G, Marion G, Davis S. Applying theory to the design of cultural competency training for medical students: a case study. Acad Med. 2003;78: 588-94.
- Martin JC, Avant RF, Bowman MA. The Future of Family Medicine: a collaborative project of the family medicine community. Annals of Family Medicine 2004; 2 (1) S3-S32.
- Williams DR & Rucker TD. Understanding and Addressing Racial Disparities in Health Care. Health Care Financing Review, 2000: 21(4) 75-90.
- Brotherton SE, Rockey PH, and Etzel SI. U.S. Graduate Medical Education: 2003-2004. Journal of the American Medical Association 2004: 296(9) 1032–1037.
Written for May 2015 by
Amine Rakab, M.D.
Senior Attending Physician
Division of Acute Care Medicine
Sidra Medical & Research Center