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RESEARCH ARTICLE
Baseline cultural competence in physician
assistant students
Melanie M. Domenech Rodrı
´guezID
1
*, Paula B. Phelps
2
, H. Cathleen Tarp
2,3
1Department of Psychology, Utah State University, Logan, Utah, United States of America, 2Physician
Assistant Studies Department, Idaho State University, Pocatello, Idaho, United States of America, 3Global
Studies and Languages Department, Idaho State University, Pocatello, Idaho, United States of America
*melanie.domenech@usu.edu
Abstract
Purpose
Cultural competence is a critical component in health care services. The relationship
between health disparities and prejudice and discrimination is well documented. Prejudicial
attitudes and discriminatory behavior are modifiable through training yet few programs have
evidence-based training. No published data has reported on baseline levels of cultural com-
petencies in medical trainees which is necessary for tailoring programs appropriate to the
audience. This manuscript fills that gap by reporting on data from three cohorts of first-year
Physician Assistant (PA) students (N= 216). We examined students’ baseline levels with
special attention to differences in cultural competence constructs across age, gender, and
ethnicity.
Methods
Students completed self-report measures for ethnic identity, ethno-cultural empathy, multi-
cultural orientation, attitudes about diversity, health beliefs attitudes, colorblind racial atti-
tudes, and burnout at the beginning of their first year. They completed the measures online
(Qualtrics) during class time, prior to a lecture on cultural competence.
Results
Data indicate a correlation between cultural competence constructs supporting the validity
of the battery of tests as a cohesive unit to measure cultural competence. There were statis-
tically significant differences between age, gender identity, and ethnic groups across cultural
competence variables.
Conclusions
Data provide baseline data that may be used to tailor educational programs. Findings sug-
gest that our measures show promise for future educational research measuring effective-
ness of cultural competence training.
PLOS ONE | https://doi.org/10.1371/journal.pone.0215910 April 23, 2019 1 / 10
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OPEN ACCESS
Citation: Domenech Rodrı
´guez MM, Phelps PB,
Tarp HC (2019) Baseline cultural competence in
physician assistant students. PLoS ONE 14(4):
e0215910. https://doi.org/10.1371/journal.
pone.0215910
Editor: Carl Richard Schneider, The University of
Sydney School of Pharmacy, AUSTRALIA
Received: October 31, 2018
Accepted: April 10, 2019
Published: April 23, 2019
Copyright: ©2019 Domenech Rodrı
´guez et al. This
is an open access article distributed under the
terms of the Creative Commons Attribution
License, which permits unrestricted use,
distribution, and reproduction in any medium,
provided the original author and source are
credited.
Data Availability Statement: Data cannot be
shared publicly because participants could be
identified. The Utah State University Institutional
Review Board (IRB) approved consent did not
include notifying participants of the fact that data
would be made publicly available therefore we do
not have participant consent to share these data.
Since the content is sensitive and participants
could be identified, sharing data is not possible at
this time. Fully de-identified data will be available
on request. Requests may be sent to melanie.
Introduction
Cultural competence is a bona fide occupational qualification for medical and mental health
providers broadly [1–3]. There is overwhelming evidence that health disparities are related to
prejudice and discrimination broadly [3]. And while expectations are clearly stated, little is
known about how to clearly meet them in assessment [4] or training [5] activities. The purpose
of this manuscript is to provide information regarding one program’s evaluation of cultural
competence in their first-year students across three cohorts and examine students’ baseline
levels across years with special attention to differences in cultural competence constructs
across age, gender, and ethnicity. The aim of this study is to measure baseline cultural compe-
tence in first year PA students using self-measurement tools and to determine factors that may
affect these baseline measures.
Dictionary definitions of culture point to beliefs, customs, ways of life, and ways of thinking
or behaving shared by a people or group. In the academic literature, culture has been defined
as “learned, socially shared, and variable.” [6]. The “systems of meaning” are passed on from
one generation to the next and cultural groups are identifiable as cohesive social units. Culture
encompasses beliefs, values, and behaviors learned by people in the context of relationships
and practices shared over time. Although cultures are constantly evolving, systems of meaning
remain cohesive and recognizable over time.
Cultural competence has been defined as “the ability of healthcare professionals to commu-
nicate with and effectively provide high-quality care to patients from diverse sociocultural
backgrounds” [7]. Dimensions of diversity include race / ethnicity, gender, sexual orientation,
religion, country of origin, among others. Most definitions of cultural competence point to
three important dimensions: self-awareness or awareness of the self as a cultural being, knowl-
edge about cultural others, and specific skills in working with others [8,9].
Improving cultural competence in Physician Assistant (PA) training is a professional neces-
sity at a time when standards of competence in the health professions [3], medicine [10], and
the PA profession [11] specifically require their workforce to have these skills. The principal
standard of the National Standards for Culturally and Linguistically Appropriate Services
(NCLAS) in Health and Health Care is to “provide effective, equitable, understandable, and
respectful quality care and services that are responsive to diverse cultural health beliefs and
practices, preferred languages, health literacy, and other communication needs.” [3]. The
NCLAS Blueprint calls for training and evaluation to address this standard, but does not pro-
vide specific guidance on how to train or evaluate. The literature provides some general guid-
ance in regards to training. A systematic review of 34 published articles found strong evidence
for the impact of cultural competence training on provider’s knowledge, attitudes, skills, and
patient satisfaction [5]. The link between cultural competence training and patient outcomes
is weaker although emerging [12,13]. Little and incomplete information is available on cost-
effectiveness of cultural competence training programs [12,13]. No reviews point to tailoring
training to students’ baseline levels of competence. Finally, there is little consistency in how
cultural competence is measured across studies [5,13].
Measuring cultural competence can be challenging. Measures such as Health Beliefs and
Attitudes Survey [14] and the Colorblind Racial Attitudes Scale [15] have been used to exam-
ine individuals’ attitudes toward others and show strong psychometric properties. Colorblind-
ness is the belief that race “does not matter.” [15]. Self-awareness also includes a recognition of
individuals’ own cultural context. Measures examining ethnic identity [16] can provide some
insights into providers’ own perception of themselves as cultural beings. Knowledge is mea-
sured by actual experiences. The Multicultural Experiences Questionnaire [17] measures mul-
ticultural experiences (including past travel, language knowledge, and friendships) and the
Baseline cultural competence in physician assistant students
PLOS ONE | https://doi.org/10.1371/journal.pone.0215910 April 23, 2019 2 / 10
domenech@usu.edu or to the IRB of USU at
irb@usu.edu.
Funding: This project is supported by the Health
Resources and Services Administration (HRSA) of
the U.S. Department of Health and Human Services
(HHS) as part of an award totaling $1,035,126 with
0 percentage financed with non-governmental
sources. The contents are those of the author(s)
and do not necessarily represent the official views
of, nor an endorsement, by HRSA, HHS, or the U.S.
Government. For more information, please visit
HRSA.gov. The funder had no role in study design,
data collection and analysis, decision to publish, or
preparation of the manuscript.
Competing interests: The authors have declared
that no competing interests exist.
desire to pursue more multicultural experiences. Finally, skills are possibly the most difficult to
measure. Direct observations of patients and providers interacting would be ideal to examine
cultural competence, however, these measures would be costly and difficult to obtain. There
are no known published behavioral observation rating codes to captures cultural competence
globally. In lieu of such ratings, measures that capture empathy [18] provide a good proxy for
examining skills [19]. None of these measures have been used with medical trainees to inform
cultural competence training development.
The present manuscript provides data across three cohorts of Physician Assistant Studies
trainees. The data presented here can begin to provide context for students’ expected levels of
ethnic identity, multicultural experiences, health beliefs and attitudes, and ethnocultural empa-
thy at the outset of training and potentially inform interventions to improve cultural compe-
tence in these medical providers.
Methods
Procedures
The research was approved by the Utah State University Institutional Review Board (Protocol
#6859). Informed consent was acquired in written form. Participants completed the battery of
measures in January of 2016 (class of 2017), September of 2016 (class of 2018), and September
of 2017 (class of 2019). Students completed these measures as part of an in-class exercise to
increase self-awareness about cultural competence. The in-class exercise was developed in
response to HRSA funding to Idaho State University to address cultural competence training
and burnout prevention at the program level. Before completing the surveys, students were
informed that their data might be retained for research purposes and they had the opportunity
to opt in or out. This study was reviewed and approved by the Utah State University Institu-
tional Review Board. Once students completed the surveys, the data was accessible only the
first author to avoid any program faculty having access to individual’s data which could
adversely affect students in the program. After the students’ scores were analyzed, individual
reports were returned, and a group report was prepared and made available to students so they
could review their scores relative to their peers. A sample individualized report and a group
report are available through Open Science Framework at https://osf.io/rdnbj/.
Measures
Participants completed measures for ethnic identity, ethnocultural empathy, multicultural ori-
entation, attitudes about diversity, health beliefs attitudes, colorblind racial attitudes, and
burnout. A similar battery has been utilized in a pedagogical context for multicultural training
using the tripartite model [20].
Ethnic identity. Ethnic identity was measured with the Multiethnic Identity Measure
(MEIM). The MEIM yields two subscales, exploration (5 items) and affirmation (7 items)
which together comprise the full 12 item scale. Each item is answered on a scale that ranges
from 1 (strongly disagree) to 4 (strongly agree). Higher scores are indicative of higher ethnic
identity. The MEIM is an often-used measure of ethnic identity and has strong reliability
across studies.
Ethnocultural empathy. The Scale of Ethnocultural Empathy [18] measures respondents
empathy towards people that belong to different ethnic groups. The scale measures ethnocul-
tural empathy along four domains of empathic feeling and expression, empathic perspective
taking, acceptance of cultural differences, and empathic awareness. Each of the 30 items is
rated on a scale ranging from 1 (strongly disagree) to 6 (strongly agree). The original scale
Baseline cultural competence in physician assistant students
PLOS ONE | https://doi.org/10.1371/journal.pone.0215910 April 23, 2019 3 / 10
developers provided evidence for the factor structure, reliability for the subscales and total
scale, as well as evidence of discriminant and concurrent validity.
Multicultural experiences. The Multicultural Experiences Questionnaire [17] yields two
indices, experience and desire, and a total score that is the sum of the two indices. The items
ratings and anchors vary. Higher scores are indicative of greater experiences and desire.
Colorblind racial ideology. Colorblind racial ideology was measured with the Colorblind
Racial Attitudes Scale [15]. The scale has 20-items and is rated from 1 (strongly disagree) to 6
(strongly agree) with higher scores indicating greater colorblindness. Items are summed and
the scale ranges from 20–120. The original scale validation showed strong reliability, split-half-
reliability, concurrent, discriminant, and criterion-related validity.
Healthcare beliefs and attitudes. Providers’ beliefs and attitudes toward patients’ opin-
ions and cultural context were measured with the Health Beliefs Attitudes Scale (HBAS) [14].
The HBAS has four subscales (opinion, beliefs, context, and quality) and a total scale score.
The wording of the items was altered to fit the PA population (e.g., “PAs should ask patients
for their opinions about their illnesses”). The 15 items are rated on a Likert scale ranging from
1 (strongly disagree) to 5 (strongly agree) and the total score is calculated as a mean of items.
Burnout. The Abbreviated Maschlach Burnout Inventory [21,22] captured three dimen-
sions of burnout: exhaustion, dissociation, and personal accomplishment. Items are rated on a
7-point scale from 6 (every day) to 0 (never) with higher scores on exhaustion and dissociation
indicating higher burnout and higher scores on personal accomplishment indicating lower
burnout.
Data analyses
Initial examination of the variables reflected a violation of the assumption of normality. Thus
we used nonparametric tests to examine correlations (Spearman Rho) and mean group differ-
ences (Mann Whitney U). To examine differences across class cohorts (graduating class of
2017, 2018, 2019) for all variables, we used Independent Samples Kruskal-Wallis tests.
Results
Participants were first year students in a Physician Assistant Studies Department in the west-
ern United States. Students participated in assessment that were in the graduating classes of
2017, 2018, and 2019. Each year 72 students completed the assessment (N= 216) and a total of
204 consented to research for a participation rate of 94.44%. Students were 22 to 50 years of
age (M= 28.71, SD = 5.67). Although an inclusive item asked about gender identity broadly
[23], all participants identified as cisgender and predominantly female (n= 119, 58.3%). Stu-
dents were married (n= 91, 44.6%), single (n= 61, 29.9%), in a committed relationship
(n= 43, 21.1%), or cohabiting (n= 9, 4.4%). Only 3 participants reported they currently pro-
vided services to patients. The vast majority of participants identified as White American
(n= 175, 85.8%) with the remainder identifying as Asian or Asian American (n= 11, 5.4%),
Hispanic/Latino (n= 7, 3.4%), mixed ethnic (n= 4, 2.0%), and Black or Black American
(n= 1, 0.5%). An additional four students selected “other” ethnicity and two did not provide
ethnicity information.
Means and standard deviations across scales reveal scores below the midpoint for the
exhaustion and depersonalization scales of the burnout inventory. Student scores were around
the midrange for ethnic identity and colorblindness. Finally, scores were above the midrange
for health beliefs, all the multicultural experiences scales, the personal acceptance subscale of
the burnout inventory, and ethnocultural empathy. See Table 1 for all means and standard
deviations. See Table 2 for scale ranges and midpoints.
Baseline cultural competence in physician assistant students
PLOS ONE | https://doi.org/10.1371/journal.pone.0215910 April 23, 2019 4 / 10
We tested differences between cohorts using Independent-Samples Kruskal-Wallis tests.
Significant differences emerged between cohorts on multicultural experiences, exhaustion and
personal accomplishment. There was a statistically significant difference in multicultural expe-
riences, χ
2
(2) = 6.153, p= .046, with a mean rank multicultural experience score of 116.72 for
the class of 2017, 93.80 for the class of 2018, and 96.59 for the class of 2019. There was a statisti-
cally significant difference in exhaustion, χ
2
(2) = 37.349, p<.001, with a mean rank exhaus-
tion score of 118.54 for the class of 2017, 121.46 for the class of 2018, and 67.08 for the class of
2019. Finally, there was a statistically significant difference in personal accomplishment, χ
2
(2)
= 52.535, p<.001, with a mean rank personal accomplishment score of 82.38 for the class of
2017, 79.11 for the class of 2018, and 143.24 for the class of 2019.
Next, we examined differences across White (n= 175) and non-White (n= 23) students
across the variables of interest using Mann-Whitney U tests. Even though the groups were
highly unequal in size and the group of ethnic minority students was quite small, significant
mean rank differences were found across the two groups in (a) ethnic identity (M
w
= 94.39,
M
nonw
= 138.41), U = 2907.50, p= .001, (b) multicultural experiences subscale (M
w
= 96.08,
M
nonw
= 125.54), U = 2611.50, p= .020, (c) desire for multicultural experiences (M
w
= 96.20,
M
nonw
= 124.61), U = 2590.00, p= .024, (d) total multicultural experiences scale (M
w
= 95.57,
M
nonw
= 129.37), U = 2699.50, p= .008, (e) ethnocultural empathy (M
w
= 93.52, M
nonw
=
144.98), U = 3058.50, p<.001, and (f) colorblindness (M
w
= 102.80, M
nonw
= 74.37),
U = 1434.50 p= .025. Not surprisingly, non-White students had higher rank means for ethnic
Table 1. Mean and standard deviations for cultural competence constructs across groups.
Total Sample White Americans Non-White Americans
αN M SD n M SD n M SD
Ethnic Identity .840 204 2.72 0.44 175 2.70 0.42 23 2.98 0.39
Health Beliefs .778 203 3.97 0.42 174 3.96 0.40 23 4.08 0.51
Multicultural Experience .726 204 27.09 5.64 175 26.71 5.56 23 30.00 5.78
Multicultural Desire .793 204 20.83 2.93 175 20.73 2.95 23 22.13 2.03
Multicultural Experience Questionnaire Total .762 204 47.92 7.44 175 47.45 7.36 23 52.13 6.96
Burnout: Exhaustion .476 203 7.97 3.86 174 8.02 3.81 23 7.57 3.82
Burnout: Depersonalization .794 203 2.74 3.45 174 2.83 3.58 23 2.26 2.44
Burnout: Personal Achievement .631 203 13.67 3.62 174 13.66 3.60 23 14.00 3.75
Ethnocultural Empathy .778 204 4.53 0.53 175 4.48 0.52 23 4.93 0.49
Colorblindness .926 204 57.08 17.55 175 57.81 17.64 23 49.48 11.91
https://doi.org/10.1371/journal.pone.0215910.t001
Table 2. Range and midpoint of variables of interest.
Range Midpoint Sample Mean
Ethnic Identity 1–4 2.5 2.72
Health Beliefs 1–5 3.0 3.97
Multicultural Experience 9–42 16.5 27.09
Multicultural Desire 6–30 12 20.83
MEQ Total 15–72 28.5 47.92
Burnout: Exhaustion 0–18 9.5 7.97
Burnout: Depersonalization 0–18 9.5 2.74
Burnout: Personal Acceptance 0–18 9.5 13.67
Ethnocultural Empathy 1–6 3.5 4.53
Coloblindness 20–120 50 57.08
https://doi.org/10.1371/journal.pone.0215910.t002
Baseline cultural competence in physician assistant students
PLOS ONE | https://doi.org/10.1371/journal.pone.0215910 April 23, 2019 5 / 10
identity, multicultural experiences, ethnocultural empathy, and lower mean rank colorblind-
ness than White students. There were no differences across groups in health beliefs or the
burnout scales. See Table 1 for sample means and standard deviations.
An examination of mean differences across gender using the Mann Whitney U test revealed
three statistically significant differences between men and women in the sample. Men had
lower mean rank ethnocultural empathy scores than women (M
w
= 110.19, M
m
= 91.73),
U = 4142.00, p= .028. Women had lower mean rank colorblind scores than men (M
w
= 93.93,
M
m
= 114.50), U = 6077.50, p= .028. Women had lower mean rank depersonalization scores
than men (M
w
= 92.19; M
m
= 115.61), U = 6172.00, p= .003.
Since age is a continuous variable, relationships between age and the cultural competence
constructs were examined via Spearman Rho correlation (see Table 3). Two statistically signifi-
cant relationships were evident between age and ethnic identity, and age and multicultural
experiences. The negative correlation between age and ethnic identity (R= -.203, p= .004)
shows that younger students tend to report a stronger sense of identity compared to older stu-
dents. Conversely, older students tend to report more multicultural experiences than their
younger counterparts (R= .222 p= .002).
We also examined the cultural competence constructs to verify that they were related in the
ways in which we expected (see Table 3). Significant negative relationships were observed
between colorblindness and health beliefs, multicultural experience, desire, and total scores,
and ethnocultural empathy such that students with lower colorblind scores had (a) more posi-
tive attitudes toward culturally diverse patients in the medical setting, (b) a greater desire to
have multicultural experiences, and (c) higher empathy for persons of diverse ethnic groups.
The colorblindness construct was not related to any of the burnout scales. See Table 3 for
strength of correlations and statistical significance.
Ethnocultural empathy showed strong relationships with health beliefs, multicultural expe-
riences, multicultural desire, and the total MEQ scale such that students with higher ethnocul-
tural empathy scores had (a) more positive attitudes toward culturally diverse patients in the
medical setting, (b) a greater number of multicultural experiences, and (c) a greater desire to
have multicultural experiences. There were no significant relationships between ethnocultural
empathy and the burnout. See Table 3 for strength of correlations and statistical significance.
Table 3. Correlations between cultural competence constructs.
1 2 3 4 5 6 7 8 9 10
n199 204 203 203 204 204 203 203 203 204
1 Age in years 1
2 Ethnic identity -.203�� 1
3 Health beliefs -.044 .161�1
4 Multicultural experience .222�� .138�.125 1
5 Multicultural desire .095 .133 .304�� .380�� 1
6 MEQ Total .211�� .153�.214�� .923�� .683�� 1
7 Exhaustion -.033 .128 .016 .044 -.030 .031 1
8 Depersonalization .083 .026 -.191�� -.030 -.110 -.062 .486�� 1
9 Personal Achievement -.07 .13 .091 -.036 .007 -.037 .054 .076 1
10 Ethnocultural empathy .136 .141�.361�� .378�� .443�� .459�� -.051 -.092 .124 1
11 Colorblindness -.074 .169�-.199�� -.150�-.282�� -.221�� .046 -.049 -.078 -.550��
Note:
�=p<.05
�� =p<.01
https://doi.org/10.1371/journal.pone.0215910.t003
Baseline cultural competence in physician assistant students
PLOS ONE | https://doi.org/10.1371/journal.pone.0215910 April 23, 2019 6 / 10
Health beliefs and attitudes that are patient-centered and consider the patient’s culture
were also strongly correlated with multicultural desire and total score, in addition to the
already reported relationships with ethnocultural empathy and colorblindness. Specifically,
students with more culturally centered health beliefs and attitudes reported significantly higher
desire for multicultural experiences as well as more frequent multicultural experiences than
students with lower health beliefs and attitudes. There was also a strong negative correlation
between culturally centered health beliefs and attitudes and depersonalization. See Table 3 for
strength of correlations and statistical significance.
Discussion
PA students show relatively low levels of burnout, average colorblindness [15], high levels of
ethnocultural empathy, personal acceptance, and health beliefs. These scores make sense in the
context of students at the beginning of their graduate program and, although relatively good,
there is evidence of room for improvement. Furthermore, important differences emerged
across groups by age, gender identity, and ethnic minority status that are important for pro-
grams to consider. Structural diversity, that is accepting students who are from different age,
gender identity, racial/ethnic, and other backgrounds, may play an important role in bringing
diversity of thought and experience into the classroom. This is consistent with established find-
ings on the relationship between structural diversity and classroom learning [24]. Representa-
tion of ethnic minorities in PA studies is already low [25] and was even lower than expected in
our sample. One simple way to intervene to increase cultural competence may be to work to
change the composition of the student body along gender and ethnic lines. That can be an
incredibly challenging task, especially in rural locations that have little ethnic diversity in sur-
rounding communities.
Existing health disparities and professional mandates to work proactively to reduce them,
require immediate attention to increasing cultural competence in medical education and can-
not be paused while student bodies become more diverse. The health professions follow evi-
dence-based approaches to services provision across specialty areas. It is surprising that in the
literature documenting cultural competence development little attention has been paid to
obtaining data about the population being trained that could support the development of
appropriate training (intervention) activities. Trainings are simply developed and delivered
without a strong foundation of knowledge of the group being trained. We report on a battery
of measures related to cultural competence that show good reliability when used with PA stu-
dents. Students across three cohorts were able to complete the battery of surveys in about 20
minutes and provided important data for program purposes. It may be very useful to collect
data at multiple points in time over training to gain an understanding of how these variables
move over time. For example, there is a documented relationship between empathy and burn-
out termed compassion fatigue [26]. It makes sense that these relationships are not evident in
our data, a mere month into training. Overall, cultural competence constructs can be mea-
sured with acceptable reliability in a sample of PA students.
For the most part, scores across cohorts were stable. However, we found some differences
by cohort multicultural experiences and two burnout scales, exhaustion and personal accom-
plishment. These may be a function of differences in the timing of data collection. For the
2017 cohort, data collection occurred early in the spring of their first year instead of the fall, as
was the case for the 2018 and 2019 cohorts. When they took the self-assessment, some PA stu-
dents in the 2017 cohort had already participated in community and short-term medical ser-
vice trips as part of their training. On the burnout scales, it may be that one semester into PA
studies, students are already beginning to show some signs of distress. It may be useful in
Baseline cultural competence in physician assistant students
PLOS ONE | https://doi.org/10.1371/journal.pone.0215910 April 23, 2019 7 / 10
training to assess burnout at various times during training to assess the progression and, per-
haps more importantly, give students an indication of their scores so they may act to reduce
distress. This is consistent with research that support self-monitoring in the attainment of
goals ([27]
More diverse programs may find different baseline levels of cultural competence in their
student cohorts. Samples with larger numbers of ethnic minority students would provide
more robust and stable findings from which to build. Our data are also cross-sectional and
self-reported. Advancing our knowledge of cultural competence should include experimental
and/or longitudinal research. The limited ethnic diversity in our sample results in limited gen-
eralizability of our findings and signals the need for more data on PA students of color.
The significant correlations between cultural competence constructs suggests that we were
measuring variables that are conceptually related. The different scales had strong relationships
between them suggesting that the constructs may be dimensions of a larger concept (i.e., cul-
tural competence), yet the relationships were not so strong so as to suggest we were measuring
a single construct. Each scale provided unique information. Future research should focus on
developing cutoff scores for these scales so that scores may be used to determine the level of
training needed for specific cohorts, and, potentially, to also identify needed targeted training
for students that are significantly below their peers.
Implications to current educational practice and future research
Since our data are correlational, causation should not be implied. However, from a conceptual
standpoint, some constructs are more “movable” than others. For example, programs can eas-
ily provide opportunities for engagement in multicultural experiences. Faculty and staff
modeling of multicultural engagement may be powerful in moving students desire for multi-
cultural experiences. Another relatively accessible point of intervention is with colorblindness.
Consistent with existing recommendations from the Tool for Assessing Cultural Competency
Training [28], instructors can target colorblindness in the curriculum by including content
that makes culture visible (e.g., reporting health disparities). Furthermore, programs can use
these scales with their students in an effort to increase students’ self-awareness in regards to
the various constructs and also their movement over time [20]. Connecting the interventions
to specific constructs being measured would allow for a clear connection between interven-
tions and the accompanying shifts in specific cultural competence constructs providing medi-
cal educators with a process befitting an evidence-based profession.
Conclusions
Culture and language are critical to how health care services are delivered and received, as they
define the limits and effectiveness of the working relationship between the health care provider
and the patient. If health professions programs wish to produce more providers who choose to
work with underserved populations, it is imperative that they prepare students who are sensi-
tive to the needs and preferences of culturally diverse patients. Overall, this manuscript con-
tributes important knowledge regarding baseline levels of various cultural competence
constructs in three cohorts of PA students. As the field tries to address the need for cultural
competence training and, with it, the assessment of training efforts, these data suggest that our
measures show promise for future use.
Acknowledgments
This work was possible due to a Health Resources and Services Administration grant (HRSA-
15-054) to the authors (Phelps, PI).
Baseline cultural competence in physician assistant students
PLOS ONE | https://doi.org/10.1371/journal.pone.0215910 April 23, 2019 8 / 10
Author Contributions
Conceptualization: Melanie M. Domenech Rodrı
´guez.
Data curation: Melanie M. Domenech Rodrı
´guez.
Formal analysis: Melanie M. Domenech Rodrı
´guez.
Funding acquisition: Melanie M. Domenech Rodrı
´guez, Paula B. Phelps, H. Cathleen Tarp.
Methodology: Melanie M. Domenech Rodrı
´guez.
Writing – original draft: Melanie M. Domenech Rodrı
´guez, Paula B. Phelps.
Writing – review & editing: Melanie M. Domenech Rodrı
´guez, Paula B. Phelps, H. Cathleen
Tarp.
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