What should we include in a cultural competence curriculum? An emerging formative evaluation process to foster curriculum development

Abstract

Purpose: To identify, prioritize, and organize components of a cultural competence curriculum to address disparities in cardiovascular disease.

Method: In 2006, four separate nominal group technique sessions were conducted with medical students, residents, community physicians, and academic physicians to generate and prioritize a list of concepts (i.e., ideas) to include in a curriculum. Afterward, 45 educators and researchers organized and prioritized the concepts using a card-sorting exercise. Multidimensional scaling (MDS) and hierarchical cluster analysis produced homogeneous groupings of related concepts and generated a cognitive map. The main outcome measures were the number of cultural competence concepts, their relative ranks, and the cognitive map.

Results: Thirty participants generated 61 concepts; 29 were identified by at least two participants. The cognitive map organized concepts into four clusters, interpreted as (1) patient's cultural background (e.g., information on cultures, habits, values), (2) provider and health care (e.g., clinical skills, awareness of one's bias, patient centeredness, professionalism), communication skills (e.g., history, stereotype avoidance, health disparities epidemiology), (3) cross-culture (e.g., idiomatic expressions, examples of effective communication), and (4) resources to manage cultural diversity (e.g., translator guides, instructions, community resources). The MDS two-dimensional solution demonstrated a good fit (stress = 0.07; R² = 0.97).

Conclusions: A novel, combined approach allowed stakeholders' inputs to identify and cognitively organize critical domains used to guide development of a cultural competence curriculum. Educators may use this approach to develop and organize educational content for their target audiences, especially in ill-defined areas like cultural competence.

Figure 1

A graphical representation of the question development, the nominal group technique groups, and how the responses to the question that was developed were processed. The study goal was to identify, prioritize, and organize components of a cultural competence curriculum that could address disparities in care for cardiovascular disease.

Figure 2

Representation of ideas, “families,” and “neighborhoods” to include in a cultural competence curriculum. The x-axis is a dimension of patient centeredness (Patient Centrism) with a neighborhood of issues more intrinsic to the patient (Patient’s Background, on the left side of the figure) and a neighborhood of issues more extrinsic to the patient (Resources, on the right side). Similarly, the y-axis is a dimension of health-care centeredness (Provider and Health- System Centrism) with a neighborhood of issues more intrinsic to health care (Provider/Health Care, on the upper portion of the figure) and a neighborhood of issues more extrinsic to health care (Resources and Cross-Culture, on the lower portion of the figure). “Resources” stands for resources to manage cultural diversity (translator guides, Instructions, and community resources). “Cross-Culture” indicates such things as idiomatic expressions and examples of effective communication. For the statements of the ideas (1–29) see Table 1.