Article 15

Development and evaluation of a cultural competency training curriculum.

Thom DH, Tirado MD, Woon TL, McBride MR.

BMC Med Educ. 2006 Jul 26; 6:38.

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This study involved 53 primary care physicians at 4 diverse practice sites (academic, medical center-based family practice; community-based primary care practice; rural family medicine residency program; and inner-city family medicine residency program). All four sites received feedback on cultural competency and 2 randomly selected sites received training intervention. From these sites 429 patients with diabetes and/or hypertension were enrolled. Disease specific outcomes such as weight loss and control of blood pressure and glucose levels were assessed. Patients who were identified as Hispanic or Asian were asked to participate using mailed questionnaires. The primary outcome measure used was the Patient Reported Physician Cultural Competency (PRPCC) Scale. The curriculum content and teaching methods included 3 modules with the following objectives:

1. Expanding Knowledge of Ethnic Patients
   1. to discuss the cultural gap between provider’s and patient’s knowledge and belief systems
   2. present information about incidence, prevalence and complications of diabetes and hypertension in different racial/ethnic groups
   3. provide examples of culturally-based beliefs and practices
   4. to teach techniques for assessing beliefs and practices of individual patients
2. Enhancing Communication Skills for Cultural Competency
   1. To present techniques for eliciting the patient’s explanatory disease model and use of traditional treatments
   2. To apply the LEARN model to the patient interview
   3. To model problematic and improved physician communication
3. Use of Interpreters and Cultural Brokering
   1. Understanding the importance of working with trained interpreters and how to use interpreters effectively
   2. Negotiating a treatment plan with the patient and family
   3. Filling the role of a cultural broker by connecting the patient to community and health plan resources

The results showed that there was relatively little change in outcome variables in either intervention group. The study failed to show any measurable impact of a brief (4.5 hours) training curriculum. The authors propose that a stronger intervention – with a longer period of training and practice time and regular reinforcement over time – is needed to effect a measurable behavioral change.

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