Cultural Competence — Needed Now More Than Ever

In the past couple of years, our nation has experienced a tide of significant social events: the shooting of Michael Brown and other black lives lost in police custody leading to the Black Lives Matter movement; the most public gender transition in nation’s our history with Caitlyn Jenner and her family in the spotlight; the Supreme Court decision legalizing gay marriage nationwide; the tragic shooting at Emanuel African Methodist Episcopal Church in Charleston, South Carolina; a lead exposure crisis in Flint, Michigan; and often offensive and hurtful political debates about immigration and religious freedoms. It’s clear that our students are not immune to, or insulated from, these complicated events.

It is my hope that, as a nation, we will use these difficult issues as opportunities for learning and growth. The differences between us — whether faculty to faculty, faculty to student, student to student, PA to patient, or PA to other medical professional — matter in both small and very big ways. One key example is the issue of health inequality in the United States as well as across the globe.

As educators and medical professionals, we can also use this opportunity to renew our commitments to diversity and to getting cultural competence right — even though it can be an elusive challenge.

According to John L. Coulehan and Marian R. Block in their classic book, The Medical Interview: Mastering Skills for Clinical Practice: “The goal of cultural competence is to deliver the best possible health care to diverse populations in our society.” Like many others who have written on the subject, the authors emphasize the importance of personal self-awareness, respect, empathy, and cultural humility.

In addition to wanting to help our students when they graduate be able to deliver the best possible health care, we, as PA educators, have the ARC-PA Accreditation Standard B1.06 (a “must” standard) to guide our curriculum. This standard states that “the curriculum must include instruction to prepare students to provide medical care to patients from diverse populations.” As far as national health care goals and initiatives, we also have Healthy People 2020 helping us to focus on specific areas for improvement.

There are resources that many of us use to help with self-awareness and humility, like the “Crossing the Line” exercise and Barnga: A Simulation Game on Cultural Clashes — but other excellent teaching resources are out there, and the Cultural Competencies Committee, a committee of PAEA’s Inclusion and Diversity Council, would like to highlight and share some of these resources.

PAEA members can now benefit from a cultural competence resource page on the PAEA website. Committee members have compiled and vetted some resources and have organized them by topic using both broad and specific subject headings, including: Culturally Appropriate Care, Health Disparities, Health Equity and Bias, Health Literacy, LGBT Inclusion, and Social Determinants of Health. We encourage members to submit resources for these pages in the spirit of collaboration and shared purpose for our profession.

The resource bank includes tools to address health disparities among LGBT patients as identified in Healthy People 2020. Some educators feel ill-equipped to teach LGBT-competent care or to assist students in facing biases in this area. I, for one, was surprised when I discovered an acronym with many more letters than I had initially learned and needed to use the Urban Dictionary and my on-campus ally group to educate myself. Do you know what all these letters stand for: LGBTQQIAAP? Do you know the difference between terms like gender-reassignment surgery and gender-confirming surgery?

If you would like more resources including those that outline specific needs of LGBT patients, or if you are already aware of strong resources on this topic that you’d like to share, please visit the webpage or others prepared by PAEA’s Cultural Competencies Committee at:

At times it seems the words “diversity” and “cultural competence” are thrown around so often that they begin to lose meaning and significance. It is my hope that some of you reading this still find these words fresh and exciting. If variety really is “the spice of life,” then diversity is actually the cure for the doldrums. Let’s reignite our passion to truly celebrate diversity and renew our commitment to strive for a culturally sensitive and truly patient-centered approach to the field of medicine.