Academic journal article American Journal of Pharmaceutical Education

A Comparison of Educational Interventions to Enhance Cultural Competency in Pharmacy Students

Academic journal article American Journal of Pharmaceutical Education

A Comparison of Educational Interventions to Enhance Cultural Competency in Pharmacy Students

Article excerpt


Although Americans of European descent currently make up the majority of the US population, there may not be a single majority group by 2050. (1) For healthcare professionals, this change will be reflected in an increasingly diverse patient population. In 2002, the Institute of Medicine (IOM) reported that, compared with white Americans, racial and ethnic minorities in the United States receive a lower quality of health care. (2) These disparities have been further highlighted in specific healthcare services, including screening for breast and cervical cancer and management of diabetes and anticoagulation control. (3-5) Additionally, there are disparities in the rates of diagnosis, morbidity, and mortality in minority populations compared with the same among non-Hispanic whites in cancer, diabetes, heart disease, HIV/AIDS, immunizations, infant mortality, and stroke. (6) Although the reasons for these disparities are not fully understood, the IOM has acknowledged several possible factors that may affect the ways in which healthcare providers deliver care to different populations, including language and cultural differences; distrust of the medical system among minority patients; a lack of minority physicians in clinical practice who may be more culturally sensitized to the needs of minority patients; time limitations imposed by the pressures of clinical practice; and conscious or unconscious biases, prejudices, or negative racial and ethnic stereotypes. (2)

These disparities are particularly important for individuals in the profession of pharmacy, considering that those of Caucasian descent represent 90%, 75%, and 89% of pharmacists, pharmacy faculty members, and pharmacy students in this country, respectively. (7,8) Therefore, given the underrepresentation of minorities among pharmacy professionals and trainees, education and training are imperative to the effective provision of care for patients of nonmajority cultures. The American Pharmacists Association, the American Society of Health-System Pharmacists, and the American Association of Colleges of Pharmacy have all published policies and statements highlighting the importance of increasing knowledge and awareness of cultural differences. (9-11) Similarly, the Accreditation Council for Pharmacy Education (12) requires the inclusion of education in cultural competence in the doctor of pharmacy (PharmD) degree program.

The goal of education and training is to produce a healthcare provider with the knowledge, attitudes, and skills to provide culturally competent care. Cultural competence has been described as a process, not an endpoint, in which the practitioner continuously strives to achieve the ability to effectively work within the cultural context of an individual, family, or community from a diverse cultural background. (13) Cultural competence can be classified into 6 components: cultural awareness, cultural knowledge, cultural skills, cultural encounters, cultural desire, and cultural empathy. (14,15)

Methods of instruction to improve cultural competence vary, and many have been published in the pharmacy literature. There are multiple descriptions of cultural competency education and awareness in individual courses, throughout several courses, and in introductory and advanced pharmacy practice experiences (IPPEs/APPEs). (16-24) Some colleges and schools of pharmacy have elected to integrate cultural competency content throughout the entire PharmD curriculum. (25-27) Activities have included assigned readings, classroom lectures, documentaries, case discussions, and portfolio reflections.

Schools of medicine, nursing, dentistry, and pharmacy have used simulated patients as a unique method of instruction to enhance student learning and to gain practical experience in a nonthreatening teaching environment. (28-34) Simulated patients have been used to teach and evaluate students' and residents' cultural competence. …

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