4.1 Cultural Competence Training
Cultural competence training focuses on developing skills and knowledge that value diversity and cultural differences and raise awareness of providers’ and care organizations’ cultural norms. Trainings provides information about patient cultures, intercultural communication skills, exploration of potential barriers to care, and institution of policies that are sensitive to the needs of patients from culturally and linguistically diverse backgrounds (UW, 2025).
There is strong evidence that cultural competence training can improve a healthcare provider’s knowledge, understanding, and skills for treating patients from culturally, linguistically, and socioeconomically diverse backgrounds (UW, 2025). Although improvements have been made, certain obstacles remain:
- lack of consensus on what should be taught
- timing of training
- lack of standard references
- limited and inconsistent formal evaluation of interventions (Gradellini et al., 2021)
4.2 Educational Approaches
A widely used tool for understanding and improving cultural sensitivity is Bennett’s Developmental Model of Intercultural Sensitivity (DMIS). Milton Bennett, a professor at Portland State University in Oregon, developed the tool as a framework to explain how people experience cultural differences. It provides a roadmap of how we move from an ethnocentric to an ethnorelative perspective and highlights stages of development with the goal of intercultural acceptance, adaptability, and integration. Use the Developmental Model of Intercultural Sensitivity (DMIS) to analyze the following case.
4.2.1 Case: Haseya
Haseya is a 62-year-old traditional Navajo patient with advanced type 2 diabetes who consistently misses follow-up appointments and is “non-compliant” with her insulin regimen. She has said that she prefers visiting a traditional tribal medicine man. Analyze your response to Haseya using the DMIS model below. The approach you choose can directly dictate how you will react to this patient, diagnose the underlying issue, and formulate a care plan.
Stage 1. Denial: You do not see cultural differences or consider them relevant. You assume “a body is a body, and standard medicine works the same for everyone.”
Stage 2. Defensiveness: You acknowledge cultural differences but view them in an “us vs. them” hierarchy. Your Western medical training is seen as superior, and the patient's cultural practices are viewed as an obstacle or threat.
Stage 3. Minimizing or Trivializing the Patient’s Concerns: You acknowledge differences but trivialize them by overemphasizing human commonalities. You rely on a “colorblind” or “we are all the same underneath” philosophy, which masks deep, systemic cultural differences. Your approach is forcing the patient to adjust your worldview. In the next three stages, you shift your approach and adjust care to match the patient.
Stage 4. Recognizing and Accepting Cultural Differences: You recognize and genuinely respect patterns of cultural differences. You realize Western medicine is just one worldview of health among many, even if you don't fully understand the other views yet.
Stage 5. Adaptation: You can shift cultural perspective intentionally and actively adapt your clinical behavior to bridge the gap across worldviews.
Stage 6. Integrating Cultural Competency Into your Daily Practice: Your clinical identity is fluid. You move effortlessly between cultural perspectives to construct an inclusive environment, often acting as systemic change agents within the hospital.
Source: Adapted from HHS, 2022
Learn more about this tool here.
4.2.2 Self-Assessment
The Implicit Association Test and the Cultural Competency Checklist are two commonly used tools for self-assessing cultural competence.
The Implicit Association Test (IAT) measures the strength of our automatic mental associations with concepts like racial groups, age categories, or sexual orientations. It measures fraction-of-a-second cognitive processing to show how cultural stereotypes can automatically influence clinical decision-making. Rapid-categorization exercises focus on specific clinical responses. For example:
- Do you automatically associate older age with cognitive decline?
- Do you associate low income with an inability to adhere to complex medical instructions?
- Do you think an overweight patient lacks willpower and is unable to make good lifestyle choices?
The Cultural Competence Checklist is used to assess cultural competency, increasing a provider’s awareness and sensitivity to cultural and linguistic concepts. The checklist serves as a mirror, helping you identify your strengths and areas for growth. The value of self-assessment lies in using the tool to identify gaps in your learning. Here are some sample assessment scenarios from the Cultural Competency Checklist:
- For someone who speaks a language or dialect other than English, I try to learn and use key words in their language so that I am better able to communicate with them during assessment, treatment, or other interventions.
Yes No - I try to understand local or cultural expressions used by individuals or families that may impact assessment, treatment, or interventions.
Yes No - I use visual aids, gestures, and physical prompts in my interactions with individuals who have limited English proficiency (LEP).
Yes No - I understand that limited English proficiency is in no way a reflection of intellectual functioning.
Yes No - I understand that limited English proficiency has no bearing on a person’s ability to communicate in their language of origin.
Yes No
More self-assessments tools can be found on the NCCC website.