Resident physicians report that training often not adequate to treat patients from other cultures

September 06, 2005

Many resident physicians report a lack of preparedness in caring for patients with specific cultural characteristics, such as those who have beliefs or practices at odds with Western medicine, according to an article in the September 7 issue of JAMA, a theme issue on medical education.

Sociocultural differences between patients and physicians influence communication and clinical decision making, and there is evidence that patient-physician communication is directly linked to patient satisfaction, adherence, and overall quality of care, according to background information in the article. Unexplored or misunderstood sociocultural differences between patients and physicians can lead to patient dissatisfaction, poor adherence to treatment, and poor health outcomes. In an effort to provide health care professionals with the knowledge and skills to effectively care for diverse populations, an educational movement in "cross-cultural care" has emerged. Little has been known about residents' educational experience in this area.

Joel S. Weissman, Ph.D., of Massachusetts General Hospital, Boston, and colleagues conducted a study to assess the self-perceived preparedness of resident physicians to provide quality care to diverse patient populations and to determine whether they reported receiving formal training and evaluation in cross-cultural care during their residency. To accomplish this, surveys were mailed in 2003 to approximately 3,500 residents in 7 specialties in their final year of training at major U.S. teaching hospitals.

Responses were obtained from 60 percent (2,047) of the sample. Virtually all (96 percent) of the residents indicated that it was moderately or very important to address cultural issues when providing care. The number of respondents who indicated that they believed they were not prepared to care for diverse cultures in a general sense was only 8 percent. However, a larger percentage of respondents believed they were not prepared to provide specific components of cross-cultural care, including caring for patients with health beliefs at odds with Western medicine (25 percent), new immigrants (25 percent), and patients whose religious beliefs affect treatment (20 percent). In addition, 24 percent indicated that they lacked the skills to identify relevant cultural customs that impact medical care. In contrast, only a small percentage of respondents (1 percent-2 percent) indicated that they were not prepared to treat clinical conditions or perform procedures common in their specialty.

Approximately one-third to half of the respondents reported receiving little or no instruction in specific areas of cross-cultural care beyond what was learned in medical school. Forty-one percent (family medicine) to 83 percent (surgery and obstetrics/gynecology) of respondents reported receiving little or no evaluation in cross-cultural care during their residencies. Barriers to delivering cross-cultural care included lack of time (58 percent) and lack of role models (31 percent).

"These findings have implications for how residency training programs prepare physicians to provide high-quality care to an increasingly diverse nation. The practice of medicine continues to be complex and it is difficult to achieve a high level of competence in all areas. Nevertheless, the views from residents indicate that a lot of additional training and the presence of good role models and mentors go a long way to ensure that they are sufficiently skilled to deliver high-quality medical care," the authors write.

"Our study is the first, to our knowledge, to obtain a national estimate of the readiness of new physicians to deliver high-quality care to culturally diverse populations. While attitudes regarding the importance of cross-cultural care seem to be positive, there appear to be relatively few opportunities for meaningful education and mentoring, and little evaluation. These findings highlight a need for significant improvement in cross-cultural education to help eliminate racial and ethnic disparities in health care," the authors conclude.
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(JAMA. 2005; 294:1058 - 1067. Available pre-embargo to the media at www.jamamedia.org.)

Editor's Note: This work was supported by grants from The California Endowment and The Commonwealth Fund.

The JAMA Network Journals

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