It’s a buzzword in medical education: teaching cultural competency. But how do you “teach it?” Would it be lecture-based, reflection-based, small-group-based? To declare oneself as culturally competent in itself may always be premature. Will you ever fully understand a culture or perspective that you don’t identify with?
At Dartmouth, every student is required to complete at least one clerkship that fulfills “cultural competence.” So what does that look like? Well, here I am, 2 weeks into my psychiatry clerkship in San Francisco, and it amazes me how diverse the city is. Even though I’ve always lived in urban centers, living in a rural center for the past 2 years really puts things in perspective. During rounds, we often have a translator service ready if a patient needs it. Patients will discuss how urban gentrification has affected their access to healthcare. Even the hospital here is making weekly efforts to teach cultural competency. There are cultural competency lunches, and the last one I attended was on the SF Chinese community. It was very interesting. The facilitator talked about the different services within the city that tailor healthcare to Chinese and Chinese-American patients. He talked about different cultural practices, like how a patient’s family members often want to be the ones to clean the hospital room and tend to his needs, rather than hospital staff. Or, that a patient will often wait for family members to be at the hospital before they eat. And how patients often will request hot water (instead of cold water).
What was most interesting was in a discussion about patient autonomy in medicine. Our medical education really emphasizes patient choice: provide a list of treatment options and the patient chooses, base don what they believe is best for them. But during this session, the facilitator talked about how many patients view the physician as the one who should tell them what to do. It strikes up this tension in medicine which is really interesting.
In just 1 hr I learned so much about just 1 population of individuals, and it hardly scratched the surface of being culturally competent. So I know it’s going to be a never-ending exposure to learning about people’s backgrounds and beliefs throughout medicine (during school and beyond).