Culturally competent care pedagogy: what works?

BACKGROUND: In its 2002 publication Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care, the Institute of Medicine reported American racial and ethnic minorities receive lower-quality health care than white Americans. Because caregiver bias may contribute to disparate health care, the Liaison Committee on Medical Education and the Accreditation Council for Graduate Medical Education have issued specific directives to address culturally competent care education. QUESTIONS/PURPOSES: We discuss the general approaches to culturally competent care education, the tools used in evaluating such endeavors, and the impact of such endeavors on caregivers and/or the outcomes of therapeutic interventions from three perspectives: (1) Where are we now? (2) Where do we need to go? (3) How do we get there?
METHODS: We summarized information from (1) articles identified in a PubMed search of relevant terms and (2) the authors' experience in delivering, evaluating, and promoting culturally competent care education. WHERE ARE WE NOW?: Considerable variation exists in approaches to culturally competent care education; specific guidelines and valid evaluation methods are lacking; and while existing education programs may promote changes in providers' knowledge and attitudes, there is little empirical evidence that such efforts reduce indicators of disparate care. WHERE DO WE NEED TO GO?: We must develop evidence-based educational strategies that produce changes in caregiver attitudes and behaviors and, ultimately, reduction in healthcare disparities. HOW DO WE GET THERE?: We must have ongoing dialog about, development in, and focused research on specific educational and evaluation methodologies, while simultaneously addressing the economic, political, practical, and social barriers to the delivery of culturally competent care education.