Park E, Betancourt J, Kim M, Maina A, Weissman J; AcademyHealth. Meeting (2004 : San Diego, Calif.).
Abstr AcademyHealth Meet. 2004; 21: abstract no. 1693.
Massachusetts General Hospital, Institute for Health Policy, 50 Staniford Street, 909, Boston, MA 02114 Tel. 617.724.6836 Fax 617.724.4738
RESEARCH OBJECTIVE: The Institute of Medicine Report Unequal Treatment cited cross-cultural training as a mechanism to address racial and ethnic disparities in health care, but little is known about residents' preparedness to provide quality care to diverse populations or the barriers they face in practice. This study explores residents' perceptions of 1) their preparedness to deliver care to diverse patients; 2) the barriers they face in delivering such care; and 3) the educational climate for cross-cultural training at their institution. STUDY DESIGN: Seven focus groups and 10 individual interviews were conducted with 58 resident physicians across the country. Groups and interviews were recorded and transcribed. Thematic content analyses were performed. POPULATION STUDIED: Residents in six specialties. PRINCIPAL FINDINGS: Residents reported wide variability in perceived preparedness (knowledge, attitudes, skills) to deliver cross-cultural care across specialties. Many residents tended to view cross-cultural care as it relates to language and found it difficult to conceptualize culture in broader terms. Nevertheless, many felt the need to increase their own self-awareness and acquire knowledge about cultural norms, family, and religious beliefs. Some residents reported that they had developed certain methods of coping with the challenges of caring for diverse patients, including assessing patient comprehension and beliefs about the cause of illness, and recognizing visual cues and body language. Barriers to delivering care included language difficulties, mistrust, family interference, and religious differences. Residents cited many negative health implications resulting from poor cross-cultural communication.When asked about the educational climate for cross-cultural care at their institution, the level of support and value for cross-cultural care varied by specialty. Although there was an overall sense of endorsement for cross-cultural care, the sense was that this was a low priority. In addition, there was little awareness and availability of resources. Many residents learned through informal mechanisms, such as talking to other residents and interacting with diverse patients, and reported little formal training during residency. Residents wanted more formal training in cross-cultural care (communication/idiom training, working with interpreters) but expressed concern that culture-specific training can lead to stereotypes. They also recommended informal training mechanisms (diversifying faculty, learning from multidisciplinary staff). CONCLUSIONS: There is little formal training for residents in cross-cultural care. Rather, they obtain cross-cultural skills while on the job. As a result, many developed coping behaviors, rather than skills based on best practices. Residents had developed some skills to deliver cross-cultural care, but levels of preparedness varied. Although residents felt that they needed more culturally-specific knowledge, there was a strong sense that they should not engage in culturally-specific treatment. Overall educational climates at the residents institutions did not prioritize cross cultural training and practice. IMPLICATIONS FOR POLICY, DELIVERY OR PRACTICE: Training environments need to augment formal and informal training mechanisms to enhance residents preparedness to deliver cross-cultural care if the medical profession is to achieve the goals set by the IOM.
Publication Types:
Keywords:
- Communication
- Cultural Diversity
- Culture
- Delivery of Health Care
- Education, Medical
- Ethnic Groups
- Faculty
- Focus Groups
- Humans
- Internship and Residency
- Interviews as Topic
- Language
- Self-Evaluation Programs
- education
- ethnology
- methods
- hsrmtgs
UI: 103624727
From Meeting Abstracts