September 16, 2005

Many resident physicians feel unprepared to care for culturally diverse patients

Many resident physicians responding to a national survey do not feel prepared to address issues they commonly face in caring for patients from different cultural backgrounds. Most 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 MGH Institute for Health Policy appeared 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 and 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.”

Almost all of the more than 2,000 residents responding to the survey acknowledged that culturally based difficulties could result in significant problems in patient care. While only a few indicated that they felt unprepared to respond to general questions about caring for patients of different cultures, 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. One third to one half reported receiving little or no training in handling specific situations. 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.

“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 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.”

MGH co-authors of the study are Eric Campbell, PhD, Elyse Park, PhD, David Blumenthal, MD, Angela Maina and Karen Lee, MD.