Effect of Medical Education and Life Experiences on the Cultural Competence of Physicians

Background The 2002 Institute of Medicine report “Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care” recommended cultural competence training as a means of improving health care disparities among minorities. Currently, most U.S. medical schools provide some form of cultural competency curriculum for their medical students, although the type and amount vary considerably. There is no current consensus on the best way to teach cultural competence, as outcomes on these curricula have not been measured. Methods The CCTOP study (Cultural Competency Training and Outcomes in Patients) is a multicenter, cross-sectional study of patients presenting for care at 11 outpatient clinics and their physicians\u27 attitudes regarding culture, bias, and health care. Cultural competence was scored using the Inventory for Assessing the Process of Cultural Competence Among Healthcare Professionals (IAPCC), an 80-point validated scale (Campinha -Bacote, 1997). The IAPCC scores were dichotomized into respondents who were “culturally competent” (score of 60-74) and “culturally aware” (score of 40-59). In addition to the IAPCC, physicians were asked questions of specific cultural knowledge, attitudes, and life experiences and demographics. Results Preliminary results are available from one hundred and thirty physicians (83 residents, 47 attendings). Bivariate analyses revealed that cultural competence was significantly associated with receiving training in third year of medical school (p = .02), and training received post-residency (p = .02). We detected trends toward significantly higher IAPCC scores in respondents who served in the military (p = .07), traveled outside of the U.S. for greater than one month (p = .10), and were female (p = .08). Cultural competence was not associated with training received in the first two years of medical education, race of physician (p = .80), socioeconomic status in childhood (p = .94), or being born outside the U.S. (p = .59). Conclusions Although fewer physicians were exposed to cultural competence training beyond the first two years of training, those exposed in third year and post-residency were more culturally competent as tested by the IAPCC. These data are preliminary, but the findings may impact the design and focus of cultural competency curricula in medical and graduate medical education. Future research should focus on other determinants of cultural competence, including whether certain life experiences impact cultural competence as much or more than curricular interventions