Academic journal article American Journal of Pharmaceutical Education

Nine Constructs of Cultural Competence for Curriculum Development

Academic journal article American Journal of Pharmaceutical Education

Nine Constructs of Cultural Competence for Curriculum Development

Article excerpt


Cultural competence has emerged as an important strategy to respond to the multicultural, multiracial, and multilingual needs of a growing diverse population in the United States, and to reduce disparities in health and health care. (1) Although policies are in place that mandate culturally and linguistically competent health care, and several national organizations and accreditation bodies require the inclusion of training in cultural competence in continuing education and academic programs, (2) several studies show that health professionals still are not prepared to interact adequately with the diverse cultures in our nation's patient populations. (3) The Accreditation Council for Pharmacy Education's (ACPE's) revised standards includes Guideline 9.1: "The college or school must ensure that the curriculum addresses patient safety, cultural competence, health literacy, health care disparities, and competencies needed to work as a member of or on an interprofessional team." (4)

To satisfy this academic standard at Xavier University of Louisiana College of Pharmacy, a reliable and practical instrument was needed for students to use to self-assess their perceived cultural competencies. The instrument would be used: (1) to evaluate students' needs for training in cultural competence; (2) as a baseline measure with which to compare perceived change over time in the competencies developed during the academic program; and (3) as a tool to compare students' perceptions of their level of cultural competency (self-assessment) with their performance in the real world (peer, patient, staff, and teachers' feedback, and evaluations). Also, data collected from students over time would be useful to examine differences in perceptions over the entire academic program, such as different classes in the same academic year or the same cohort over the complete curriculum, and as feedback for curriculum development and improvement. (5)

Cultural competence assessment falls into 4 categories: evaluation of the cultural competencies of the individual; evaluation of the implementation of cultural competence in the organization; evaluation of the delivery of culturally competent services and programs; and evaluation of curriculum, education, and training programs in cultural competence. In a review of the status of assessment of cultural competence, South-Paul and Like concluded that the lack of a standard definition and reliable indicators of cultural competence impede the ability to measure the impact of culturally competent provider behaviors on the outcomes of care. (6) From a meta analysis of the medical education literature, much variance was found in the way researchers assess cross-cultural education, and a mixed-methods approach was

recommended for evaluation and assessments, including self-assessment of perceived level of competencies, and the assessment of performance. (2) Mixed methods would include pre- post-tests, role playing, portfolios, standardized patients, pharmacy practice experiences, objective structured clinical examinations, and patients' evaluations. A self-assessment strategy applied systematically and sequentially throughout the pharmacy curriculum would provide opportunities for students to monitor their own progress and give faculty members insight on students' strengths and weaknesses. (7) This self-assessment could be used as an important source of data for a comprehensive assessment of the academic program. (8)

An extensive number of instruments have been developed for self-assessment of cultural competence in health professions; (9) some of them are validated and widely used measures of cultural competence, and others are used in cultural competence training. (10) A review of the most widely used measures revealed important limitations to their application in this study including: restriction to a specific specialty or profession; inherent restrictions and biases (11); abbreviated length that would not provide enough information for curriculum development; extensive length prohibiting ease of application in an academic environment; and environmental adaptability problems. …

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