Transforming the Face of Health Professions Through Cultural & Linguistic Competence Education:
The Role of the HRSA Centers of Excellence

Chapter 2: The Guiding Principles and Goals of Cultural and Linguistic Competence Education

The implementation and integration of cultural and linguistic competence training, education programs, and activities are complex tasks. While the focus of these processes is on learning activities, educators and practitioners in COEs must also carefully consider policy and systems issues within their institutions. The need to consider that community norms and expectations, as well as those of students and patients, add further complexity to these tasks. This chapter provides guiding principles and goals and is adapted from Principles and Recommended Standards for Cultural and Linguistic Competence Education of Health care Professionals (2003), which was published by the California Endowment, a private health foundation in Woodland Hills, Calif., at www.calendow.org. This guidance is designed to help health care professionals and educators in COEs maintain a clear and constructive focus on the overall goals of cultural and linguistic competency as they negotiate the complexities of curriculum design and structure.

• The overall goals of cultural and linguistic competence training for health care professionals are: 1) increased self-awareness and understanding of the centrality of culture in providing good health care to all patient populations; 2) clinical excellence and strong therapeutic alliances with patients and 3) reduction of health care disparities through improved quality and cost-effective care for all populations.
• In all educational offerings devoted to cultural and linguistic competency there should be a broad and inclusive definition of cultural and population diversity, including considerations of race, ethnicity, class, age, gender, sexual orientation, gender identity, disability, language, religion, and other indices of difference.
• Training efforts should be incremental. Institutions may start simply by including cultural and linguistic competency training as a specific area of study, but should advance to complex, integrated, and in-depth attention to cultural issues in later stages of professional education. Trainees should be expected to become progressively more sophisticated in understanding the complexities of diversity and culture as they relate to the care of patients and to the delivery of health care services.
• Cultural and linguistic competence training is best organized around enhancing providers’ attitudes, knowledge, and skills, and attention to the interaction of these three factors is important at every level of training.
• While factual information is important, educators should focus on process-oriented tools and concepts that will serve the practitioner well in communicating and developing therapeutic alliances with all types of patients.
• Cultural and linguistic competence training is best integrated into numerous courses, symposia, and into experiential, clinical, evaluation, and practicum activities as they occur throughout an educational curriculum. Initial attention will likely need to be directed to faculty, staff, and administrators when developing cultural and linguistic competence.
• Cultural and linguistic competence education should be institutionalized within an educational program so that when curriculum or training is planned or changed, appropriate cultural and linguistic competence issues can be included.
• Cultural and linguistic competency education is best achieved within an interdisciplinary framework that draws upon a variety of skills and knowledge in the field, such as medical anthropology, medical sociology, epidemiology, ethnopharmacology, and human genetics.
• Since health care is practiced within institutional and bureaucratic settings, students should have an opportunity to analyze and assess how the structure of the health care system and the organization of health care services affect the care of diverse populations.
• Both instructional programs and student learning should be regularly evaluated in order to provide feedback to the ongoing development of educational programs. Students should be involved in their own evaluation as well as the evaluation of the curricula. Students should also be given many supervised opportunities to practice, and be evaluated on their knowledge and skills.
• Education and training should be respectful of the needs, practice contexts, backgrounds, and levels of receptivity of the learners.
• Education in cultural and linguistic competence should be congruent with, and, where possible, framed in the context of existing policy and educational guidelines of professional accreditation and practice organizations, such as the Accreditation Council on Graduate Medical Education, the Liaison Committee on Medical Education, the American Academy of Nursing, the National Association of Social Workers, the Society for Public Health Education, and the Academies and Colleges of Family Practice, pediatrics, emergency medicine, obstetrics and gynecology, general dentistry, and clinical pharmacology.
• Wherever possible, diverse patients, community representatives, consumers, and advocates should participate as resources in planning, designing, implementing, and evaluating cultural and linguistic competence curricula.
• Cultural and linguistic competence education should take place in a safe, non-judgmental, supportive environment. The schools and organizations in which health care professionals study and work should be settings that visibly support the goals of culturally competent care. They must encourage and be conducive to health care delivered in a culturally and linguistically competent manner.