The emergence of the concept of cross cultural education in medical and health care curricula is a product of three salient influences. First, cross cultural education prepares health care providers with the necessary knowledge for an effective practice in the growing population diversity.
The presence of a diversity of cultures that are not in any way restricted to a geographical location requires health care professionals top be at par with the linguistic and cultural influences that impact on the quality of delivery of health care.
Second, various studies have hypothesized that the inclusion of a cross cultural education component in the medical and health care curricula would improve provider-patient relationship through effective communication and consequently work towards the elimination of pervasive racial or ethnic disparities that negatively impact on health care provision today.
Third, an understanding of the cultural systems of the receivers of health care is critical in assessing the belief and cultural systems that hinder or assist effective health care delivery. For these reasons cultural sensitivity must be ingrained into the educational experiences of the medical student(Smedley et al 202).
To achieve the desired objectives of cross cultural education, there are several approaches that are used. Basically, training is done with respect to three distinct conceptual approaches that specifically focus on the attitudes, knowledge and skills. Just like the proverbial three legged stool, each of these conceptual approaches play a unique and crucial role, consecutively the other two approaches remain indispensable.
The focus on attitudes is central to professionalism. Empathy, humility, respect, curiosity, sensitivity and awareness are core attitudes that profoundly influence the patient and consequently the health outcome. In the provider, these attitudes create the desire to explore and negotiate the diversity of health beliefs and behaviors.
With regard to attitudes, cross cultural education aims at increasing the provider awareness on the impacts of several sociocultural influences on individual patients’ health beliefs, behaviors, values and ultimately health care quality and outcomes.
Through exploration and reflection on classism, sexism , culture and racism the impacts of these sociocultural influences on health care can be discerned and strategies set to effectively mitigate against the negative impacts(Smedley et al 203).
For instance, in book The Spirit Catches You and You Fall Down, the Hmong people usually relied on shamans for help, for in their culture shamans were doctors. An account is given where Lia after going through conventional medical intervention failed to regain health and a shamans ritual had to be performed.
Another account is given concerning an American doctor, who took blood from patients and spent very little time with them. Cultural underpinnings could not allow these people to understand the reasons behind the drawing of blood nor the limited questioning time. Given the fact that the Hmong language was alien to the American doctor, communication was almost non existent.
They could not ask questions that could be interpreted as rude, for according to the Hmong culture, their medical providers; the shamans operated in Gentle ways. Such a scenario requires doctors to attain cross-cultural competencies in their practice.
A second approach of knowledge, works towards ensuring that health care professionals aqre endowed with knowledge on the beliefs, behaviors, values and attitudes of specific ethnic or cultural groups. For example, it is rather parochial to assume that beliefs on health care among Asians and Hispanics are the same.
When this difference is coupled to the differences in religion as well as other multiple influences of acculturation and socioeconomic status that define intra group variability then it becomes extremely difficult to unify facts or cultural norms. Cultural norms like fatalism among the Hispanics and passivity among the Asians and the influences of these norms on health care attest to the necessity of cross cultural education.
To acquire such knowledge students generally employ two basic tenets in training; that of community assessment or community oriented health care and evidence based approach on health delivery(Smedley et al 206).
In line with the conceptual approach of skills, providers are required to be in possession of skills that meld with the ethnographic tools of medical anthropology.
For cross cultural education to achieve this end, the framework may focus on work based approaches on culturally oriented communication skills while training health care providers on specific cross cutting cultural issues, health beliefs and social issues while at the same time creating methods of dealing with such information once it is derived from the community.
At the end of cross cultural education in health care, health care professionals would have attained cultural and linguistic competence. In essence, cultural and linguistic competence can be described as a dynamic cross cultural interaction.
It espouses the ability of providers of health care to understand and offer effective response to cultural and linguistic needs that are manifested by the patient. In context, linguistic competence enables providers to provide readily available and culturally or ethnically appropriate oral and written languages services to patients who are inefficient in English or rather patients with limited English proficiency(LEP).
In cases where a single individual does not possess the capacity to master the diversity of languages, health care organizations achieve this by having bilingual or bi cultural staff, qualified translators or trained medical interpreters(Huber 387).
On the other hand cultural competence is definitive of a set of congruent attitudes, behaviors and policies that are brought together in an agency or system or among health care professionals and which function with the aim of enabling effective provider-patient interactions in a cross cultural framework.
Such a form of competence opines that an organization should value diversity, carry out self assessments, effectively manage the dynamics of difference, engage in the acquisition and institutionalization of cultural knowledge and finally use such knowledge to adapt to the diversity and cultural concepts of the populace which they serve(Williams et al 15).
The relevance of culturally and ethnically sensitive health care is without question as it adjusts practice style to be in congruence with patients specific needs. Among learners and educators, the cross cultural approach in medical education has gained popularity as its clinical applicability drives towards ensuring that there exists quality health care for all the citizens of America.
Moreover, the diversity of the American landscape fueled by the growing minority populations from immigrant influx, required that the health care industry pro actively respond to the demographic evolution.
Given that providers are not shielded from cultural and ethnic diversity, the variations that exist in the recognition of health indicators and outcomes present a novel challenge in quality health care provision. Only cross cultural education in health care can tackle these challenges.
Fadiman, Anne. The Spirit Catches You and You Fall Down. Farrar, Straus & Giroux, 1997
Huber, Diane. Leadership and nursing care management. Elsevier Health Sciences, 2006
Smedley, D. Brian., Stith, Y. Adrienne., Nelson, R. Alan. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Institute of Medicine (U.S.). Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care. National Academies Press, 2003
Williams, V. Mark., Flanders, A. Scott, Whitcomb, F. Winthrop., Cohn, L. Steven., Michota, A. Franklin., Russell, Holman., Richard, G. Geno, J. Merli. Comprehensive Hospital Medicine: An Evidence-Based Approach. Health Sciences, 2007