Internal medicine residents' perceptions of cross-cultural training. Barriers, needs, and educational recommendations.
BACKGROUND
Physicians increasingly face the challenge of managing clinical encounters with patients from a range of cultural backgrounds. Despite widespread interest in cross-cultural care, little is known about resident physicians' perceptions of what will best enable them to provide quality care to diverse patient populations.


OBJECTIVE
To assess medicine residents' (1) perceptions of cross-cultural care, (2) barriers to care, and (3) training experiences and recommendations.


METHODS
Qualitative individual interviews were conducted with 26 third-year medicine residents at Massachusetts General Hospital in Boston (response rate=87%). Interviews were recorded, transcribed, and analyzed.


RESULTS
Despite significant interest in cross-cultural care, almost all of the residents reported very little training during residency. Most had gained cross-cultural skills through informal learning. A few were skeptical about formal training, and some expressed concern that it is impossible to understand every culture. Challenges to the delivery of cross-cultural care included managing patients with limited English proficiency, who involve family in critical decision making, and who have beliefs about disease that vary from the biomedical model. Residents cited many implications to these barriers, ranging from negatively impacting the patient-physician relationship to compromised care. Training recommendations included making changes to the educational climate and informal and formal training mechanisms.


CONCLUSIONS
If cross-cultural education is to be successful, it must take into account residents' perspectives and be focused on overcoming residents' cited barriers. It is important to convey that cross-cultural education is a set of skills that can be taught and applied, in a time-efficient manner, rather than requiring an insurmountable knowledge base.
Park
Elyse R
ER
Institute for Health Policy, Massachusetts General Hospital/Harvard Medical School, Boston, MA 02114, USA. epark@partners.org
Betancourt
Joseph R
JR
Miller
Elizabeth
E
Nathan
Michael
M
MacDonald
Ellie
E
Ananeh-Firempong
Owusu
O
Stone
Valerie E
VE
D001291:Attitude of Health Personnel; D001900:Boston; D003144:Communication Barriers; D018864:Cultural Diversity; D003695:Delivery of Health Care; D005006:Ethnicity; D005260:Female; D006801:Humans; D007388:Internal Medicine / Q000193:education*; D007396:Internship and Residency; D007407:Interviews as Topic; D008297:Male; D020380:Needs Assessment; D010817:Physician-Patient Relations; D011822:Race Relations