Cultural competence education for practicing physicians: lessons in cultural humility, nonjudgmental behaviors, and health beliefs elicitation.
BACKGROUND
Although numerous studies have examined cultural competence training, debate still exists about efficacious approaches to this training. Furthermore, little focus has been placed on training and evaluating practicing physicians.


METHODS
A skills-based course on culturally competent diabetes care was developed and subsequently tested in a controlled trial of primary physicians caring for patients enrolled in one state's Medicaid program. We hypothesized that physicians completing the course would show higher levels of self-reported cultural competence as measured by a Cultural Competence Assessment Tool (CCAT) than those in the control group. Differences in CCAT subscale scores were also compared.


RESULTS
Ninety physicians completed the study, with 41 in the control and 49 in the intervention group. Most were female (66%), with an average age of 44, and 12 years in practice. There were no significant differences on total CCAT score (212.7 ± 26.7 for control versus 217.2 ± 28.6 for intervention, p = .444) or subscales measuring cultural knowledge. There were significant positive differences on the subscales measuring physicians' nonjudgmental attitudes/behaviors (subscale score 2.38 ± 0.46 for control versus 2.69 ± 0.52 for intervention, p = .004) and future likelihood of eliciting patients' beliefs about diabetes and treatment preferences (3.11 ± 0.53 for control versus 3.37 ± 0.45 for intervention, p = .014). There was, however, a significant negative difference on the subscale measuring cultural self-awareness (3.48 ± 0.36 for control versus 3.26 ± 0.48 for intervention, p = .018).


CONCLUSIONS
A predominantly skills-based approach to training physicians did not change aggregate measures of cultural competence, but did affect key attitudes and behaviors, which may better reflect the goals of cultural competence training.
Assistant Professor, Department of Family & Community Medicine, College of Medicine, University of Arizona. rkutob@email.arizona.edu.
Randa M
RM
Kutob
John
J
Bormanis
Marjorie
M
Crago
John M
JM
Harris
Janet
J
Senf
Catherine M
CM
Shisslak
D000328:Adult; D054521:Cultural Competency / Q000193:education*; D003924:Diabetes Mellitus, Type 2 / Q000208:ethnology* / Q000523:psychology / Q000628:therapy; D004502:Education, Medical, Continuing / Q000379:methods; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D054624:Health Status Disparities; D006801:Humans; D008297:Male; D008484:Medicaid; D008875:Middle Aged; D018802:Patient-Centered Care / Q000592:standards*; D010817:Physician-Patient Relations; D058007:Physicians, Primary Care / Q000193:education* / Q000592:standards; D015397:Program Evaluation; D012647:Self-Assessment; D014481:United States
continuing medical education; cultural competency; diabetes mellitus; patient-physician relations; type 2