Cultural competence in United States medical education: a scoping review of implementation and evaluation practices.

Abstract

Objectives: The objective is to identify what is needed in Cultural Competence Curricula in medical schools and suggest a framework for evidence-based curricula that can be flexibly applied.

Methods: We conducted a scoping literature review of Cultural Competence Curricula in United States medical schools. After reviewing 160 articles, 77 met inclusion criteria for analysis. We collected qualitative data on curricula described in each article to analyze elements of curriculum structure, evaluation, and study design.

Results: Our results illustrate a high prevalence of structure styles conducive for quality learning, including longitudinality, integration, incorporation into clinical training, and experiential learning. The most common method for evaluating student learning was student self-evaluation with few programs performing reevaluations or utilizing patients as evaluators. Of knowledge, attitudes and skills, skills were least evaluated. Curricula with higher self-reported efficacy used a greater proportion of self-evaluations, while ones with lower self-reported efficacy used more external evaluations. Quasi-experimental study designs were more common in curricula with high self-reported efficacy.

Conclusions: Curriculum developers across the world can improve implementation of Cultural Competency Curricula by maximizing the quantity of structural components, having higher quality of evaluation, and connecting with the local community surrounding their medical school. To develop a robust curriculum, we encourage longitudinal multi-component learning in integrated courses evaluated via experimental and quasi-experimental study designs.