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Losing Culture on the Way to Competence
The Use and Misuse of Culture in Medical Education
The medical cultural competence movement was founded to address physician ignorance about the effects of culture and culture-specific beliefs on health and health care. The authors explore what they consider a fundamental disconnect between two elements of this movement. The first element looks at how cross-cultural education programs are meant to address physicians' discomfort with immigrant beliefs and behaviors. The second element uses such programs to eliminate racial and ethnic disparities in health care delivery, as called for in the Institute of Medicine's 2003 report. This paper discusses the mismatch between the design of these programs and their current applications, which, in coming together, collapse forces affecting minority populations (e.g., poverty, violence and racism) into the unthreatening concept "culture."
The authors offer five central concepts that should be incorporated into cultural competence curricula in order to promote curricula that do not inadvertently aggravate issues of gender and racial stereotyping:
- Culture matters in health and health care;
- Learning about culture and becoming "culturally competent" is not a panacea for health disparities;
- Culture, race and ethnicity are distinct concepts;
- Culture is mutable and multiple; and
- Context is critical.