A Path to Cultural Competence in Medicine and Medical Education

The Culturally Competent Care Education Committee at HMS Addresses Health Care Disparities

Photo by Liza Green, HMS Media Services Augustus White

The problem of health care disparities has emerged as an area of serious concern in the United States. The landmark Institute of Medicine report Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care found considerable evidence that U.S. racial and ethnic minorities receive a lower quality of health services and have worse health status indicators compared with white Americans. The report further asserts that differences among races in health care status exist even when insurance status, income, age, and severity of conditions are comparable.

The Liaison Committee on Medical Education has also weighed in on the issue. It has created standards that require cross-cultural curricula as part of undergraduate medical education. Of particular note is Educational Directive 22, which says that “medical students must learn … to recognize and appropriately address gender and cultural biases in themselves and others, and in the process of health care delivery.”

Yet the causes of health care disparities are highly complex and addressing them requires a broad and sustained commitment. Medical education reform is an essential component of any solution.

At HMS, Dean Joseph Martin has acknowledged cultural competence as one of the five great challenges facing medical education, and it has been included as one of the core competencies required for Harvard medical students.

The School’s Culturally Competent Care Education Committee (CCCEC) drives a concentrated effort to promote culturally competent care. The CCCEC was established in 2001 and, through June 2006, was chaired by co-author of this column Augustus White, the Ellen and Melvin Gordon professor of medical education and professor of orthopedic surgery. Joseph Betancourt, director of the Disparities Solutions Center and of multicultural education at Massachusetts General Hospital, and Alexander Green, senior faculty member at the Disparities Solutions Center, have assumed the roles of chair and co-chair of the committee.

The committee’s mission is to foster the development of faculty and curricula to prepare students with the knowledge, skills, and attitudes to practice culturally competent medicine, thereby diminishing health care disparities. In fact, although culturally competent care education is present in other medical schools, HMS is among the leaders in faculty and curriculum development. The process demands a multifaceted approach since culturally competent care is one of the few things, if not the only thing, we ask the faculty to teach that very few have ever been taught themselves.

The School’s elective course Emerging a Culturally Competent Physician addresses the liaison committee’s Educational Directive 22 and challenges students to think about their personal biases regarding factors such as gender, race, sexual orientation, and disabilities. This unique course has been taught to several classes of students, as well as to faculty.

Other educational programs and activities seeking to promote cultural competence among HMS students include sessions on cultural competence in the Classroom to Clerkship transition course, Year I Orientation, Social Medicine Commons Lecture Series, Women’s and Children’s Health midweek session, and a cultural competence station in the Year II Objective Structured Clinical Exam (OSCE).

Faculty development programs and workshops include Emerging a Culturally Competent Physician, as well as a case study workshop on addressing issues of culture through case-based learning, a two-day Culturally Competent Care Core Faculty Training Workshop, two yearly Grand Rounds sessions on issues of diversity and disparities, and a retreat consisting of a keynote address and two faculty development sessions.

The CCCEC’s work is directed toward achieving several key outcomes: 1) Students will graduate with experience, skills, and knowledge in cross-cultural health care; 2) Faculty will improve their capacity to provide and teach culturally competent care; 3) HMS will develop effective cross-cultural training models that can be adapted nationally and applied globally to promote better patient care for culturally diverse populations; and 4) Future leaders in medicine will have the basic training needed to practice culturally competent medicine as well as serve as ambassadors in the ongoing effort to diminish health disparities.

The CCCEC has established an Online Resource Center at www.hms.harvard.edu/cccec. This cross-cultural education website is available for use by health care providers, medical educators, students, and others interested in the teaching of cross-cultural care.

Posted on the website is Culturally Competent Care Education at Harvard Medical School: Background, History and Accomplishments, a comprehensive report including the committee’s accomplishments and concurrent efforts. The report can also be accessed through http://medweb.med.harvard.edu/cccec/_pdfs/CCCECStatusReport61406.pdf.

Most of the committee’s work to date has been the result of time and effort volunteered by faculty and students. Priorities for the current academic year include institutionalizing culturally competent care education in a more formal and sustainable way and securing funding to support its work in the future.

The CCCEC welcomes involvement from members of the HMS community. For more information, please visit the website or contact Emily Rickards at 617-432-5409 or at emily_rickards@hms.harvard.edu.

—Augustus White, the Ellen and Melvin Gordon professor of medical education and professor of orthopedic surgery, and Heidi Hoffman, an independent consultant

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