The praxis of cultural competence in medical education: Using environmental factors to develop protocols for action.

다국어 초록 (Multilingual Abstract)

Cultural competence is a topic that concerns social scientists and medical anthropologists who pay attention to demographic changes and health disparities. This study demonstrates practical approaches to developing cultural competence in medical education by using factors from the social environment to develop protocols for action. With current concerns in domestic and global health care, it is evident that health care organizations struggle to deliver culturally appropriate services. Additionally, educational institutions also struggle to evaluate culturally applied medical practices and competencies. Unlike medical competence, cultural competence is seldom evaluated, and as a result, a gap exists in health care delivery. The purpose of this research is to examine the changes in self-assessment of physician assistant (PA) medical students and graduates, as indications of changes in their medical practice and attitudes. Key objectives explore how PA medical students self-assess their own cultural competence; what factors impact their evaluation, and if change indicates cultural competence.
The methodology consisted of a qualitative approach designed to conduct focus group discussions, in-depth interviews, and field work, while results of existing quantitative data was used to inform the study. Triangulation methods substantiated the findings along with environmental and data analysis to provide rigor to this investigation. Participants were students and graduates from a Physician Assistant Studies Program in Oregon.
Major findings showed changes in participants' cultural competence self assessment due to a change in self-awareness, exposure and experiences with diverse underserved populations, in domestic and international encounters with the real world. In conclusion, change in self assessment had actually occurred, but the change in the quantitative results really portrayed a level of development on a cultural competency continuum, but not cultural competence itself.
It followed from these findings that using components which influenced change along with external and internal environmental factors, provided a basis for a model to establish procedures for action. This strategic model, the praxis of cultural competence, takes critical elements or protocols to move medical students from theory to practice. From the results of this study we can see evidence of closing the gap between the theory of cultural competence and culturally competent practices.