Gregg Jessica, Saha Somnath
Division of General Internal Medicine, Oregon Health and Science University, Portland, Oregon 97201, USA.
Acad Med. 2006 Jun;81(6):542-7. doi: 10.1097/01.ACM.0000225218.15207.30.
Most cultural competence programs are based on traditional models of cross-cultural education that were motivated primarily by the desire to alleviate barriers to effective health care for immigrants, refugees, and others on the sociocultural margin. The main driver of renewed interest in cultural competence in the health professions has been the call to eliminate racial and ethnic disparities in the quality of health care. This mismatch between the motivation behind the design of cross-cultural education programs and the motivation behind their current application creates significant problems. First, in trying to define cultural boundaries or norms, programs may inadvertently reinforce racial and ethnic biases and stereotypes while doing little to clarify the actual complex sociocultural contexts in which patients live. Second, in attempting to address racial and ethnic disparities through cultural competence training, educators too often conflate these distinct concepts. To make this argument, the authors first discuss the relevance of culture to health and health care generally, and to disparities in particular. They then examine the concept of culture, paying particular attention to how it has been used (and misused) in cultural competence training. Finally, they discuss the implications of these ideas for health professions education.
大多数文化能力培训项目都基于跨文化教育的传统模式，这些模式主要是出于消除移民、难民和其他处于社会文化边缘的人群在获得有效医疗保健方面的障碍的愿望。卫生专业领域对文化能力重新产生兴趣的主要推动因素是消除医疗保健质量方面的种族和族裔差异的呼声。跨文化教育项目设计背后的动机与当前应用背后的动机之间的这种不匹配产生了重大问题。首先，在试图界定文化边界或规范时，项目可能会无意中强化种族和族裔偏见及刻板印象，而对阐明患者实际生活的复杂社会文化背景却收效甚微。其次，在试图通过文化能力培训解决种族和族裔差异问题时，教育工作者常常将这些不同的概念混为一谈。为了阐述这一观点，作者首先讨论文化一般而言与健康和医疗保健的相关性，尤其是与差异的相关性。然后，他们审视文化的概念，特别关注其在文化能力培训中是如何被使用（以及滥用）的。最后，他们讨论这些观点对卫生专业教育的影响。
