Abstract
BACKGROUND
Recent reports from the Institute of Medicine emphasize patient-centered care and cross-cultural training as a means of improving the quality of medical care and eliminating racial and ethnic disparities.
OBJECTIVE
To determine whether, controlling for training received in medical school or during residency, resident physician socio-cultural characteristics influence self-perceived preparedness and skill in delivering cross-cultural care.
DESIGN
National survey of resident physicians.
PARTICIPANTS
A probability sample of residents in seven specialties in their final year of training at US academic health centers.
MEASUREMENT
Nine resident characteristics were analyzed. Differences in preparedness and skill were assessed using the χ2 statistic and multivariate logistic regression.
RESULTS
Fifty-eight percent (2047/3500) of residents responded. The most important factor associated with improved perceived skill level in performing selected tasks or services believed to be useful in treating culturally diverse patients was having received cross-cultural skills training during residency (OR range 1.71–4.22). Compared with white residents, African American physicians felt more prepared to deal with patients with distrust in the US healthcare system (OR 1.63) and with racial or ethnic minorities (OR 1.61), Latinos reported feeling more prepared to deal with new immigrants (OR 1.88) and Asians reported feeling more prepared to deal with patients with health beliefs at odds with Western medicine (1.43).
CONCLUSIONS
Cross-cultural care skills training is associated with increased self-perceived preparedness to care for diverse patient populations providing support for the importance of such training in graduate medical education. In addition, selected resident characteristics are associated with being more or less prepared for different aspects of cross-cultural care. This underscores the need to both include medical residents from diverse backgrounds in all training programs and tailor such programs to individual resident needs in order to maximize the chances that such training is likely to have an impact on the quality of care.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: National Academies Press; 2001.
Institute of Medicine. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Washington, DC: National Academies Press; 2002.
Barzansky B, Jonas HS, Etzel SI. Educational programs in US medical schools. JAMA. 2000;284:1114–20.
Park ER, Betancourt JR, Kim MK, Maina AW, Blumenthal D, Weissman JS. Mixed messages: residents’ experiences learning cross-cultural care. Acad Med. 2005;80:874–80.
Weissman JS, Betancourt JR, Campbell EG, Park ER, Kim M, Clarridge B, et al. Resident physician’s preparedness to provide cross-cultural care. JAMA. 2005;294:1058–67.
Blumenthal D, Gokhale M, Campbell EG, Weissman JS. Preparedness for clinical practice: reports of graduating residents at academic health centers. JAMA. 2001;286:1027–34.
Betancourt JR. Cultural competence and medical education: many names, many perspectives, one goal. Acad Med. 2006;81:499–501.
Betancourt JR. Cultural competence—marginal or mainstream movement? N Engl J Med. 2004;351:953–5.
Weissman JS, Campbell EG, Gokhale M, Blumenthal D. Residents’ preferences and preparation for caring for underserved populations. J Urban Health. 2001;78:535–49.
Weissman JS, Campbell EG, Blumenthal D. How does market competition affect resident physicians’ views toward managed care? Am J Med. 2000;109:437–42.
Park ER, Wolfe TJ, Gokhale M, Winickoff JP, Rigotti NA. Perceived preparedness to provide preventive counseling: reports of graduating primary care residents at academic health centers. J Gen Intern Med. 2005;20:386–91.
Brotherton SE, Rockey PH, Etzel SI. US graduate medical education, 2003–2004. JAMA. 2004;292:1032–7.
Cooper LA, Roter DL, Johnson RL, Ford DE, Steinwachs DM, Powe NR. Patient-centered communication, ratings of care, and concordance of patient and physician race. Annals of Int Med. 2003;139:907–15.
Malat J. Social distance and patients’ rating of healthcare providers. J Health Soc Behav. 2001;42:360–72.
Saha S, Komaromy M, Koepsell TD, Bindman AB. Patient-physician racial concordance and the perceived quality and use of health care. Arch Int Med. 1999;159:997–1004.
Cooper-Patrick L, Gallo JJ, Gonzalez JJ, et al. Race, gender, and partnership in the patient-physician relationship. JAMA. 1999;282:583–9.
Hall MA, Dugan E, Zheng B, Mishra AK. Trust in physicians and medical institutions: what is it, can it be measured, and does it matter. Millbank Q. 2001;79:613–39.
Hall MA, Camacho F, Dugan E, Balkrishnan R. Trust in the medical profession: conceptual and measurement issues. Health Serv Res. 2002;37:1419–39.
Thom DH, Hall MA, Pawlson LG. Measuring patients’ trust in physicians when assessing quality of care. Health Aff (Millwood). 2004;23:124–32.
Gamble VN. A legacy of distrust: African Americans and medical research. Am J Prev Med. 1993;9:35–8.
Collins KS, Hughes DL, Doty MM, Ives BL, Edwards JN, Tenney K. Diverse communities, common concerns: Assessing health care quality for minority Americans. Findings from the Commonwealth Fund 2001 Health Care Quality Survey. New York: The Commonwealth Fund; 2002.
Saha S, Arbelaez JJ, Cooper LA. Patient-physician relationships and racial disparities in the quality of health care. Am J Pub Health. 2003;93:1713–9.
Gelb AM, Cassell E. Approaches to the training of foreign medical graduates. J Med Educ. 1972;47:429–33.
Haveliwala YA. Problems of foreign born psychiatrists. Psychiatr Q. 1979;51:307–11.
Fiscella K, Roman-Diaz M, Lue BH, Botelho R, Frankel R. ‘Being a foreigner, I may be punished if I make a small mistake’: assessing transcultural experiences in caring for patients.”. Family Practice. 1996;14:112–6.
Croasdale M. Classes teach new IMGs American-style medicine. American Medical News; 2006;11 Dec:1, 4.
Moy E, Bartman BA. Physician race and care of minority and medically indigent patients. JAMA. 1995;273:1515–20.
Xu G, Hojat M, Veloski JJ, Brose J. A national study of factors influencing primary care career choices among underrepresented-minority, white, and Asian American physicians. Acad Med. 1996;71(Suppl 10)S10–2.
Cohen JJ. The consequences of premature abandonment of affirmative action in medical school admissions. JAMA. 2003;289:1143–9.
King TE Jr, Dickinson TA, DuBose TD Jr, Flack JM, Hellmann DB, Pamies RJ, et al. The case for diversity in academic internal medicine. Am J Med. 2004;116:284–9.
Whitla DK, Orfield G, Silen W, Teperow C, Howard C, Reede J. Educational benefits of diversity in medical school: a survey of students. Acad Med. 2003;78:460–6.
Institute of Medicine. In the Nation’s Compelling Interest: Ensuring Diversity in the Health Care Workforce. Washington, DC: National Academies Press; 2004.
Johnson D, Cujec B. Comparison of self, nurse, and physician assessment of residents rotating through an intensive care unit. Crit Care Med. 1998;26:1811–6.
Biernat K, Simpson D, Duthie E Jr, Bragg D, London R. Primary care residents self assessment skills in dementia. Adv Health Sci Educ Theory Pract. 2003;8:105–10.
Zonia SC, Stommel M. Interns’ self-evaluations compared with their faculty’s evaluations. Acad Med. 2000;75:742.
Cantor JC, Baker LC, Hughes RG. Preparedness for practice: young physicians’ views of their professional education. JAMA. 1993;270:1035–40.
Hawkins RE, Sumpton KF, Gaglione MM, Holmboe ES. The in-training examination in internal medicine: resident perceptions and lack of correlation between resident scores and faculty predictions of resident performance. Am J Med. 1999;106:206–10.
Fincher RM, Lewis LA, Kiske TT. Relationships of interns’ performances to their self-assessments of their preparedness for internship and to their academic performances in medical school. Acad Med. 1993;68(Suppl 2)S47–50.
Roberts KB, Starr S, DeWitt TG. The University of Massachusetts Medical Center office-based continuity experience: are we preparing pediatrics residents for primary care practice? Pediatrics. 1997;100:E2.
Schubert A, Tetzlaff JE, Tan M, Ryckman JV, Mascha E. Consistency, inter-rater reliability, and validity of 441 consecutive mock oral examinations in anesthesiology: implications for use as a tool for assessment of residents. Anesthesiology. 1999;91:288–98.
Betancourt JR, Weissman JS, Kim MK, Park ER, Maina AW. Resident physician’s preparedness to provide cross-cultural care: Implications for clinical care and medical education policy. Project report to the Commonwealth Fund. Available at http://www.commonwealthfund.org/publications. Accessibility verified August 2008.
Acknowledgements
Dr. Lenny Lopez acknowledges the support of an Institutional National Research Service Award #5 T32 HP11001–19. This work was supported by grant 20021803 from The California Endowment and grant 20020727 from The Commonwealth Fund. This paper was presented as a poster at the March 2007 New England Regional SGIM meeting and the April 2007 National SGIM meeting.
Conflict of interest
None disclosed.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Lopez, L., Vranceanu, AM., Cohen, A.P. et al. Personal Characteristics Associated with Resident Physicians’ Self Perceptions of Preparedness to Deliver Cross-Cultural Care. J GEN INTERN MED 23, 1953–1958 (2008). https://doi.org/10.1007/s11606-008-0782-y
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11606-008-0782-y