Tervalon Melanie
University of California, San Francisco, School of Medicine, San Francisco, California, USA.
Acad Med. 2003 Jun;78(6):570-6. doi: 10.1097/00001888-200306000-00005.
Medical educators across the United States are addressing the topics of culture, race, language, behavior, and social status through the development of cross-cultural coursework. Dramatic demographic changes and nationwide attention to eliminating racial and ethnic health disparities make educating medical students about the importance of the effects of culture on health a 21st-century imperative. Despite the urgent need for including this topic material, few medical schools have achieved longitudinal integration of issues of culture into four-year curricula. The author makes the practical contribution of describing key themes and components of culture in health care for incorporation into undergraduate medical education. These include teaching the rationale for learning about culture in health care, "culture basics" (such as definitions, concepts, the basis of "culture" in the social sciences, relationship of culture to health and health care, and health systems as cultural systems), data on and concepts of health status (including demographics, epidemiology, health disparities, and the historical context), tools and skills for productive cross-cultural clinical encounters (such as interviewing skills and the use of interpreters); characteristics and origins of attitudes and behaviors of providers; community participation (including the use of expert teachers, community-school partnerships, and the community as a learning environment); and the nature of institutional culture and policies.
美国各地的医学教育工作者正在通过开展跨文化课程来探讨文化、种族、语言、行为和社会地位等主题。巨大的人口结构变化以及全国范围内对消除种族和族裔健康差距的关注，使得让医学生了解文化对健康影响的重要性成为21世纪的当务之急。尽管迫切需要纳入这一主题内容，但很少有医学院校能够将文化问题纵向融入四年制课程。作者做出了实际贡献，描述了医疗保健中文化的关键主题和组成部分，以便纳入本科医学教育。这些内容包括讲授在医疗保健中学习文化的基本原理、“文化基础知识”（如定义、概念、社会科学中“文化”的基础、文化与健康及医疗保健的关系，以及作为文化系统的卫生系统）、健康状况的数据和概念（包括人口统计学、流行病学、健康差距以及历史背景）、进行有效的跨文化临床交流的工具和技能（如访谈技巧和口译员的使用）；医疗服务提供者态度和行为的特点及根源；社区参与（包括使用专家教师、社区与学校的伙伴关系以及将社区作为学习环境）；以及机构文化和政策的性质。
