Koehn Peter H, Swick Herbert M
The University of Montana, Missoula, Montana 59806, USA.
Acad Med. 2006 Jun;81(6):548-56. doi: 10.1097/01.ACM.0000225217.15207.d4.
Given rapidly changing global demographic dynamics and the unimpressive evidence regarding health outcomes attributable to cultural competence (CC) education, it is time to consider a fresh and unencumbered approach to preparing physicians to reduce health disparities and care for ethnoculturally and socially diverse patients, including migrants. Transnational competence (TC) education offers a comprehensive set of core skills derived from international relations, cross-cultural psychology, and intercultural communication that are also applicable for medical education. The authors discuss five limitations (conceptual, vision, action, alliance, and pedagogical) of current CC approaches and explain how an educational model based on TC would address each problem area.The authors then identify and discuss the skill domains, core principles, and reinforcing pedagogy of TC education. The five skill domains of TC are analytic, emotional, creative, communicative, and functional; core principles include a comprehensive and consistent framework, patient-centered learning, and competency assessment. A central component of TC pedagogy is having students prepare a "miniethnography" for each patient that addresses not only issues related to physical and mental health, but also experiences related to dislocation and adaptation to unfamiliar settings. The TC approach promotes advances in preparing medical students to reduce health disparities among patients with multiple and diverse backgrounds, health conditions, and health care beliefs and practices. Perhaps most important, TC consistently directs attention to the policy and social factors, as well as the individual considerations, that can alleviate suffering and enhance health and well-being in a globalizing world.
鉴于全球人口动态迅速变化，以及文化能力（CC）教育对健康结果的影响证据并不显著，现在是时候考虑一种全新且不受束缚的方法，来培养医生以减少健康差距，并为包括移民在内的具有不同种族文化和社会背景的患者提供医疗服务。跨国能力（TC）教育提供了一套全面的核心技能，这些技能源自国际关系、跨文化心理学和跨文化交流，也适用于医学教育。作者讨论了当前CC方法的五个局限性（概念、愿景、行动、联盟和教学法），并解释了基于TC的教育模式将如何解决每个问题领域。作者随后确定并讨论了TC教育的技能领域、核心原则和强化教学法。TC的五个技能领域是分析性、情感性、创造性、沟通性和功能性；核心原则包括全面且一致的框架、以患者为中心的学习和能力评估。TC教学法的一个核心组成部分是让学生为每位患者准备一份“微型民族志”，不仅要涉及与身心健康相关的问题，还要涉及与流离失所和适应陌生环境相关的经历。TC方法有助于推动培养医学生，以减少具有多元背景、健康状况以及医疗保健信仰和实践的患者之间的健康差距。也许最重要的是，TC始终将注意力引向政策和社会因素以及个人因素，这些因素能够在全球化的世界中减轻痛苦、增进健康和福祉。
