Do ratings of African-American cultural competency reflect characteristics of providers or perceivers? Initial demonstration of a generalizability theory approach.

Provider cultural competency is often identified as an important component of effective ethnic minority healthcare. However, there is limited knowledge of the manner in which cultural competency judgments operate. This study sought to provide an initial demonstration of a hitherto overlooked methodology for examining the extent to which provider cultural competency ratings reflect characteristics of providers, differences among perceivers, and also idiosyncratic pairings of specific perceivers and providers. Second and third year medical residents rated four attending physicians for cultural competency when treating African-American patients. Using a Generalizability Theory approach, cultural competency ratings were shown to most substantially reflect unique perceiver and provider pairings (47.0% relationship effect). However, cultural competency also strongly reflected differences among resident raters in their tendency to perceive attending physicians as culturally competent, regardless of the characteristics of physicians (35.0% perceiver effect). Although cultural competency significantly reflected the characteristics of providers this effect was small (3.0% provider effect). This study demonstrates an overlooked methodological approach and suggests important new directions for conceptualizing theory and research.