Recent reports have underscored the importance of cross-cultural training in addressing racial and ethnic disparities within healthcare systems. However, the actual educational experiences of resident physicians in this crucial area remain largely unexplored. This study delves into understanding resident physicians’ perspectives on Cultural Care, their self-assessed readiness to provide quality care to diverse patient populations, and the nature of their training environments in relation to cross-cultural competence.
A comprehensive survey was distributed in the winter of 2003 to a randomly selected group of 3,435 resident doctors in their final year of training. These residents represented diverse specialties including emergency medicine, family practice, internal medicine, obstetrics/gynecology, pediatrics, psychiatry, and general surgery across various US academic health centers. The survey aimed to capture a broad perspective on cultural care education within residency programs.
The study garnered responses from a significant 60% of the sampled residents, totaling 2,047 participants. An overwhelming majority, 96%, affirmed the moderate to high importance of addressing cultural factors in patient care. While a small fraction, only 8%, felt generally unprepared to care for diverse cultures, a notable proportion expressed lack of confidence in specific aspects of cultural care. This included managing patients with health beliefs differing from Western medicine (25%), caring for new immigrants (25%), and navigating patient care influenced by religious beliefs (20%). Furthermore, nearly a quarter (24%) admitted lacking the necessary skills to identify relevant cultural customs impacting medical treatment. This contrasts sharply with their confidence in core medical skills, where only 1%-2% felt unprepared in routine clinical procedures within their specialties.
The research highlighted a significant gap in training. A substantial portion of residents, ranging from one-third to half, reported minimal or no specific instruction in key areas of cross-cultural care beyond their basic medical school education. Formal evaluation in cultural care during residencies was also lacking, with reports ranging from 41% in family medicine to a concerning 83% in surgery and obstetrics/gynecology indicating little to no evaluation. Identified obstacles to delivering effective cultural care included time constraints (58%) and a lack of visible role models in this area (31%).
In conclusion, resident physicians’ perceived readiness to deliver cultural care significantly trails behind their preparedness in traditional clinical and technical skills. Despite recognizing the importance of cultural care, residency programs appear to allocate insufficient time for addressing cultural complexities and provide limited training, formal assessment, or mentorship in this domain. These inconsistent messages from the educational environment underscore a critical need for substantial enhancements in cross-cultural education. Such improvements are essential to effectively tackle racial and ethnic disparities and ensure equitable healthcare delivery for all patient populations.
