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Many resident physicians feel unprepared
to care for culturally diverse patients
JAMA report finds training
lacking in key areas, suggests improvements needed
BOSTON - September 6, 2005 - Although most resident physicians
responding to a national survey acknowledge the importance of providing
care that accommodates the needs of today's diverse patient population,
many of them do not feel prepared to address cross-cultural issues
they commonly face in practice. Most also report receiving little
or no training in providing cross-cultural care during their residencies,
and fewer still say they were evaluated on cultural aspects of their
patient communication skills. The report from the Massachusetts
General Hospital (MGH) Institute
for Health Policy appears in the Sept. 7 issue of the Journal
of the American Medical Association.
"Residents are getting mixed messages during their training,"
says Joel S. Weissman, PhD, of the MGH Institute for Health Policy,
the study's lead author. "On one hand they recognize that these
issues are important, but on the other hand they have little clinical
time to address cultural issues, they receive limited instruction
and little or no evaluation, and there are too few good role models
and mentors." Weissman has studied medical care access problems
of the uninsured and racial and ethnic minorities for many years.
Increasing attention has been paid recently to how sociocultural
differences between patients and providers can complicate health
care - leading to poor communication, patient dissatisfaction and
reduced quality of care. In the past ten years both the American
Medical Association and the Accreditation Council for Graduate Medical
Education have issued statements emphasizing the importance of training
in cross-cultural care. In 2002 the Institute
of Medicine released a report highlighting racial and ethnic
disparities disparities in health care and recommending cross-cultural
education of health professionals as one method of addressing this
crisis. The JAMA paper is the first national study of young
physicians' readiness to care for a culturally diverse population.
The research team mailed surveys to about 3,500 residents in the
final years of their training programs in seven specialties at 149
academic health centers across the U.S. Of the more than 2,000 respondents,
almost all acknowledged the importance of considering a patient's
culture when providing care. Many of them agreed that culturally
based difficulties could result in such problems as longer office
visits and patients' not understanding or complying with instructions.
Although only a few residents indicated that they felt unprepared
in response to general questions about caring for patients of different
cultures or ethnic and racial minorities, when asked about specific
situations - such as caring for patients who mistrust the U.S. health
system, have health beliefs that conflict with Western medicine
or are recent immigrants - 20 to 25 percent replied that they felt
unprepared. A similar percentage felt they could not recognize mistrust
in patients or identify cultural or religious customs that might
have an impact on care. As a comparison, only 2 to 3 percent of
respondents indicated not feeling ready to handle typical clinical
problems.
When questioned about their residency experiences, one third to
one half the respondents reported receiving little or no training
in handling such situations as properly addressing patients from
other cultures, understanding different family decision-making structures,
or working with interpreters. Even in programs that offer cross-cultural
training, significant numbers of residents reported no instruction
in key areas. Lack of time was cited most frequently as a barrier
to providing cross-cultural care; and other problems mentioned included
poor access to interpreters, absence of written materials in needed
languages and limited experience. A lack of good role models or
mentors for cross-cultural care was reported by 30 percent of respondents,
and more than 60 percent reported not being evaluated on cross-cultural
skills.
"Given the growing racial and ethnic diversity of our nation,
it is troubling that many of our newest doctors feel unprepared
to communicate effectively with patients from a broad range of cultural
backgrounds," says Joseph Betancourt, MD, MPH, director of
the MGH Disparities Solutions Center and co-lead author of the JAMA
report. "We suggest that residency programs integrate cross-cultural
education as part of both formal and informal training experiences,
provide mentorship, and evaluate resident physicians' performance
in this critical area." A member of the team that produced
the Institute of Medicine report, Betancourt is an assistant professor
of Medicine at Harvard Medical School (HMS).
Adds Weissman, an associate professor of Health Care Policy at HMS,
"The contrast between residents' preparedness to handle everyday
clinical problems and their confidence in dealing with cultural
issues suggests that graduate medical education may be too heavily
weighted toward technical skills. We know that communication is
a critical part of good patient care, and our study indicates that
there is lots of room for improvement in our training programs."
Co-authors of the JAMA study are Eric Campbell, PhD, Elyse
Park, PhD, David Blumenthal, MD, and Angela Maina of the MGH Institute
of Health Policy; Minah Kim, PhD, Ewha Women's University, Korea;
Brian Clarridge, University of Massachusetts, Boston; and Karen
Lee, MD, MPH, MGH Center for Child and Adolescent Health Policy.
The study was supported by grants from The California Endowment
and The Commonwealth Fund.
Massachusetts General Hospital, established in 1811, is the original
and largest teaching hospital of Harvard Medical School. The MGH
conducts the largest hospital-based research program in the United
States, with an annual research budget of more than $450 million
and major research centers in AIDS, cardiovascular research, cancer,
cutaneous biology, medical imaging, neurodegenerative disorders,
transplantation biology and photomedicine. In 1994, MGH and Brigham
and Women's Hospital joined to form Partners HealthCare System,
an integrated health care delivery system comprising the two academic
medical centers, specialty and community hospitals, a network of
physician groups, and nonacute and home health services.
Media Contact: Donita
Boddie, MGH Public Affairs
Physician Referral Service: 1-800-388-4644
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