This guide provides resources related to cultural competency, structural competency, and cultural humility, as well as racism and bias in clinical practice.
Significant criticisms of cultural competency have been raised. However, the phrase is still in use and is commonly searched. The owner of this guide continues to use this title after examination of search trends and terminology across websites and presentations.
She does not proclaim to be an expert in these areas and hopes to improve this guide with community input. Please contact Stacy Brody at email@example.com to discuss additional/alternative titles and resources.
NIH Request for Information (RFI): Inviting Comments and Suggestions to Advance and Strengthen Racial Equity, Diversity, and Inclusion in the Biomedical Research Workforce and Advance Health Disparities and Health Equity Research. Response Date: April 09, 2021.
AHRQ RFI: Use of Clinical Algorithms That Have the Potential To Introduce Racial/Ethnic Bias Into Healthcare Delivery. Response Date: May 4, 2021.
"Attitudes and behaviors, which are characteristic of a group or community." (HRSA, 2019)
"A set of similar behaviors, attitudes, and policies that come together in a system, agency, or among professionals that enables effective work in cross-cultural situations." (HRSA, 2019)
Another definition for cultural competence comes from the Center for Substance Abuse Treatment. Substance Abuse: Administrative Issues in Outpatient Treatment. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2006. (Treatment Improvement Protocol (TIP) Series, No. 46.) Chapter 4. Preparing a Program To Treat Diverse Clients.
"It is a process that requires humility as individuals continually engage in self-reflection and self-critique as lifelong learners and reflective practitioners.1-2,7 It is a process that requireshumility in how physicians bring into check the power imbalances that exist in the dynamics of physician-patient communication by using patient-focused interviewing and care.8,9 And it is a process that requires humility to develop and maintain mutually respectful and dynamic partnerships with communities on behalf of individual patients and communities in the context of community-based clinical and advocacy training models.4,6,7" (Tervalon and Murray-Garcia,1998)
Tervalon M, Murray-García J. Cultural humility versus cultural competence: a critical distinction in defining physician training outcomes in multicultural education. J Health Care Poor Underserved. 1998 May;9(2):117-25. doi: 10.1353/hpu.2010.0233. PMID: 10073197. Access the PDF via Himmelfarb.
Masters C, Robinson D, Faulkner S, Patterson E, McIlraith T, Ansari A. Addressing Biases in Patient Care with The 5Rs of Cultural Humility, a Clinician Coaching Tool. J Gen Intern Med. 2019 Apr;34(4):627-630. doi: 10.1007/s11606-018-4814-y. Epub 2019 Jan 8. PMID: 30623383; PMCID: PMC6445906..
See: Why cultural safety rather than cultural competency is required to achieve health equity: a literature review and recommended definition (Curtis, E., Jones, R., Tipene-Leach, D., Walker, C., Loring, B., Paine, S. J., & Reid, P., 2019). The article presents a number of definitions for different terms, as collected from a literature review, and recommends a definition for cultural safety.
See January 2020 article from County Health Rankings for background reading
"critical consciousness... places medicine in a social, cultural, and historical context and which is coupled with an active recognition of societal problems and a search for appropriate solutions" (Kumagai & Lypson, 2009)
Kumagai, A. K., & Lypson, M. L. (2009). Beyond cultural competence: Critical consciousness, social justice, and multicultural education: Academic Medicine, 84(6), 782–787. https://doi.org/10.1097/ACM.0b013e3181a42398
"occurs when providers respond to the inherent uncertainty of the diagnostic and treatment processes by interpreting the data and information relevant to a minority patient differently from the way they do with white patients"... involves "misusing and misapplying factually accurate information to reach an inaccurate conclusion concerning the specific patient."
See pages 98-99 in Matthew (2015).
Matthew, D. (2015). Just medicine : a cure for racial inequality in American health care. New York University Press.
Available online through Himmelfarb.
"the trained ability to discern how a host of issues defined clinically as symptoms, attitudes, or diseases (e.g., depression, hypertension, obesity, smoking, medication “non-compliance,” trauma, psychosis) also represent the downstream implications of a number of upstream decisions about such matters as health care and food delivery systems, zoning laws, urban and rural infrastructures, medicalization, or even about the very definitions of illness and health" (Metzl & Hansen 2014)
See also: Spring 2014 article, With Understanding Comes Empowerment, from New Physician and Sep 2014 article, Structural Competency Meets Structural Racism: Race, Politics, and the Structure of Medical Knowledge, from AMA Journal of Medical Ethics.