Núñez A E
Dr. Núñez is assistant professor of medicine and director, Women's Health Education Program, Institute of Women's Health, Department of Medicine, MCP Hahnemann University, Philadelphia, Pennsylvania, USA.
Acad Med. 2000 Nov;75(11):1071-80. doi: 10.1097/00001888-200011000-00011.
To prepare students to be effective practitioners in an increasingly diverse United States, medical educators must design cross-cultural curricula, including curricula in women's health. One goal of such education is cultural competence, defined as a set of skills that allow individuals to increase their understanding of cultural differences and similarities within, among, and between groups. In the context of addressing health care needs, including those of women, the author states that it is valid to define cultural groups as those whose members receive different and usually inadequate health care compared with that received by members of the majority culture. The author proposes, however, that cross-cultural efficacy is preferable to cultural competency as a goal of cross-cultural education because it implies that the caregiver is effective in interactions that involve individuals of different cultures and that neither the caregiver's nor the patient's culture offers the preferred view. She then explains why cross-cultural education needs to expand the objectives of women's health education to go beyond the traditional ones, and emphasizes that learners should be trained in the real-world situations they will face when aiding a variety of women patients. There are several challenges involved in both cross-cultural education and women's health education (e.g., resistance to learning; fear of dealing openly with issues of discrimination; lack of teaching tools, knowledge, and time). There is also a need to assess the student's acquisition of cross-cultural efficacy at each milestone in medical education and women's health education. Components of such assessment (e.g., use of various evaluation strategies) and educational objectives and methods are outlined. The author closes with an overview of what must happen to effectively integrate cross-cultural efficacy teaching into the curriculum to produce physicians who can care effectively for all their patients, including their female patients.
为使学生能够在美国日益多元化的环境中成为高效的从业者，医学教育工作者必须设计跨文化课程，包括妇女健康方面的课程。这种教育的一个目标是文化能力，它被定义为一组技能，使个人能够增进对群体内部、群体之间以及不同群体之间文化差异和相似性的理解。在满足包括妇女在内的医疗保健需求的背景下，作者指出，将文化群体定义为其成员与多数文化群体成员相比获得不同且通常不足的医疗保健的群体是合理的。然而，作者提出，作为跨文化教育的目标，跨文化效能比文化能力更可取，因为它意味着护理人员在与不同文化背景的个体互动中是有效的，而且护理人员和患者的文化都不具有优先地位。然后，她解释了为什么跨文化教育需要扩展妇女健康教育的目标，使其超越传统目标，并强调学习者应该在帮助各类女性患者时将会面临的现实情况中接受培训。跨文化教育和妇女健康教育都涉及几个挑战（例如，对学习的抵触；害怕公开处理歧视问题；缺乏教学工具、知识和时间）。此外，还需要在医学教育和妇女健康教育的每个里程碑处评估学生对跨文化效能的掌握情况。文中概述了这种评估的组成部分（例如，使用各种评估策略）以及教育目标和方法。作者最后概述了要有效地将跨文化效能教学融入课程，以培养能够有效照顾所有患者（包括女性患者）的医生，必须要做的事情。
