What should we include in a cultural competence curriculum? An emerging formative evaluation process to foster curriculum development.
OBJECTIVE
To identify, prioritize, and organize components of a cultural competence curriculum to address disparities in cardiovascular disease.


METHODS
In 2006, four separate nominal group technique sessions were conducted with medical students, residents, community physicians, and academic physicians to generate and prioritize a list of concepts (i.e., ideas) to include in a curriculum. Afterward, 45 educators and researchers organized and prioritized the concepts using a card-sorting exercise. Multidimensional scaling (MDS) and hierarchical cluster analysis produced homogeneous groupings of related concepts and generated a cognitive map. The main outcome measures were the number of cultural competence concepts, their relative ranks, and the cognitive map.


RESULTS
Thirty participants generated 61 concepts; 29 were identified by at least two participants. The cognitive map organized concepts into four clusters, interpreted as (1) patient's cultural background (e.g., information on cultures, habits, values), (2) provider and health care (e.g., clinical skills, awareness of one's bias, patient centeredness, professionalism), communication skills (e.g., history, stereotype avoidance, health disparities epidemiology), (3) cross-culture (e.g., idiomatic expressions, examples of effective communication), and (4) resources to manage cultural diversity (e.g., translator guides, instructions, community resources). The MDS two-dimensional solution demonstrated a good fit (stress = 0.07; R² = 0.97).


CONCLUSIONS
A novel, combined approach allowed stakeholders' inputs to identify and cognitively organize critical domains used to guide development of a cultural competence curriculum. Educators may use this approach to develop and organize educational content for their target audiences, especially in ill-defined areas like cultural competence.
Division of Continuing Medical Education, University of Alabama at Birmingham, Birmingham, Alabama 35294, USA.
Katie
K
Crenshaw
Richard M
RM
Shewchuk
Haiyan
H
Qu
Lisa J
LJ
Staton
Judy Ann
JA
Bigby
Thomas K
TK
Houston
Jeroan
J
Allison
Carlos A
CA
Estrada
D002318:Cardiovascular Diseases / Q000517:prevention & control; D002983:Clinical Competence; D016000:Cluster Analysis; D003194:Computer-Assisted Instruction; D054521:Cultural Competency / Q000193:education*; D003479:Curriculum; D020375:Education, Distance / Q000458:organization & administration*; D054625:Healthcare Disparities; D006801:Humans; D020380:Needs Assessment; D016730:Program Development
Lancet. 2004 Jul 31-Aug 6;364(9432):429-37
15288741
Diabetes Educ. 2000 Mar-Apr;26(2):305-10, 312, 314
10865596
Acad Med. 2010 Apr;85(4):583-5
20354370
Ann Intern Med. 2007 Nov 6;147(9):654-65
17975188
Am J Public Health. 1972 Mar;62(3):337-42
5011164
J Gen Intern Med. 2007 Dec;22(12):1648-55
17957346
Health Mark Q. 2002;20(2):69-88
14609021
Soc Sci Med. 2006 Mar;62(5):1192-204
16140448
Acad Med. 2006 Jun;81(6):557-64
16728806
J Contin Educ Health Prof. 2005 Summer;25(3):221-8
16173055
Acad Med. 2006 Jun;81(6):499-501
16728795
Soc Sci Med. 2009 Feb;68(3):533-43
19019520
J Soc Psychol. 2009 Feb;149(1):105-15
19245050
Fam Med. 2009 Mar;41(3):167-74
19259838
J Am Med Dir Assoc. 2006 Sep;7(7):420-5
16979085
J Natl Med Assoc. 2008 Nov;100(11):1275-85
19024223
J Gen Intern Med. 2010 May;25 Suppl 2:S108-14
20352503
Nurs Res. 2008 Jan-Feb;57(1):64-8
18091294
Fam Pract. 1993 Mar;10(1):76-81
8477899
J Gen Intern Med. 2008 Jul;23(7):1060-5
18612745
J Healthc Manag. 2002 Mar-Apr;47(2):111-24; discussion 124-6
11933599
Acad Med. 2003 Jun;78(6):560-9
12805034
Mark Health Serv. 2009 Fall;29(3):30-1
19777732
Patient Educ Couns. 2010 Apr;79(1):77-82
19699600
Evid Rep Technol Assess (Summ). 2004 Jan;(90):1-8
15164678