Foreword
In the early 1980s, there was increasing recognition of the powerful challenge that our health care system was facing in providing highquality care to increasingly diverse populations. As a result, the term “cultural competence” entered the language of health professions education in the late 1980s. Based on the work of Cross and others, many authors began to articulate frameworks for defining cultural competence (1). Yet cultural competence was slow to emerge as an important fixture in health professions education.
A large part of this slow progress was the ongoing debate on defining cultural competence. Is cultural competence the knowledge of the unique traditions, health beliefs, and health of a defined population? Is it a set of communication skills to better understand the unique health needs and beliefs of any patient? Is it more of an attitude—a stance—in which the physician shows the humility and curiosity to explore the patient’s background and allow what is learned to inform diagnosis and treatment? In reality, cultural competence is all these things. This recognition has stymied many educators seeking to develop curricula to address the challenge.
In 2000, the Liaison Committee for Medical Education, the organization that sets and applies accreditation standards for U.S. Medical Schools, added a standard for teaching about the role of culture in clinical practice:
“The faculty and students must demonstrate an understanding of the manner in which people of diverse cultures and belief systems perceive health and illness and respond to various symptoms, diseases, and treatments. Medical students should learn to recognize and appropriately address gender and cultural biases in health care delivery, while considering first the health of the patient” (2).
In 2003, the Institute of Medicine (IOM) published its landmark report, Unequal Treatment. This publication cataloged the growing body of evidence of the vast extent of disparities in health care in the United States. The IOM recommended that health care profession education include specific training in cultural competence. These two strong statements drew attention to a previously overlooked area of education and training, and many educators began to scramble to find ways to teach cultural competence (3).
The cause of cultural competence education took a major step forward with the publication by the Association of American Medical College’s Tools for Assessing Cultural Competence Training (TACCT) in 2005. Developed by a national expert panel of educators in this area, TACCT provides a framework of broad domains of cultural competence and 42 specific learning objectives for use in constructing a robust cultural competence curriculum (4).
Currently, the majority of health professions schools, postgraduate training programs, and health care systems are working to meet the goal of preparing a workforce who can deliver high-quality and culturally and linguistically appropriate care to all. The remaining challenge in cultural competence—and it is not a small one—is developing meaningful and effective strategies to teach cultural competence. There are a few Web-based resources, most notably the National Consortium for Multicultural Education for the Health Professions the University of Pennsylvania School of Medicine and the University of Alabama at Birmingham Web sites, but precious few textbooks or guides to teaching and learning in this area, until now (5–7). Hark and DeLisser’s Achieving Cultural Competency: A Case-Based Approach for Training Health Professionals is a fabulous addition to the growing list of resources for teaching. The authors have assembled a rich resource, with contributions from many of the top educators in cultural competence in the United States.
This book fills an important niche, providing a rich and diverse set of cases for teaching and learning. By mapping the learning objectives of the cases to the TACCT, the authors and their contributors have added incredible value. The authors have masterfully molded their years of combined experience into a usable guide to case-based education in cultural competence. Now educators seeking to add curriculum on a particular TACCT domain or set of learning objectives can select high-quality materials for the kind of teaching that embraces principles of adult learning: experiential and case-based teaching (See pp. xxix and Appendix 3).
Achieving Cultural Competency: A Case-Based Approach for Training Health Professionals will undoubtedly become a fixture in the libraries of faculty in health professions schools who are charged to develop, expand, or augment their curriculum in cultural competence. I’m certain that the originators of the cultural competence movement would be gratified to see the kind of high-quality attention this topic is now receiving in health professions education.
Clarence H. Braddock III, MD, MPH, FACP
Associate Professor of Medicine
Associate Dean for Medical Education
Stanford University School of Medicine
Director, National Consortium for Multicultural Education for Health Professionals.
1. Cross T.L., Bazron B.J., Isaacs M.R., et al. Towards a culturally competent system of care:A monograph on effective services for minority children who are severely emotionally disturbed. Georgetown University Center for Child Health and Mental Health Policy, CASSP Technical Assistance Center, Washington DC, 1989.
2. Liaison Committee for Medical Education. Functions and Structure of a Medical School: Standards for Accreditation of Medical Education Programs Leading to the M.D. Degree, 2007.
3. Smedley B.D., Stith A.Y., Nelson A.R. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Institute of Medicine (U.S.): Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care. The National Academies Press, 2003.
4. Association of American Medical Colleges. Cultural Competence Education for Medical Students. 2005. Available at: http://www.aamc.org/meded/tacct/start.htm.
5. National Consortium for Multicultural Education for Health Professionals. Available at: http://culturalmeded.stanford.edu.
6. University of Pennsylvania School of Medicine’s Cultural Competency Medical Education Program and Resources. Available at: http://www.med.upenn.edu/culture.
7. Cultural Competence Online for Medical Practice (CCOMP). A Clinician’s Guide to Reduce Cardiovascular Disparities, especially hypertension, University of Alabama at Birmingham. Available at http://www.c-comp.org.