C.E. Vasquez Guzman is a family medicine postdoctoral fellow, Oregon Health & Science University, Portland, Oregon.
A.L. Sussman is associate professor, Comprehensive Cancer Center and Department of Family and Community Medicine, University of New Mexico, Albuquerque, New Mexico.
Acad Med. 2021 Jun 1;96(6):894-899. doi: 10.1097/ACM.0000000000004015.
Twenty years have passed since the Liaison Committee on Medical Education (LCME) mandated cultural competence training at U.S. medical schools. There remain multiple challenges to implementation of this training, including curricular constraints, varying interpretations of cultural competence, and evidence supporting the efficacy of such training. This study explored how medical schools have worked to implement cultural competence training.
Fifteen regionally diverse public and private U.S. medical schools participated in the study. In 2012-2014, the authors conducted 125 interviews with 52 administrators, 51 faculty or staff members, and 22 third- and fourth-year medical students, along with 29 focus groups with an additional 196 medical students. Interviews were recorded, transcribed, and imported into NVivo 10 software for qualitative data analysis. Queries captured topics related to students' preparedness to work with diverse patients, engagement with sociocultural issues, and general perception of preclinical and clinical curricula.
Three thematic areas emerged regarding cultural competence training: formal curriculum, conditions of teaching, and institutional commitment. At the formal curricular level, schools offered a range of courses collectively emphasizing communication skills, patient-centered care, and community-based projects. Conditions of teaching emphasized integration of cultural competence into the preclinical years and reflection on the delivery of content. At the institutional level, commitment to institutional diversity, development of programs, and degree of prioritization of cultural competence varied.
There is variation in how medical schools approach cultural competence. Among the 15 participating schools, longitudinal and experiential learning emerged as important, highlighting the needs beyond mere integration of cultural competence content into the formal curriculum. To determine efficacy of cultural competence programming, it is critical to conduct systematic assessment to identify and address gaps. While LCME standards have transformed aspects of medical education, further research is needed to clarify evidence-based, effective approaches to this training.
自医学教育联络委员会（LCME）要求美国医学院进行文化能力培训以来，已经过去了 20 年。在实施这种培训方面仍然存在许多挑战，包括课程限制、对文化能力的不同解释以及支持这种培训效果的证据。本研究探讨了医学院如何努力实施文化能力培训。
15 所来自不同地区的美国公立和私立医学院参与了这项研究。在 2012 年至 2014 年期间，作者对 52 名管理人员、51 名教职员工和 22 名三、四年级医学生进行了 125 次访谈，对另外 196 名医学生进行了 29 次焦点小组访谈。访谈内容被记录、转录并输入到 NVivo 10 软件中进行定性数据分析。查询捕获了与学生准备与不同患者合作、参与社会文化问题以及对基础临床课程的总体看法有关的主题。
关于文化能力培训，出现了三个主题领域：正式课程、教学条件和机构承诺。在正式课程层面，学校提供了一系列课程，共同强调沟通技巧、以患者为中心的护理和基于社区的项目。教学条件强调将文化能力融入基础医学年，并对内容的传授进行反思。在机构层面，对机构多样性、项目开发和文化能力的优先程度的承诺程度存在差异。
医学院在处理文化能力方面存在差异。在参与的 15 所学校中，纵向和体验式学习显得尤为重要，突出了将文化能力内容融入正式课程之外的需求。为了确定文化能力计划的效果，进行系统评估以确定和解决差距至关重要。尽管 LCME 标准已经改变了医学教育的某些方面，但仍需要进一步研究以明确这种培训的基于证据、有效的方法。
