Fung Kenneth, Andermann Lisa, Zaretsky Ari, Lo Hung-Tat
Department of Psychiatry, University of Toronto, Toronto Western Hospital, Toronto, Ontario M5T 2S8, Canada.
Acad Psychiatry. 2008 Jul-Aug;32(4):272-82. doi: 10.1176/appi.ap.32.4.272.
As it is increasingly recognized that cultural competence is an essential quality for any practicing psychiatrist, postgraduate psychiatry training programs need to incorporate cultural competence training into their curricula. This article documents the unique approach to resident cultural competence training being developed in the Department of Psychiatry at the University of Toronto, which has the largest residency training program in North America and is situated in an ethnically diverse city and country.
The authors conducted a systematic review of cultural competence by searching databases including PubMed, PsycINFO, PsycArticles, CINAHL, Social Science Abstracts, and Sociological Abstracts; by searching government and professional association publications; and through on-site visits to local cross-cultural training programs. Based on the results of the review, a resident survey, and a staff retreat, the authors developed a deliberate "integrative" approach with a mindful, balanced emphasis on both generic and specific cultural competencies.
Learning objectives were derived from integrating the seven core competencies of a physician as defined by the Canadian Medical Education Directions for Specialists (CanMEDS) roles framework with the tripartite model of attitudes, knowledge, and skills. The learning objectives and teaching program were further integrated across different psychiatric subspecialties and across the successive years of residency. Another unique strategy used to foster curricular and institutional change was the program's emphasis on evaluation, making use of insights from modern educational theories such as formative feedback and blueprinting. Course evaluations of the core curriculum from the first group of residents were positive.
The authors propose that these changes to the curriculum may lead to enhanced cultural competence and clinical effectiveness in health care.
鉴于文化能力日益被视为执业精神科医生的一项基本素质，精神科研究生培训项目需要将文化能力培训纳入其课程设置。本文记录了多伦多大学精神病学系正在开发的针对住院医师文化能力培训的独特方法，该系拥有北美最大的住院医师培训项目，且位于一个种族多样化的城市和国家。
作者通过检索包括PubMed、PsycINFO、PsycArticles、CINAHL、社会科学文摘和社会学文摘在内的数据库，检索政府和专业协会出版物，并实地考察当地跨文化培训项目，对文化能力进行了系统综述。基于综述结果、住院医师调查和员工务虚会，作者制定了一种深思熟虑的“综合”方法，有意识、平衡地强调一般文化能力和特定文化能力。
学习目标源于将加拿大医学专家教育方向（CanMEDS）角色框架定义的医生七项核心能力与态度、知识和技能的三方模型相结合。学习目标和教学计划进一步整合到不同的精神科亚专业以及住院医师培训的连续几年中。用于促进课程和机构变革的另一个独特策略是该项目对评估的强调，利用了诸如形成性反馈和蓝图设计等现代教育理论的见解。第一批住院医师对核心课程的课程评估是积极的。
作者提出，课程的这些变化可能会提高医疗保健中的文化能力和临床效果。
