Skip Navigation LinksHome > May 2000 - Volume 75 - Issue 5 > The Teaching of Cultural Issues in U.S. and Canadian Medical...
Academic Medicine:
Educating Physicians: Research Reports

The Teaching of Cultural Issues in U.S. and Canadian Medical Schools

Flores, Glenn MD; Gee, Denise; Kastner, Beth MPH

Free Access
Article Outline
Collapse Box

Author Information

Dr. Flores is assistant professor of pediatrics and public health, Boston University Schools of Medicine and Public Health; founder and co-director, Pediatric Latino Clinic, Boston Medical Center; consultant, Center for MassHealth Evaluation and Research, University of Massachusetts School of Medicine, Worcester; and Robert Wood Johnson Minority Medical Faculty Development Scholar. Ms. Gee is a medical student, Boston University School of Medicine. Ms. Kastner is research coordinator, Division of Pediatric Emergency Medicine, Boston Medical Center.

Correspondence and requests for reprints should be addressed to Dr. Flores, Division of General Pediatrics, Boston Medical Center, 91 East Concord Street, Maternity 419, Boston, MA 02118; e-mail: 〈glenn.flores@bmc.org〉.

The authors thank Deborah Danoff, MD, for her assistance during several phases of the study, and Gregory Lawson, for providing information about US medical schools for the multivariate analysis. Supported by grants from the Robert Wood Johnson Minority Medical Faculty Development Program (#030878) and an Institutional Research Training Grant of the Health Resources Services Administration (HRSA).

Presented in part at the annual meetings of the Association for American Medical Colleges, Washington, DC, November 3, 1996, and the Pediatric Academic Societies, Washington, DC, May 4, 1997.

Collapse Box

Abstract

Purpose: Despite the importance of culture in health care and the rapid growth of ethnic diversity in the United States and Canada, little is known about the teaching of cultural issues in medical schools. The study goals, therefore, were to determine the number of U.S. and Canadian medical schools that have courses on cultural issues, and to examine the format, content, and timing of those courses.

Method: The authors contacted the deans of students and/or directors of courses on cultural issues at all 126 U.S. and all 16 Canadian medical schools. Using a cross-sectional telephone survey, they asked whether each school had a course on cultural sensitivity or multicultural issues and, if so, whether it was separate or contained within a larger course, when in the curriculum the course was taught, and which ethnic groups the course addressed.

Results: The response rates were 94% for both U.S. (118) and Canadian (15) schools. Very few schools (U.S. = 8%; and Canada = 0%) had separate courses specifically addressing cultural issues. Schools in both countries usually addressed cultural issues in one to three lectures as part of larger, mostly preclinical courses. Significantly more Canadian than U.S. schools provided no instruction on cultural issues (27% versus 8%; p =.04). Few schools taught about the specific cultural issues of the largest minority groups in their geographic areas: only 28% and 26% of U.S. schools taught about African American and Latino issues, respectively, and only two thirds of Canadian schools taught about either Asian or Native Canadian issues. Only 35% of U.S. schools addressed the cultural issues of the largest minority groups in their particular states.

Conclusions: Most U.S. and Canadian medical schools provide inadequate instruction about cultural issues, especially the specific cultural aspects of large minority groups.

The United States and Canada rapidly are becoming more diverse. Racial and ethnic minorities comprise 28% of the U.S. population1 and 15% of the Canadian population.2 It is estimated that by 2000, minorities will outnumber whites in at least three states and the District of Columbia.3 In eight of the ten largest American cities, ethnic minority groups already outnumber whites.4 In addition, more than 31 million Americans are unable to speak the same language as their health care providers.5

Numerous studies have documented that culture (including language) can profoundly influence health care. Culture has been shown to affect access, adherence, health status, continuity of care, preventive screening, doctor-patient communication, analgesia adequacy, use of harmful remedies, immunization rates, and prescription practices.6

Despite the importance of culture in health care and the growing diversity of the United States and Canada, little is known about the teaching of cultural issues in medical schools. Only one published study has examined this topic. Lum and Korenman7 found that in 1991–92, most U.S. medical schools did not have courses on cultural sensitivity. Their study, however, had a 78% response rate, and they did not survey Canadian medical schools or examine in detail the format, content, and timing of courses. The objectives of our study, therefore, were to (1) determine the number of U.S. and Canadian medical schools that have separate courses on cultural issues; (2) examine the format, content, and timing of courses; and (3) investigate whether the cultural issues of major ethnic groups are taught in these courses.

Back to Top | Article Outline

METHOD

Subjects

For 1996 to 1998, we attempted to contact by telephone the deans or assistant deans of students and/or the directors of courses on cultural issues at all 126 U.S. (excluding Puerto Rico) and all 16 Canadian medical schools. When telephone contact failed, we also e-mailed and faxed the deans and course directors. Up to eight calls per school were made for initial non-responders to increase the likelihood of a response.

Back to Top | Article Outline
Study Design and Survey

The study design was a cross-sectional telephone survey. The survey instrument consisted of the following questions and requests: (1) Does your school offer a course on cultural sensitivity or multicultural issues? (2) If so, is the course incorporated into the curriculum as a separate required course or elective, or as part of a larger course? (3) Please briefly describe your course. (4) In which year(s) of medical school is the course taught? (5) How many years has the course been in existence? (6) Which ethnic groups are addressed in the course?

The survey took five to ten minutes to complete. We also requested supplemental course materials (syllabi or handouts).

Back to Top | Article Outline
Definition

A course was considered to meet the qualifications of teaching about cultural issues if it had one or more of the following topics as a central focus: culture, cultural differences, ethnicity, race, or language and its relation to health care.

Back to Top | Article Outline
Analysis

Data were entered and bivariate analyses performed using Epi Info 6.03.8 Major ethnic/racial groups in a U.S. medical school's region were identified using data from the Statistical Abstract.4 Multiple logistic regressions were done in a stepwise fashion using True Epistat9; two dependent variables were examined: course of any kind offered on cultural issues; and separate course offered on cultural issues. Independent variables examined in multivariate analyses included: medical school ownership (public versus private); age of school in years, endowment in dollars, percentage of women students, percentage of minority students, class size, and preference given to applicants from the inner city.

Back to Top | Article Outline

RESULTS

Response Rates

All medical schools that were successfully contacted agreed to participate in the study. Only eight U.S. schools and one Canadian school did not respond to repeated contacts, for a response rate of 94% for each country (118/126, and 15/16, respectively). We were unable to determine why the nine schools chose not to participate in the study.

Back to Top | Article Outline
Course Format, Duration, and Timing

Only 8% of U.S. and no Canadian medical schools taught cultural issues to medical students in separate courses (Table 1). Most schools (U.S., 87%; Canadian, 67%) presented cultural issues as a few lectures incorporated into larger courses or electives; the numbers of such lectures ranged from one to three. Cultural issues were taught in electives by 16% of U.S. but no Canadian schools. Canadian schools were significantly more likely than were U.S. schools to offer no instruction on cultural issues (27% versus 8%, respectively; p =.04).

Table 1
Table 1
Image Tools

Most courses (both separate and integrated) in U.S. and Canadian medical schools had been taught for less than six years (Table 1). A surprisingly large proportion of schools reported teaching courses for more than 15 years. Several schools in each nation stated that they were uncertain how long the courses had been taught.

The most common format for teaching cultural issues in both countries was case-based instruction (Table 1). Didactic and group-learning formats were used more often in U.S. schools, whereas problem-based learning was more common in Canadian schools. Cultural issues were taught as part of clinical clerkships in 6% of U.S. schools, but in no Canadian school.

Most courses on cultural issues were taught in the first two years of medical school in both countries (Table 1). Canadian schools reported substantially more often that they taught about cultural issues in the third and fourth years of medical school. For example, about three fourths of Canadian schools said that they taught about culture in the third year, compared with about one fourth of U.S. schools. About two thirds of U.S. schools taught about culture for only one to two years, whereas almost three fourths of Canadian schools taught about culture for three to four years. Cultural issues were taught only in the first two years by 61% of U.S. and 27% of Canadian schools. Of note, 20% of U.S. and 36% of Canadian schools reported teaching about culture in all four years of medical school.

Back to Top | Article Outline
Course Coverage of Specific Ethnic/Racial Groups

Most U.S. and Canadian medical schools did not address the specific cultural issues of the largest non-white ethnic groups (Table 1). More than two thirds of U.S. schools did not teach about African American cultural issues, and close to three fourths failed to teach about Latino cultural issues. More than 80% of U.S. schools did not provide instruction about cultural issues of either Asians/Pacific Islanders or Native Americans. The specific cultural issues of the largest non-white ethnic group in a given medical school's state were taught by only 35% of U.S. schools.

More than two thirds of Canadian schools did not teach about cultural issues of either of the nation's two largest non-white ethnic groups, Native Canadians and Asians/Pacific Islanders (Table 1). Significantly more Canadian than U.S. schools (27% versus 7%, p =.03) provided no instruction about the specific cultural issues of any non-white ethnic group.

Back to Top | Article Outline
Multivariate Analysis

Multiple logistic regression analyses revealed that none of the seven independent variables (medical school ownership, age of school, endowment, percentage of women students, percentage of minority students, class size, and preference given to those from the inner city) was significantly associated with either of the two outcome variables (having any instruction about cultural issues and having a separate course on cultural issues).

Back to Top | Article Outline

CONCLUSION

It is surprising that most U.S. and Canadian medical schools do not teach about specific cultural issues of the largest minority groups. In the United States, there are 33 million African Americans, 31 million Latinos, almost ten million Asians/Pacific Islanders, and two million Native Americans,1 but cultural issues of these groups are taught by only 17% to 28% of U.S. medical schools. In Canada, there are 1.2 million Asians (of Chinese, Southeast Asian, Japanese, or Korean descent) and 1.1 million Native Canadians,2 but cultural issues of either group are taught by only 27% of Canadian medical schools. Greater cultural understanding might help to eliminate the often dramatic ethnic disparities in health and use of health services that exist in both countries, such as significant racial differences in cardiac procedures.10,11 Although cultural competency is a relatively new field, medical school course directors already have several available resources for teaching about cultural issues, including textbooks12,13 and cultural competency models.6 Another important but underutilized educational resource is citizens and faculty from major ethnic groups residing in a medical school's surrounding communities. By providing patients' and clinicians' perspectives on culture and health care, these community members can have a key impact on medical students.

Many studies6 document that culture can affect doctor—patient communication, access to health care, health status, and the use of health services, but very few U.S. and no Canadian medical schools offer separate courses about cultural issues. It is also concerning that most schools teach about cultural issues in only one to three lectures in larger courses during the preclinical years. Because culture can profoundly influence clinical care and because the ethnic diversity of patients will only increase, we recommend that medical schools consider teaching cultural issues in a separate, devoted course. Part of this course or the entire course might be given during the medical students' clinical years, so that students can directly and immediately apply the principles. A comprehensive course on cultural issues might consist of presentation of a cultural competency model, skills for using interpreters, folk illnesses, sessions on cultural issues of major ethnic groups, and analysis of cases. We believe that adequate instruction on these essential concepts can be accomplished only in a semester-long (or longer), separate, required course.

Three potential limitations of this study should be noted. It is possible that the reported courses of some medical schools participating in this study may not have corresponded to the actual courses taught. The study results, therefore, may overestimate the prevalence, content, and ethnic coverage of courses on cultural issues. Because the study findings, however, already indicate that the teaching of cultural issues in medical schools is not adequate, such overestimates would not alter the conclusions. A second potential limitation is that the people we interviewed may not always have been aware of all courses in which cultural issues were taught. It is therefore possible that some courses were overlooked in which a lecture or component was devoted to cultural issues. This might have led to an underestimation of the number of schools offering any instruction on cultural issues, but would not affect this study's findings regarding the limited number of schools offering separate courses focusing on cultural issues. A third limitation is that, as with other surveys that do not have a 100% response, non-response bias may have distorted the findings. Because response rates were high (94% for both countries), however, the results could change by no more than 6% with full response by all schools, which still would not substantially alter the conclusions.

It is not clear why most Canadian medical schools have lagged behind their American counterparts in teaching cultural issues. Canadian schools significantly more often offer no course on cultural issues and no instruction about the specific cultural issues of any non-white ethnic group. These findings are particularly surprising given the recent creation of a new territory, Nunavut, in which 85% of the residents are Inuit.14 These results are also of concern in light of data that show the multilingual nature of Canada is growing as a result of increased immigration. In 1996, for example, 4.7 million Canadians, or 16% of the total population, reported a mother tongue other than English or French, a 15% increase from 1991.15 This increase was 2.5 times faster than the overall growth rate of the Canadian population. The greater recognition of diversity and the growing multilingual population in Canada suggest that a critical priority for medical schools should be teaching cultural issues to future Canadian physicians.

Fewer U.S. medical schools teach cultural issues now compared with earlier in the decade. A 1991 study7 found that 13% of U.S. schools had separate cultural sensitivity courses, compared with 8% in our study. It is disturbing that the teaching of cultural issues in U.S. and Canadian medical schools is inadequate and may be getting worse, particularly given the rapid growth of diversity in both countries and mounting evidence on the important effects of culture in clinical care. Our findings suggest that a required medical school course on cultural issues would reverse these disturbing trends, and ensure that we train culturally competent physicians able to provide quality care, with improved communication and patient satisfaction.

Back to Top | Article Outline

REFERENCES

1. U.S. Bureau of the Census. Resident Population of the United States: Estimates, by Sex, Race, and Hispanic Origin, with Median Age. December 28, 1998. 〈http://www.census.gov/populations/estimates/nation/intfile3-1.txt〉.

2. Official Release and Media Relations Section, Communications Division, Statistics Canada. 1996 Census: ethnic origin, visible minorities. In: Currie D (ed). Statistics Canada, The Daily, catalogue 001E, February 17, 1998. 〈http://www.statcan.ca/Daily/English/980217/d980217.htm〉.

3. Campbell PR. Population Projections for States by Age, Sex, Race, and Hispanic Origin: 1995 to 2025. U.S. Bureau of the Census, Population Division, PPL-47. Updated March 29, 1999. 〈http://www.census.gov/population/www/projections/pp147.html〉.

4. U.S. Bureau of the Census. Statistical Abstract of the United States: 1998. 118th ed. Washington, DC: U.S. Department of Commerce, 1998.

5. Woloshin S, Bickell N, Schwartz L, Gany F, Welch G. Language barriers in medicine in the United States. JAMA. 1995;273:724–8.

6. Flores G. Culture and the patient—physician relationship: achieving cultural competency in health care. J Pediatr. 2000:136;14–23.

7. Lum C, Korenman S. Cultural-sensitivity training in U.S. medical schools. Acad Med. 1994;69:239–41.

8. Dean AG, Dean JA, Coulombier D, et al. Epi Info, Version 6: A Word Processing, Database, and Statistics Program for Epidemiology and Microcomputers. Atlanta, GA: Centers for Disease Control and Prevention, 1994.

9. Gustafson TL. True Epistat. Version 5.0. Richardson, TX: Epistat Services, Inc., 1994.

10. Peterson ED, Shaw LK, DeLong ER, Pryor DB, Califf RM, Mark DB. Racial variation in the use of coronary revascularization procedures. Are the differences real? Do they matter? N Engl J Med. 1997;336:480–6.

11. Schulman KA, Berlin JA, Harles W, et al. The effect of race and sex on physicians' recommendations for cardiac catheterization. N Engl J Med. 1999;340:618–26.

12. Harwood A (ed). Ethnicity and Medical Care. Cambridge, MA: Harvard University Press, 1981.

13. American Medical Association. Culturally Competent Health Care for Adolescents. A Guide for Primary Care Providers. Chicago, IL: American Medical Association, 1994:39–67.

14. DePalma A. In new land of Eskimos, a new chief offers help. New York Times. 1999:April4:A4.

15. Official Release and Media Relations Section, Communications Division, Statistics Canada. 1996 Census: Mother tongue, home language and knowledge of languages. In: Currie D (ed). Statistics Canada, The Daily, catalogue 001E, December 2, 1997. <http://www.statcan.ca/Daily/English/971202/d971202.htm>.

Cited By:

This article has been cited 74 time(s).

Medical Teacher
A new approach to developing cross-cultural communication skills
Rosen, J; Spatz, ES; Gaaserud, AMJ; Abramovitch, H; Weinreb, B; Wenger, NS; Margolis, CZ
Medical Teacher, 26(2): 126-132.
10.1080/01421590310001653946
CrossRef
Journal of General Internal Medicine
Can a web-based curriculum improve students' knowledge of, and attitudes about, the interpreted medical interview?
Kalet, AL; Mukherjee, D; Felix, K; Steinberg, SE; Nachbar, M; Lee, A; Changrani, J; Gany, F
Journal of General Internal Medicine, 20(): 929-934.
10.1111/j.1525-1497.2005.0193.x
CrossRef
Journal of General Internal Medicine
Validating measures of third year medical students' use of interpreters by standardized patients and faculty observers
Lie, D; Boker, J; Bereknyei, S; Ahearn, S; Fesko, C; Lenahan, P
Journal of General Internal Medicine, 22(): 336-340.
10.1007/s11606-007-0349-3
CrossRef
Family Medicine
Culture, language, and the doctor-patient relationship
Ferguson, WJ; Candib, LM
Family Medicine, 34(5): 353-361.

Jama-Journal of the American Medical Association
The health of Latino children - Urgent priorities, unanswered questions, and a research agenda
Flores, G; Fuentes-Afflick, E; Barbot, O; Carter-Pokras, O; Claudio, L; Lara, M; McLaurin, JA; Pachter, L; Gomez, FR; Mendoza, F; Valdez, RB; Villarruel, AM; Zambrana, RE; Greenberg, R; Weitzman, M
Jama-Journal of the American Medical Association, 288(1): 82-90.

Journal of General Internal Medicine
Patient-provider and patient-staff racial concordance and perceptions of mistreatment in the health care setting
Blanchard, J; Nayar, S; Lurie, N
Journal of General Internal Medicine, 22(8): 1184-1189.
10.1007/s11606-007-0210-8
CrossRef
Medical Teacher
Understanding what residents want and what residents need: the challenge of cultural training in pediatrics
Macdonald, ME; Carnevale, FA; Razack, S
Medical Teacher, 29(5): 464-U9.
10.1080/01421590701509639
CrossRef
Pediatrics
The truth about language barriers: One residency program's experience
O'Leary, SCB; Federico, S; Hampers, LC
Pediatrics, 111(5): E569-E573.

Medical Teacher
Self-perceived attitudes and skills of cultural competence: a comparison of family medicine and internal medicine residents
Shapiro, J; Hollingshead, J; Morrison, E
Medical Teacher, 25(3): 327-329.

American Journal of Managed Care
Cultural competency as it intersects with racial/ethnic, linguistic, and class disparities in managed healthcare organizations
Zambrana, RE; Molnar, C; Munoz, HB; Lopez, DS
American Journal of Managed Care, 10(): SP37-SP44.

Journal of the National Medical Association
Knowledge of cultural competence among third-year medical students
Bussey-Jones, J; Genao, I; George, DMS; Corbie-Smith, G
Journal of the National Medical Association, 97(9): 1272-1276.

Journal of General Internal Medicine
Disparities Education: What Do Students Want?
Gonzalez, CM; Bussey-Jones, J
Journal of General Internal Medicine, 25(): S102-S107.
10.1007/s11606-010-1250-z
CrossRef
Social Science & Medicine
Cultural competence among physicians treating Mexican Americans who have diabetes: a structural model
Reimann, JOF; Talavera, GA; Salmon, M; Nunez, JA; Velasquez, RJ
Social Science & Medicine, 59(): 2195-2205.
10.1016/j.socscimed.2004.03.025
CrossRef
Pediatrics
Cultural and linguistic determinants in the diagnosis and management of developmental delay in a 4-year-old (Reprinted from J Dev Behav Pediatr, vol 23, pg 371, 2002)
Stein, MT; Flores, G; Graham, EA; Magana, L; Willies-Jacobo, L; Gulbronson, M
Pediatrics, 114(5): 1442-1447.
10.1542/peds.2004-1721I
CrossRef
Teaching and Learning in Medicine
A critical intervention in lesbian, gay, bisexual, and transgender health: Knowledge and attitude outcomes among second-year medical students
Kelley, L; Chou, CL; Dibble, SL; Robertson, PA
Teaching and Learning in Medicine, 20(3): 248-253.
10.1080/10401330802199567
CrossRef
Academic Psychiatry
Evaluating a lecture on cultural competence in the medical school preclinical curriculum
Lim, RF; Wegelin, J; Hua, LL; Kramer, EJ; Servis, ME
Academic Psychiatry, 32(4): 327-331.

Journal of the American Geriatrics Society
The ETHNIC(S) mnemonic: A clinical tool for ethnogeriatric education
Kobylarz, FA; Heath, JM; Like, RC
Journal of the American Geriatrics Society, 50(9): 1582-1589.

Pediatrics
Errors in medical interpretation and their potential clinical consequences in pediatric encounters
Flores, G; Laws, MB; Mayo, SJ; Zuckerman, B; Abreu, M; Medina, L; Hardt, EJ
Pediatrics, 111(1): 6-14.

Family Medicine
Patient-based Cultural Competency Curriculum for Pre-Health Professionals
Melamed, E; Wyatt, LE; Padilla, T; Ferry, RJ
Family Medicine, 40(): 726-733.

Journal of General Internal Medicine
A Model for Interprofessional Health Disparities Education: Student-Led Curriculum on Chronic Hepatitis B Infection
Sheu, LC; Toy, BC; Kwahk, E; Yu, A; Adler, J; Lai, CJ
Journal of General Internal Medicine, 25(): S140-S145.
10.1007/s11606-009-1234-z
CrossRef
Teaching and Learning in Medicine
"Learning by teaching": A peer-teaching model for diversity training in medical school
Tang, TS; Hernandez, EJ; Adams, BS
Teaching and Learning in Medicine, 16(1): 60-63.

Ethnicity & Disease
Childhood obesity among Head Start enrollees in southeastern Minnesota: Prevalence and risk factors
Hu, WT; Foley, TA; Wilcox, RA; Kozera, RM; Morgenstern, BZ; Juhn, YJ
Ethnicity & Disease, 16(1): 23-28.

Jama-Journal of the American Medical Association
Cultural competence training in US medical schools
Champaneria, MC; Axtell, S
Jama-Journal of the American Medical Association, 291(): 2142.

Ambulatory Pediatrics
Evaluation of a culturally effective health care curriculum integrated into a core pediatric clerkship
Paul, CR; Devries, J; Fliegel, J; Van Cleave, J; Kish, J
Ambulatory Pediatrics, 8(3): 195-199.

American Journal of Managed Care
Changing healthcare professionals' behaviors to eliminate disparities in healthcare: What do we know? How might we proceed?
Horner, RD; Salazar, W; Geiger, HJ; Bullock, K; Corbie-Smith, G; Cornog, M; Flores, G
American Journal of Managed Care, 10(): SP12-SP19.

Journal of General Internal Medicine
"Oh! She doesn't speak English!" Assessing resident competence in managing linguistic and cultural barriers
Zabar, S; Hanley, K; Kachur, E; Stevens, D; Schwartz, MD; Pearlman, E; Adams, J; Felix, K; Lipkin, M; Kalet, A
Journal of General Internal Medicine, 21(5): 510-513.
10.1111/j.1525-1497.2006.00439.x
CrossRef
Sociology of Health & Illness
Beyond cultural competency: Bourdieu, patients and clinical encounters
Lo, MCM; Stacey, CL
Sociology of Health & Illness, 30(5): 741-755.
10.1111/j.1467-9566.2008.01091.x
CrossRef
American Journal of Pharmaceutical Education
Neighborhood Geographical Factors and the Presence of Advanced Community Pharmacy Practice Sites in Greater Chicago
Johnson, CL; Crawford, SY; Lin, SJ; Salmon, JW; Smith, MM
American Journal of Pharmaceutical Education, 73(1): -.
ARTN 8
CrossRef
Ambulatory Pediatrics
Culture, ethnicity, and linguistic issues in pediatric care: Urgent priorities and unanswered questions
Flores, G
Ambulatory Pediatrics, 4(4): 276-282.

Medical Teacher
Student reflections on learning cross-cultural skills through a 'cultural competence' OSCE
Miller, E; Green, AR
Medical Teacher, 29(4): E76-E84.
10.1080/01421590701266701
CrossRef
Journal of the National Medical Association
Empowering Students With Cultural Competence Knowledge: Randomized Controlled Trial of a Cultural Competence Curriculum for Third-Year Medical Students
Genao, I; Bussey-Jones, J; St George, DM; Corbie-Smith, G
Journal of the National Medical Association, 101(): 1241-1246.

Journal of General Internal Medicine
Teaching Cultural Diversity: Current Status in UK, US, and Canadian Medical Schools
Dogra, N; Reitmanova, S; Carter-Pokras, O
Journal of General Internal Medicine, 25(): S164-S168.
10.1007/s11606-009-1202-7
CrossRef
Medical Care Research and Review
Can cultural competency reduce racial and ethnic health disparities? A review and conceptual model
Brach, C; Fraser, I
Medical Care Research and Review, 57(): 181-217.

Family Medicine
The BELIEF Instrument: A preclinical teaching tool to elicit patients' health beliefs
Dobbie, AE; Medrano, M; Tysinger, J; Olney, C
Family Medicine, 35(5): 316-319.

Journal of the American Board of Family Practice
Issues for South Asian Indian patients surrounding sexuality, fertility, and childbirth in the US health care system
Fisher, JA; Bowman, ML; Thomas, T
Journal of the American Board of Family Practice, 16(2): 151-155.

Academic Medicine
Developing culturally competent community faculty: A model program
Ferguson, WJ; Keller, DM; Haley, HL; Quirk, M
Academic Medicine, 78(): 1221-1228.

Medical Teacher
Is culture important in the choice of role models? Experiences from a culturally diverse medical school
McLean, M
Medical Teacher, 26(2): 142-149.
10.1080/01421590310001653964
CrossRef
Medical Education
Survey on Aboriginal issues within Canadian medical programmes
Spencer, A; Young, T; Williams, S; Yan, D; Horsfall, S
Medical Education, 39(): 1101-1109.
10.1111/j.1365-2929.2005.02316.x
CrossRef
British Medical Journal
Teaching of cultural diversity in medical schools in the United Kingdom and Republic of Ireland: cross sectional questionnaire survey
Dogra, N; Connin, S; Gill, P; Spencer, J; Turner, M
British Medical Journal, 330(): 403-404.
10.1136/bmj.38338.661493.AE
CrossRef
Journal of Cancer Education
Enhancing patient-physician communication: A community and culturally based approach
Martin, MY; Keys, W; Person, SD; Kim, Y; Ashford, RS; Kohler, C; Norton, P
Journal of Cancer Education, 20(3): 150-154.

Journal of the National Medical Association
Medical students' perspectives on a multicultural curriculum
Lypson, ML; Ross, PT; Kumagai, AK
Journal of the National Medical Association, 100(9): 1078-1083.

Emergency Medicine Clinics of North America
Vulnerable populations: Cultural and spiritual direction
Quest, TE; Franks, NM
Emergency Medicine Clinics of North America, 24(3): 687-+.
10.1016/j.emc.2006.05.010
CrossRef
Annals of Internal Medicine
Recommendations for teaching about racial and ethnic disparities in health and health care
Smith, WR; Betancourt, JR; Wynia, MK; Bussey-Jones, J; Stone, VE; Phillips, CO; Fernandez, A; Jacobs, E; Bowles, J
Annals of Internal Medicine, 147(9): 654-665.

Annual Review of Psychology
Prejudice Reduction: What Works? A Review and Assessment of Research and Practice
Paluck, EL; Green, DP
Annual Review of Psychology, 60(): 339-367.
10.1146/annurev.psych.60.110707.163607
CrossRef
Social Science & Medicine
Provider and clinic cultural competence in a primary care setting
Paez, KA; Allen, JK; Carson, KA; Cooper, LA
Social Science & Medicine, 66(5): 1204-1216.
10.1016/j.socscimed.2007.11.027
CrossRef
Family Medicine
Teaching and assessing family medicine clerks' use of medical interpreters
Shriner, CJ; Hickey, DP
Family Medicine, 40(5): 313-315.

Journal of Homosexuality
Caring for vulnerable populations: Curricula in US internal medicine residencies
McGarry, KA; Clarke, JG; Landau, C; Cyr, MG
Journal of Homosexuality, 54(3): 225-232.
10.1080/08873260801982064
CrossRef
Journal of General Internal Medicine
Innovative health care disparities curriculum for incoming medical students
Vela, MB; Kim, KE; Tang, H; Chin, MH
Journal of General Internal Medicine, 23(7): 1028-1032.
10.1007/s11606-008-0584-2
CrossRef
Jama-Journal of the American Medical Association
Cultural diversity: An evolving challenge to physician-patient communication
Kundhal, KK; Kundhal, PS
Jama-Journal of the American Medical Association, 289(1): 94.

Pediatrics
Racial and ethnic disparities in early childhood health and health care
Flores, G; Olson, L; Tomany-Korman, SC
Pediatrics, 115(2): E183-E193.
10.1542/peds.2004-1474
CrossRef
Journal of the American Geriatrics Society
Barriers to optimum end-of-life care for minority patients
Krakauer, EL; Crenner, C; Fox, K
Journal of the American Geriatrics Society, 50(1): 182-190.

International Journal of Intercultural Relations
Assessing changes in intercultural sensitivity among physician trainees using the intercultural development inventory
Altshuler, L; Sussman, NM; Kachur, E
International Journal of Intercultural Relations, 27(4): 387-401.
10.1016/S0147-1767(03)00029-4
CrossRef
Academic Emergency Medicine
Emergency medicine education and health care disparities
Hamilton, G; Marco, CA
Academic Emergency Medicine, 10(): 1189-1192.
10.1197/S1069-6563(03)00488-3
CrossRef
Clinical Gastroenterology and Hepatology
Integration of Racial, Cultural, Ethnic, and Socioeconomic Factors Into a Gastrointestinal Pathophysiology Course
Shields, HM; Leffler, DA; White, AA; Hafler, JP; Pelletier, SR; O'Farrell, RP; Llerena-Quinn, R; Hayward, JN; Salamone, S; Lenco, AM; Blanco, PG; Peters, AS
Clinical Gastroenterology and Hepatology, 7(3): 279-284.
10.1016/j.cgh.2008.10.012
CrossRef
Journal of Clinical Ethics
Multi-cultural considerations and the American College of Physicians Ethics Manual
Berger, JT
Journal of Clinical Ethics, 12(4): 375-381.

Ethnicity & Disease
Childhood obesity among Head Start enrollees in southeastern Minnesota: Prevalence and risk factors
Hu, WT; Foley, TA; Wilcox, RA; Kozera, RM; Morgenstern, BZ; Juhn, YJ
Ethnicity & Disease, 17(1): 23-28.

Public Health Reports
Defining cultural competence: A practical framework for addressing racial/ethnic disparities in health and health care
Betancourt, JR; Green, AR; Carrillo, JE; Ananeh-Firempong, O
Public Health Reports, 118(4): 293-302.

Medical Education
Integrating cultural competency into the undergraduate medical curriculum
Rapp, DE
Medical Education, 40(7): 704-710.
10.1111/j.1365-2929.2006.02515.x
CrossRef
Journal of General Internal Medicine
A prescription for cultural competence in medical education
Kripalani, S; Bussey-Jones, J; Katz, MG; Genao, I
Journal of General Internal Medicine, 21(): 1116-1120.
10.1111/j.1525-1497.2006.00557.x
CrossRef
Australian Occupational Therapy Journal
Diversity and inclusion within an occupational therapy curriculum
Trentham, B; Cockburn, L; Cameron, D; Iwama, M
Australian Occupational Therapy Journal, 54(): S49-S57.
10.1111/j.1440-1630.2006.00605.x
CrossRef
Teaching and Learning in Medicine
Teaching About Racial/Ethnic Health Disparities: A National Survey of Clerkship Directors in Internal Medicine
Chheda, S; Hemmer, PA; Durning, S
Teaching and Learning in Medicine, 21(2): 127-130.
10.1080/10401330902791172
CrossRef
Academic Medicine
Bringing Interdisciplinary and Multicultural Team Building to Health Care Education: The Downstate Team-Building Initiative
Hope, JM; Lugassy, D; Meyer, R; Jeanty, F; Myers, S; Jones, S; Bradley, J; Mitchell, R; Cramer, E
Academic Medicine, 80(1): 74-83.

PDF (282)
Academic Medicine
Viewpoint: Physician, Know Thyself: The Professional Culture of Medicine as a Framework for Teaching Cultural Competence
Boutin-Foster, C; Foster, JC; Konopasek, L
Academic Medicine, 83(1): 106-111.
10.1097/ACM.0b013e31815c6753
PDF (61) | CrossRef
Academic Medicine
Educational Benefits of Diversity in Medical School: A Survey of Students
Whitla, DK; Orfield, G; Silen, W; Teperow, C; Howard, C; Reede, J
Academic Medicine, 78(5): 460-466.

PDF (91)
Academic Medicine
Implementation and Evaluation of an Undergraduate Sociocultural Medicine Program
Tang, TS; Fantone, JC; Bozynski, ME; Adams, BS
Academic Medicine, 77(6): 578-585.

PDF (140)
Academic Medicine
Are Residents More Comfortable Than Faculty Members When Addressing Sociocultural Diversity in Medicine?
Tang, TS; Bozynski, ME; Mitchell, JM; Haftel, HM; Vanston, SA; Anderson, RM
Academic Medicine, 78(6): 629-633.

PDF (75)
The American Journal of the Medical Sciences
Building the Case for Cultural Competence
Genao, I; Bussey-Jones, J; Brady, D; Branch, WT; Corbie-Smith, G
The American Journal of the Medical Sciences, 326(3): 136-140.

PDF (123)
Journal of Developmental & Behavioral Pediatrics
Cultural and Linguistic Determinants in the Diagnosis and Management of Development Delay in a Four Year Old

Journal of Developmental & Behavioral Pediatrics, 23(5): 371-376.

PDF (92)
Journal of Pediatric Orthopaedics
Cultural Competence: Serving Latino Patients
Poon, AW; Gray, KV; Franco, GC; Cerruti, DM; Schreck, MA; Delgado, ED
Journal of Pediatric Orthopaedics, 23(4): 546-549.

PDF (193)
Academic Medicine
Medically Related Cultural Issues Can Be Learned Outside the Classroom
Kwan, CY
Academic Medicine, 76(1): 1-2.

PDF (111)
Academic Medicine
Viewpoint: Cultural Competence and the African American Experience with Health Care: The Case for Specific Content in Cross-Cultural Education
Eiser, AR; Ellis, G
Academic Medicine, 82(2): 176-183.
10.1097/ACM.0b013e31802d92ea
PDF (70) | CrossRef
Academic Medicine
Assessing Medical Students' Skills in Working With Interpreters During Patient Encounters: A Validation Study of the Interpreter Scale
Lie, D; Bereknyei, S; Braddock, CH; Encinas, J; Ahearn, S; Boker, JR
Academic Medicine, 84(5): 643-650.
10.1097/ACM.0b013e31819faec8
PDF (77) | CrossRef
Academic Medicine
Applying Theory to the Design of Cultural Competency Training for Medical Students: A Case Study
Crandall, SJ; George, G; Marion, GS; Davis, S
Academic Medicine, 78(6): 588-594.

PDF (86)
Pediatric Emergency Care
The importance of cultural and linguistic issues in the emergency care of children
FLORES, G; RABKE-VERANI, J; PINE, W; SABHARWAL, A
Pediatric Emergency Care, 18(4): 271-284.

PDF (723)
Back to Top | Article Outline

© 2000 Association of American Medical Colleges

Login

Article Tools

Images

Share