An Integrative Approach to Cultural Competence in the Psychiatric Curriculum

Department of Psychiatry, University of Toronto, Toronto Western Hospital, Toronto, Ontario M5T 2S8, Canada.
Academic Psychiatry (Impact Factor: 0.81). 07/2008; 32(4):272-82. DOI: 10.1176/appi.ap.32.4.272
Source: PubMed


As it is increasingly recognized that cultural competence is an essential quality for any practicing psychiatrist, postgraduate psychiatry training programs need to incorporate cultural competence training into their curricula. This article documents the unique approach to resident cultural competence training being developed in the Department of Psychiatry at the University of Toronto, which has the largest residency training program in North America and is situated in an ethnically diverse city and country.
The authors conducted a systematic review of cultural competence by searching databases including PubMed, PsycINFO, PsycArticles, CINAHL, Social Science Abstracts, and Sociological Abstracts; by searching government and professional association publications; and through on-site visits to local cross-cultural training programs. Based on the results of the review, a resident survey, and a staff retreat, the authors developed a deliberate "integrative" approach with a mindful, balanced emphasis on both generic and specific cultural competencies.
Learning objectives were derived from integrating the seven core competencies of a physician as defined by the Canadian Medical Education Directions for Specialists (CanMEDS) roles framework with the tripartite model of attitudes, knowledge, and skills. The learning objectives and teaching program were further integrated across different psychiatric subspecialties and across the successive years of residency. Another unique strategy used to foster curricular and institutional change was the program's emphasis on evaluation, making use of insights from modern educational theories such as formative feedback and blueprinting. Course evaluations of the core curriculum from the first group of residents were positive.
The authors propose that these changes to the curriculum may lead to enhanced cultural competence and clinical effectiveness in health care.

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    • "Another option is to use cultural mediators who can not only offer linguistic interpretation, but also mediate between health professionals and service users [93]. Learning objectives can be derived from the seven core competencies of a physician as defined by the Canadian Medical Education Directions for Specialists (CanMEDS) roles framework with the tripartite model of attitudes, knowledge, and skills [41] [62]. These roles are defined as medical expert, communicator, scholar, professional, collaborator, manager and health advocate. "
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    ABSTRACT: The stress of migration as well as social factors and changes related to the receiving society may lead to the manifestation of psychiatric disorders in vulnerable individuals after migration. The diversity of cultures, ethnicities, races and reasons for migration poses a challenge for those seeking to understand how illness is experienced by immigrants whose backgrounds differ significantly from their clinicians. Cultural competence represents good clinical practice and can be defined as such that a clinician regards each patient in the context of the patient's own culture as well as from the perspective of the clinician's cultural values and prejudices. The EPA Guidance on cultural competence training outlines some of the key issues related to cultural competence and how to deal with these. It points out that cultural competence represents a comprehensive response to the mental health care needs of immigrant patients and requires knowledge, skills and attitudes which can improve the effectiveness of psychiatric treatment. To reach these aims, both individual and organizational competence are needed, as well as teaching competence in terms of educational leadership. The WPA Guidance on Mental Health and Mental Health Care for Migrants and the EPA Guidance on Mental Health Care for Migrants list a series of recommendations for policy makers, service providers and clinicians; these are aimed at improving mental health care for immigrants. The authors of this paper would like to underline these recommendations and, focusing on cultural competency and training, believe that they will be of positive value. Copyright © 2015 Elsevier Masson SAS. All rights reserved.
    European Psychiatry 02/2015; 30(3). DOI:10.1016/j.eurpsy.2015.01.012 · 3.44 Impact Factor
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    • "The four pairs of essays are followed by three commentaries from experienced clinical educators, including two from the United States and one from Germany. Several features set this collection apart from related recent work by clinical educators (Betancourt 2003, 2006; Fung et al. 2008; Kripalani et al. 2006; Smith et al. 2007; Sumpter and Carthon 2011) and anthropologists alike. First, our aim is not to document or propose any specific pedagogical models or ''best practices,'' but "

    Culture Medicine and Psychiatry 04/2013; 37(2). DOI:10.1007/s11013-013-9319-x · 1.29 Impact Factor
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    • "These concepts may be understood as subsets of cultural competence that emerged from specific social contexts and their usefulness therefore tends to be narrower in scope. Cultural competence, on the other hand, encompasses the minimal requisites of safety and humility, but extends beyond this to compel the health care system and service providers to proactively and appropriately address the needs of diverse vulnerable populations (Fung, et al., 2008; Srivastava, 2007). "
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