Bienvenido, bienvenue, hello and welcome to the website, www.elementarymydearmd.com, and blog of the Elementary My Dear Humanities in Medicine Podcast Experience.

My name is Dr. Michelle K. Watson, my pronouns are she/her/hers/ela/ella/elle, and as your bold, unabashedly intrepid host, I am pleased to have you accompany me on this sublime audio journey where the belief is that equity in medicine can be both evolutionary and revolutionary.

Our mission in healthcare is to include and stay divine, every single time. 

I am thrilled to have you accompany me on this journey to educate, investigate, evaluate, and create an open think tank for solutions necessary for achieving healthcare equity for BIPOC populations around the world.

The article we will be referencing for this episode is a contribution from:

Social Work Education, 2015 Vol. 34 

And

The Journal of Ethnic & Cultural Diversity in Social Work

In this article, 

the authors: (Fisher-Borne, Cain, and Martin) advocate a move from a focus on mastery in understanding ‘others’ to a framework that requires personal accountability in challenging institutional barriers that impact marginalized communities. 

The article begins with a broad discussion of the evolution of culturally specific work as a means of addressing disparities in the fields of medicine, nursing, psychology, and social work. 

I will then discuss cultural competence within health and human service professions and present critiques of the concept. 

Acknowledging the critiques of cultural competence, I will present cultural humility as an alternative. I will conclude with a conceptual model and essential questions for cultural humility as a useful framework to move allied health practitioners from a ‘mastery’ based model to one in which the health professions practitioner pursues individual and institutional accountability in challenging the barriers that impact marginalized communities.

Cultural humility, however- while a promising concept, has been less fully explored.

Therefore, I present a conceptual model of cultural competency along with strategic questions for providers and organizations to integrate into their practice and pedagogy. 

The etiology of cultural competency, as it is understood in medicine, can be traced to medical anthropology and the work of Arthur Kleinman in 1981. 

He argued for a client centered, rather than a disease-based, approach to health and developed an Explanatory Model of Health and Illness to recognize and validate clients’ conceptions, explanations, and expectations of their experience of illness based on cultural beliefs and encounters. 

Though providers may identify illness from a purely biomedical perspective, individuals’ experiences of health and disease are more complex. The exploration of this complexity and the role culture plays, from both a provider and a client perspective, has provided the medical field with a foundation for understanding cultural competency.  

Since the early 1900s, the field of nursing has explored cultural aspects of health. In 1917, the Committee on Curriculum of the National League for Nursing published a curriculum guide that included content on social inequalities (DeSantis & Lipson, 166 M. Fisher-Borne et al. 2007).

In the 1950s, Madeline Leininger pioneered the field of transcultural nursing and provided the foundational concepts of cultural competency in the field of nursing (Leininger, 1991). 

The term cultural competency is currently used interchangeably with cross-cultural or transcultural nursing. 

Leininger asserted that understanding the learned, shared, and transmitted values as well as beliefs, norms, and life experiences of a particular group would help nurses provide culturally specific and congruent care. 

In 1983, the National League for Nursing developed criteria for nursing education curricula that addressed ethnic, racial, and cultural diversity (DeSantis & Lipson, 2007). 

In 1992, the American Academy of Nursing’s Expert Panel on Culturally Competent Care first defined culturally competent care as that which is ‘sensitive to issues related to culture, race, gender, and sexual orientation’ (American Academy of Nursing, 1992, p. 278). 

In 2007, the panel reconvened, citing an increased need to focus on cultural competency as a way to eliminate health disparities and, in an effort to ‘advance clarity and understanding of the concept’, offered new recommendations related to identifying an effective model of culturally competent care and furthering related research in the nursing profession (Giger et al., 2007, p.96). 

While awareness of culture in the field of psychology includes the work of prominent scholars such as Carl Jung and Erik Erikson, the body of work by Sue and colleagues has set the standard for cultural competency in the field of mental health on an individual provider level. 

In 1982, Sue et al.  developed multicultural counseling guidelines that are now considered standard cultural competency guidelines by:

• Six divisions of the American Counseling Association.
• Two divisions of the American Psychological Association. 

General concepts of cultural competency focus on cross-cultural language skills, awareness of diversity, and providing effective care across lines of difference. 

Joseph Ponterotto has also made significant contributions in multicultural psychology and counseling. His 2007-2011 work has challenged the methods used to examine culture, race, and identity. 

Noting the limitations of racial identity theories, Ponterotto and his colleagues recently introduced a comprehensive theory of multicultural personality to better understand the clinician characteristics through the use of both quantitative and qualitative methods which has added to the field of multicultural psychology. 

Cultural competency has been at the core of social work theory and practice since the term was first introduced with the work of Sue et al. in 1982 that formed the foundation for early cultural competency models in social work. 

In Social Work Education, 167 Terms related to culture and social work practice emerged in the literature in the early 1980s.

These terms included:

• Ethnic sensitive social work practice
• Cultural awareness
• Cross-cultural social work
• Ethnic competency
• Process-stage approach 

With people of color. 

According to Green in 1995, ethnic competency represents a provider’s awareness of his or her limitations, being open to cultural differences, adopting a client-centered approach, and utilizing cultural resources. 

In 1999, Lum introduced the term culturally competent practice to social work and provided a foundation for social workers to understand and evaluate multicultural counseling competencies with people of color. 

Social worker Terry Cross and his colleagues provided pioneering work in the field of cultural competency in 1989. To date, their description of cultural competence as ‘a set of attitudes, skills, behaviors, and policies enabling individuals and organizations to establish effective interpersonal and working relationships that supersede cultural differences’ is the most widely cited definition. 

They also expanded the discussion to include an institutional framework for assessing effective services for minority populations. 

Cross et al. argued that the same skills needed on an individual and clinical level were necessary on a macro level, which included the evaluation of an agency’s policies, procedures, and practices to assess their cultural compatibility with the populations they serve.

In terms of Professional Mandates for Cultural Competence:

Numerous accreditation bodies in medicine, public health, nursing education, and social work consider cultural competency a standard of care within their educational objectives 

Including the-

The American Public Health Association or (APHA)

The Office of Minority Health (OMH)

And the Accreditation Council on Graduate Medical Education or the (ACGME).

Do no harm, my doctors.

Do no harm, my people.

All Humanities in Medicine Podcast Experience blog articles and podcast episodes illustrate the significance and virtues of the diversity, equity, and inclusion (DEI) concepts of cultural competence and cultural humility with an extensive healthcare literature review, and touches of world culture, humor and musicality.

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Informed, culturally relevant content.

Custom-created and curated for an informed listener base.

For a more informed future.

Elementary my dear listeners.

I am Dr. Michelle K. Watson, innovator, producer, host, and creator of the Elementary My Dear Humanities in Medicine Podcast Experience. Join me on this audio revolution for a new episode every month on all major podcast hosting platforms. 

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I thank you for allowing me to be of service to you.

This is Dr. Michelle K. Watson, signing off, wishing all of you a safe and equitable life journey.

Until we meet again, for the next episode in this revolution.

Evolve safely. 

Be the change you want to see in the world.

Namaste.