April 4-6, 2024 • Hyatt Regency • Lexington, KY
Innovations in Health Communication
Innovations in Health Communication
Abstract: Practicing Across the Rural-Urban Divide: Gaps in Cultural Competency Training in Medical Schools
In 2003, the Institute for Medicine called for the incorporation of cultural competency curricula into medical education, in order to address the poor communication and worse health outcomes experienced among patients of color (Smedley, et al, 2003). The Accreditation Council of Graduate Medical Education (ACGME) state that the curriculum for all specialties must contain a number of educational components, including the following:
IV.B.I.a).(1).(e) respect and responsiveness to diverse patient populations, including but not limited to diversity in gender, age, culture, race, religion, disabilities, national origin, socioeconomic status, and sexual orientation (www.acgme.org).
While such training programs have been mandated for twenty years, there is little consistency in the definitions of culture, the methods of training, and evidence of the effectiveness of the training across medical schools (Chun, 2010). In a 2020 study, students interviewed after received cultural competency training focused on individual characteristics of patients without a recognition of system or structural realities which formed different identities (Goyal, et al, 2020). Finally, training has largely focused on racial and ethnic distinctions, and more recently LGBTQ awareness, leaving uncovered issues of gender, generational and rural-urban distinctions.
This study will focus in particular on rural-urban distinctions in medicine. The rural-urban distinction in culture is complex. On one hand, both public and scholarly texts often depend upon generalizations and stereotypes, such as rural as traditional and urban as modern. At the same time, actual distinctions such as cultural values (Doran, et al, 2013), access to internet and use for information retrieval (Phillips, et al, 2014), elements of social capital and associated media effects (Beaudoin, 2004), and access to medical and education opportunities do exist. Authors Johnson, Gilley, and Gray argue that rural describes “an astoundingly complex assemblage of people, places, and personalities” (2016). Ballard-Reisch suggests that scholars must then listen to the voices of rural people, centering their perspectives in one’s scholarship (2010). This project began as an examination of misunderstandings encountered when medical students from the University of Washington, which is the primary teaching hospital for a five-state area (Washington, Wyoming, Alaska, Montana and Idaho) went to do clerkships in rural clinics.
For this paper, I evaluate the curriculum of a number of medical schools for the areas they cover within cultural competency, and the methods by which the information is taught. Next, this information will be compared with the results of long interviews with 20+ doctors with experience working in rural communities, for what they believe medical students need to know before coming into clerkships, residency, and beyond in rural areas. Finally, I point out gaps in the cultural competency education being provided and make suggestions for broadening the curriculum.
IV.B.I.a).(1).(e) respect and responsiveness to diverse patient populations, including but not limited to diversity in gender, age, culture, race, religion, disabilities, national origin, socioeconomic status, and sexual orientation (www.acgme.org).
While such training programs have been mandated for twenty years, there is little consistency in the definitions of culture, the methods of training, and evidence of the effectiveness of the training across medical schools (Chun, 2010). In a 2020 study, students interviewed after received cultural competency training focused on individual characteristics of patients without a recognition of system or structural realities which formed different identities (Goyal, et al, 2020). Finally, training has largely focused on racial and ethnic distinctions, and more recently LGBTQ awareness, leaving uncovered issues of gender, generational and rural-urban distinctions.
This study will focus in particular on rural-urban distinctions in medicine. The rural-urban distinction in culture is complex. On one hand, both public and scholarly texts often depend upon generalizations and stereotypes, such as rural as traditional and urban as modern. At the same time, actual distinctions such as cultural values (Doran, et al, 2013), access to internet and use for information retrieval (Phillips, et al, 2014), elements of social capital and associated media effects (Beaudoin, 2004), and access to medical and education opportunities do exist. Authors Johnson, Gilley, and Gray argue that rural describes “an astoundingly complex assemblage of people, places, and personalities” (2016). Ballard-Reisch suggests that scholars must then listen to the voices of rural people, centering their perspectives in one’s scholarship (2010). This project began as an examination of misunderstandings encountered when medical students from the University of Washington, which is the primary teaching hospital for a five-state area (Washington, Wyoming, Alaska, Montana and Idaho) went to do clerkships in rural clinics.
For this paper, I evaluate the curriculum of a number of medical schools for the areas they cover within cultural competency, and the methods by which the information is taught. Next, this information will be compared with the results of long interviews with 20+ doctors with experience working in rural communities, for what they believe medical students need to know before coming into clerkships, residency, and beyond in rural areas. Finally, I point out gaps in the cultural competency education being provided and make suggestions for broadening the curriculum.