Julia M. Rosenberg,,New York,NY,TJ . Jirasevijinda,,New York,NY
Title: If the trainers have not been trained: Gaps in residency curriculum in cultural competence
As the US population grows increasingly diverse, cultural competence (CC) is becoming a crucial component of medical education across the continuum. Medical school curricula transitionally include CC only in the pre-clinical years. Students rely heavily on the hidden curriculum, including role modeling, to learn about CC during clinical rotations. Whether these concepts “stick” depends on the curriculum their supervising residents have received. Limited data exist on whether pediatric residency programs routinely incorporate CC in their curricula, and if so what topics are covered.
The aim of this pilot needs-assessment study is to assess CC curricula in the residency programs that administer core clinical rotations to medical students.
An online, anonymous survey based on the Tool for Assessing Cultural Competence Training (TACCT), developed by the Association of American Medical Colleges (AAMC), was administered to all 19 directors of residency programs through which medical students at our institution rotate for their core clerkships: Pediatrics, Internal Medicine, Obstetrics/Gynecology, Psychiatry, Family Medicine, Surgery and Neurology. The original tool was revised to shorten its length while maintaining its scope. Reponses were dichotomized to “Yes” or “No.” Items on the revised survey were then classified as “knowledge,” “attitude,” or “skills.” The survey also gathered basic demographic information about the program directors. Data were examined as an aggregate using frequency analysis. Number of subjects was too small for statistical correlation.
Sixteen residency program directors (84%) responded to the survey. At least one residency in every specialty field was represented. Mean length at their current position was 10 years (range 1-18). The revised instrument contained 3 attitude (A), 17 (K) knowledge and 12 skills (S) questions. Topics most frequently covered (>75%) include: importance of self-reflection/assessment (A), value of curiosity, empathy and respect (A), diverse of patient values, cultures and beliefs (K), unique institutional culture (K), how to practice shared decision making (S), and how to practice patient/family-centered care (S). Topics least frequently addressed (<40%) include: collaborating with community (S), dealing with cultural conflicts/misunderstanding (S), history/impact of healthcare discrimination (K), recognizing bias in healthcare (S), impact of physician characteristics on healthcare (K), and skills for overcoming health disparities (S).
Residents teaching medical students at our affiliate institutions receive certain components of CC as part of their curriculum. Gaps in the curriculum, particularly in the knowledge and skills domain, should be enhanced. Further study is needed to map out a national pattern.