Cultural competencytraining is a vehicle topromote patient-centredcareAarti Bansal, Academic Unit of Primary Medical Care, University of Sheffield, UK

Iread with interest your recentarticle by Illingworth,1 whichclarifies the definition of

patient-centred care, and I wishto highlight links between thegoals of medical undergraduatecultural competency training andthe promotion of patient-centredcare.

I have recently introduced abrief (3-hour) cultural competencytraining session for third-yearmedical students that explores theconcept of ‘culture’ and how itinfluences doctors’ and patients’perceptions of health and illness,and expectations of health care.Through interactive exercises, thetraining emphasises that culture isdynamic, multidimensional(encompassing socio-economicstatus, religion, gender, sexualorientation, occupation,

disability, etc.), and that everyoneis ‘multicultural’ in that individu-als belong to multiple groups. Therisks and consequences of stereo-typing a patient on the basis of asingle dimension of their culturalidentity, such as ethnicity orreligion, are also explored.

Cultural competency trainingis based on attitudes of curiosity,empathy and respect – attitudesthat are central to patient-cen-tred care.2 The need to elicit thepatient’s perspective, which is akey requirement of patient-centred care, is particularlyimportant when the ‘culturaldistance’ between patient anddoctor is great.3 Research hasdemonstrated that doctors aremore likely to employ a patient-centred approach with patientsfrom a similar background to

themselves, compared with theirapproach to those from culturalbackgrounds that differ from theirown.4 In addition, Bower et al.suggest that cultural differencesbetween patients’ and doctors’health perceptions and expecta-tions challenge the delivery ofpatient-centred care.5 However,they also propose that this‘cultural challenge’ can informteaching in patient-centred care,making training more clinicallyrelevant for medical students.

Self-awareness and reflectionare widely acknowledged to begeneric skills essential forlifelong learning, and explorationof personal biases and assump-tions (which are often culturallyinformed) is a key requirementfor developing cultural compe-tence.3 Notably, one of Mead and

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Bower’s ‘five dimensions ofpatient-centredness’, i.e. doctoras a person, also supports thisrequirement.6

In a recent review of culturalcompetency, Kodjo recommendsthree areas for exploration duringa medical consultation: themeaning of illness; the socialcontext; and negotiation of ashared agreement.7 These keyareas mirror closely the aspira-tions of patient-centred careoutlined by Illingworth.1 Widerrecognition that promotion ofpatient-centred care is a centralaim of cultural competence may

encourage medical educators tointegrate cultural competencytraining into the mainstreamundergraduate curriculum.

REFERENCES

1. Illingworth R. What does ‘patient-

centred’ mean in relation to the con-

sultation? Clin Teach 2010;7:116–120.

2. Carillo JE, Green AR, Betancourt JR.

Cross-cultural primary care: a patient-

based approach. Ann Intern Med

1999;130:829–834.

3. Betancourt JR. Cultural competence

and medical education: many names,

many perspectives, one goal. Acad

Med 2006;81:499–501.

4. Johnson RL, Roter D, Powe NR, Cooper

LA. Patient race ⁄ ethnicity and quality

of patient–physician communication

during medical visits. Am J Public

Health 2004;94:2084–2090.

5. Bower DJ, Young S, Larson G, Simpson

D, Tipnis S, Begaz T, Webb T. Charac-

teristics of patient encounters that

challenge medical students’ provision

of patient-centred care. Acad Med

2009;84:S74–S78.

6. Mead N, Bower P. Patient-centred-

ness: a conceptual framework and re-

view of the empirical literature. Soc

Sci Med 2000;51:1087–1110.

7. Kodjo C. Cultural competence in

clinician communication. Pediatr Rev

2009;30:57–63.

Corresponding author’s contact details: Dr Aarti Bansal, Academic Unit of Primary Medical Care, University of Sheffiled, Sam Fox House,Northern General Hopsital, Sheffield S5 7AU, UK. E-mail: a.bansal@shef.ac.uk

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