Alliance meeting day 4: Addressing health care disparities and cultural competence in CME/CPD programs

This is such an important topic for CME providers that I hope the Alliance gives it a marathon of its own next year. Now that New Jersey and California have rules mandating some form of cultural competency training for healthcare workers in place, and several other states are considering it, this topic will only get hotter as time goes on and the U.S. population continues to diversify—and as disparities in healthcare among different ethnicities continue to plague our people. OK, off my soapbox.

I'll wait until I get the slides before doing a full writeup on this one. Medical Meetings also covered some of the same ground in an article I can't find right now online (I'll add the link when I can find it. Update: here it is). Plus writing up the marathon commercial support session has me whipped for the night. But presenter Alejandro Aparicio, MD, with the AMA, made a compelling case for the pervasiveness of healthcare disparities that exist in the U.S., even after adjusting for income and insurance. The Institute of Medicine 2001 and 2002 reports said that medicine should be equitable, and that healthcare providers can benefit from cross-cultural education. Robert Like, MD, with the UMDNJ Center for Healthy Families and Cultural Diversity, outlined the efforts in this area currently going on in the undergraduate and graduate arenas, the Calif. and N.J. rules, and efforts going on globally from New Zealand and Australia to Europe.

Like talked about the business case for cultural competency training for healthcare workers (employers have to cope with absenteeism and unhealthy workers as a result of the disparity in care), the research case, and of course the financial case.

"Keep in mind that there can be huge disparities and differences within one group," he added. For example, be careful when using the terms "Hispanic" or "Latino" when addressing that ethnicity: "There are political things attached to each term, and you could get a volcanic reaction if you use the one that isn't how people identify themselves."

Some rules to live by:

* There is no "cookbook approach" to treating patients.

* Avoid stereotyping and overgeneralization.

* Think of ethnicities in terms of strengths and assets

* Keep in mind that every encounter is a cross-cultural encounter.

Admittedly, this self-selected group already had an interest in the topic, but I still was surprised when, using an audience response system, we found out that 64 percent of the audience had already provided CME activities dealing with healthcare disparities or cultural competency. Some examples the audience provided of programs they'd done:

* To resolve problems physicians were having dealing with death and dying among patients of different ethnicities, the provider brought in religious leaders within the various cultures to help docs understand how to handle their specific needs.

* Another provider said his university was in the fourth year of providing conferences on disparities in specific disease states.

* Another is planning a three-day program on disparities in healthcare.

Eighty percent of the audience also said they were planning to provide cultural competency activities in the future. But there are hurdles to overcome. For example, one audience member is struggling with terminology: to her, the "underserved" in the annual CME innovations in best practices for the underserved her organization puts on means "minorities," since she's in an urban environment. For others in her organization in more rural areas, "underserved" means something else. There's also pushback from docs, as one California-based provider said. "Physicians in California are angry because they're being legislated to have to do cultural competency CME, on top of the other mandated topics. It's just another micromanaged part of their education." But, as Like pointed out, cultural competency isn't just another topic for CME—it's part of everything you do (remember, every encounter is a cross-cultural one. Think about it.).

Cultural competency training really has to take a systems approach, he added. "It's not just the culture of the patients, but also the doctor's cultural background, the culture of the organization, and the culture of healthcare.

Update/Note: When I interviewed Dr. Like for this article on cultural competency and CME last year, he sent me a terrific list of resources to go to for more information. It fell off our home page when we redesigned Medical Meetings last fall; I'll add it back, now that I notice it had disappeared. To download the Word file, click here.

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