CDE Appendix 1 Literature Review - Central East Local Health ...

The Culture, Diversity and Equity Project: Literature Review
This framework and the specific ternary of competencies within each of these framework pillars are presented in full
in Appendix 5.
5.2 CULTURAL COMPETENCE TRAINING STANDARDS & QUALITY ASSURANCE
US post-secondary educational institutions have been at the forefront of developing and incorporating cultural
competence modules into the standard educational curriculum for medical/health-care professionals in training. A
2004 paper in the Journal of the American Medical Association for instance found that among close to 8,000
graduate medical educational programs surveyed in the United States, 50.7 percent offered cultural competence
training in 2003–2004, up from 35.7 percent in 2000–2001 (Brotherton, 2004; cited in Betancourt et al., 2005).
Betancourt et al. (2005) attribute this transformation to a combination of ‘stick’ and ‘carrot’ approaches.
The ‘stick’, in this respect, has taken the form of increasing regulatory pressures since 2002, particularly in the form
of accreditation standards. In 2002, the Liaison Committee on Medical Education (LCME) introduced the first
official cultural competence accreditation standards, and required all medical schools to integrate these into their
curricula.
The Accreditation Council of Graduate Medical Education (ACGME) has also introduced cultural competence
standards for residency programs (see ACGME, 2004). New Jersey has gone even further with the stick approach
and passed legislation in 2005 that requires cultural competence education as a requirement for the licensure of
health care professionals (see Salas-Lopez et al., 2007; also see Baquet et al., 2004).
Exemplifying the ‘carrot’ approach, which has also helped to move the medical education field forward in the area
of cultural competence, the New York State of Health modified its $33 million per year Graduate Medical Education
Reform Incentive Pool in 2004 to ‘reward residency programs that provided eight hours of cultural competence
training to at least 80 percent of residents’ (New York Dept of Health 2004; cited in Betancourt et al., 2005).
Demonstrating the effectiveness of this ‘carrot’ approach, “[i]n the first year, 66 of the 104 residency programs in
New York State proposed new cultural competence curricula” (ibid.).
Cultural competence training outside of post-secondary educational contexts, for practicing healthcare professionals,
contrastingly, remains “haphazard and varying in quality”, in no small part due to the lack of agreed upon standards
and evaluative criteria by which to assess cultural competence training in such contexts (California Endowment,
2003).
The development of such training standards in continuous professional education and development contexts is a key
area for future research. In the meantime, educational standards and evaluative tools (such as the TACCT; see
below) of cultural competence borrowed from post-secondary educational contexts and curricula could be adapted to
continuous learning contexts.
Aside from the Association for Multicultural Counselling and Development’s Multicultural Counselling
Competencies, which have been proposed by Sue et al. (1998) as standards for the American Counselling
Association but not adopted, the only other proposed ‘standards’ for cultural competency training discovered in the
literature derive from the California Endowment’s (2003) Report, Principles and Recommended Standards for
Cultural Competence Education of Health Care Professionals. The recommendations from this report are explored
below.
Principles and Recommended Standards for Cultural Competence Education of Health Care Professionals.
(California Endowment, 2003): The Principles and Standards recommended in the 2003 California Endowment
report are designed to accompany the Culturally and Linguistically Appropriate Services in Health Care (CLAS
Standards) adopted by the Office of Minority Health in 2002. Intended for “persons who are charged with direct
patient care and the delivery of health care services” (CE, 2003), the standards “provide guidance as to the general
content and organization of educational programs” (ibid.). The Reports authors thus advise that “experts in specific
health care disciplines” be consulted to integrate relevant subject matter into the suggested framework of standards
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