Mixed messages: residents' experiences learning cross-cultural care.
OBJECTIVE
An Institute of Medicine report issued in 2002 cited cross-cultural training as a mechanism to address racial and ethnic disparities in health care, but little is known about residents' training and capabilities to provide quality care to diverse populations. This article explores a select group of residents' perceptions of their preparedness to deliver quality care to diverse populations.


METHODS
Seven focus groups and ten individual interviews were conducted with 68 residents in locations nationwide. Qualitative analysis of focus-group and individual interview transcripts was performed to assess residents' perceptions of (1) preparedness to deliver care to diverse patients; (2) educational climate; and (3) training experiences.


RESULTS
Most residents in this study noted the importance of cross-cultural care yet reported little formal training in this area. Residents wanted more formal training yet expressed concern that culture-specific training could lead to stereotyping. Most residents had developed ad hoc, informal skills to care for diverse patients. Although residents perceived institutional endorsement, they sensed it was a low priority due to lack of time and resources.


CONCLUSIONS
Residents in this study reported receiving mixed messages about cross-cultural care. They were told it is important, yet they received little formal training and did not have time to treat diverse patients in a culturally sensitive manner. As a result, many developed coping behaviors rather than skills based on formally taught best practices. Training environments need to increase training to enhance residents' preparedness to deliver high-quality cross-cultural care if the medical profession is to achieve the goals set by the Institute of Medicine.
Park
Elyse R
ER
Massachusetts General Hospital / Harvard Medical School, 50 Staniford Street, 9th floor, Boston, MA 02114, USA. epark@partners.org
Betancourt
Joseph R
JR
Kim
Minah K
MK
Maina
Angela W
AW
Blumenthal
David
D
Weissman
Joel S
JS
D000328:Adult; D001291:Attitude of Health Personnel; D001294:Attitude to Health / Q000208:ethnology; D002983:Clinical Competence; D003144:Communication Barriers; D018864:Cultural Diversity; D005006:Ethnicity; D005260:Female; D017144:Focus Groups; D006801:Humans; D007396:Internship and Residency / Q000592:standards*; D008297:Male; D010817:Physician-Patient Relations; D011787:Quality of Health Care; D011822:Race Relations; D012938:Social Perception; D012959:Socioeconomic Factors; D013240:Stereotyping; D014175:Translating; D014481:United States