Cultural competency, race, and skin tone bias among pharmacy, nursing, and medical students: implications for addressing health disparities

Med Care Res Rev. 2009 Aug;66(4):436-55. doi: 10.1177/1077558709333995. Epub 2009 Apr 15.


The Institute of Medicine report, Unequal Treatment, asserts that conscious and unconscious bias of providers may affect treatments delivered and contribute to health disparities. The primary study objective is to measure, compare, and contrast objective and subjective cognitive processes among pharmacy, nursing, and medical students to discern potential implications for health disparities. Data were collected using a cultural competency questionnaire and two implicit association tests (IATs). Race and skin tone IATs measure unconscious bias. Cultural competency scores were significantly higher for non-Hispanic Blacks and Hispanics in medicine and pharmacy compared with non-Hispanic Whites. Multiracial nursing students also had significantly higher cultural competency scores than non-Hispanic Whites. The IAT results indicate that these health care preprofessionals exhibit implicit race and skin tone biases: preferences for Whites versus Blacks and light skin versus dark skin. Cultural competency curricula and disparities research will be advanced by understanding the factors contributing to cultural competence and bias.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Cultural Competency* / psychology
  • Female
  • Healthcare Disparities
  • Humans
  • Male
  • Prejudice*
  • Psychological Tests
  • Racial Groups / psychology*
  • Skin Pigmentation*
  • Stereotyping
  • Students, Health Occupations / psychology*
  • Surveys and Questionnaires
  • Uncertainty
  • United States