Cultural Competence Instruction in Pharmacy Curriculum
Cultural Competence Instruction in Pharmacy Curriculum
Objective. To assess the change in the level of cultural competency and knowledge of health disparities among students in the third year of the doctor of pharmacy (PharmD) program at the University of Florida and to explore the demographic correlates.
Methods. A cross-sectional survey was conducted in 3 consecutive academic years. Chi-square tests, analysis of variance (ANOVA), and multivariate regression were used for data analysis.
Results. Following the inclusion of relevant instruction, there was some increase in knowledge of health disparities and self-awareness, but no significant increase in cultural competency skills. More students reported receiving relevant instruction within the pharmacy school curriculum than outside the curriculum.
Conclusion. Current effort to incorporate cultural competence and health disparities instruction into the pharmacy curriculum has met with some success. However, there is a need to establish standards on how much relevant training is required and further explore ways to effectively incorporate it into pharmacy education.
One of the core components of quality health care is patient centeredness. The Institute of Medicine (IOM) describes the patient-centered approach to health care as encompassing "qualities of compassion, empathy, and responsiveness to the needs, values, and expressed preferences of the individual patient." This requires a shift from focusing on the medical condition to regarding each patient uniquely and delivering of health care accordingly. With the patient-centered approach, the health care process becomes a partnership that takes into account both provider and patient perspectives and encourages patients to participate in their own care. Patient-centered care is driven by effective provider-patient communication. Good communication facilitates patient understanding and ensures that patient needs and desires are well understood and adequately addressed. This approach to care improves health outcomes and quality of health care.
In the United States, disparities in health care are associated with the increasing racial and ethnic diversity of the population. The United States is currently one of the most culturally diverse societies, with minority populations constituting 34% of the total population. Projections by the US Census Bureau place the minority population at approximately half of the US population by the year 2050. Compared to non-Hispanic whites, minority populations are disproportionately affected by many disease conditions and generally tend to have poorer health outcomes. To eliminate health disparities, health care providers, including pharmacists, need to be aware of such disparities in health care and recognize cultural diversity as a key factor. Meeting the health care needs of different patient populations requires that providers take into consideration the influence of culture on patient perceptions, attitudes, and health-related behavior. They also need to work with cultural differences between different populations and integrate this knowledge into their delivery of patient care. Essentially, health care providers need culturally competency training.
In 2006, the Accreditation Council for Pharmacy Education (ACPE) responded to this need by including a cultural competency component in its accreditation standards and guidelines. Moreover, cultural competency levels improve among pharmacy students following relevant educational training. However, until recently, there was no consensus on how this training could be effectively incorporated into the curriculum, which specific knowledge and skills should be taught, and the relevant competencies students should have acquired by program completion. To address some of these gaps, the approved ACPE standards and guidance document have included more directives. Key elements of educational outcomes now include cultural sensitivity (Standard 3.5) and self-awareness (Standard 4.1). The new guidelines call for the incorporation of and exposure to cultural factors in didactic and experiential curricula. The guidelines acknowledge the difficulty in defining and evaluating these outcomes and encourage the culture of sharing best practices for assessment.
Along similar lines, the Center for the Advancement of Pharmacy Education (CAPE) 2013 Educational Outcomes recognize and emphasize the importance of developing professional skills and cultivating attributes that enhance the delivery of pharmaceutical care. This version of the CAPE outcomes was expanded to include the affective domain, the purpose of which is to ensure the integration of basic scientific knowledge with relevant skills, attitudes, and approaches to facilitate effective practice and patient-centered care. One outcome expectation outlined by the 2013 CAPE Outcomes is cultural sensitivity, in recognition of the role that social determinants play in health disparities and their contribution to inequities in access to quality care. Learning objectives to achieve this outcome include the recognition of cultural differences, demonstration of a respectful attitude to different cultures, assessment of health literacy and tailoring communication to the patient's specific needs, and appropriate incorporation of cultural beliefs and practices into the patient's care plan without compromising safety. This study observes efforts made to meet these standards and outcomes and assesses the changes in students' knowledge of health disparities and cultural competency over a 3-year period as a result of incorporating such efforts.
The long-term goal of this research is to foster a curriculum that adequately equips pharmacists with skills to effectively deliver care to diverse patient populations. In a previous study, we evaluated the level of clinical cultural competency and health disparities knowledge among third-year PharmD students in two public schools in the state of Florida. We also explored the demographic correlates (age, gender, race/ethnicity, institution, and country of birth) of cultural competency level and health disparities knowledge. For this study, our objectives were: (1) to assess the change in the level of cultural competency and knowledge of health disparities among students in the third year of the PharmD program over time following the inclusion of relevant instruction in the curriculum; (2) to assess the level of awareness among students in the third year of the PharmD program of cultural competence instruction in the pharmacy school curriculum; and (3) to explore the demographic correlates (age, gender, race/ethnicity, country of birth, multiple-language proficiency) of cultural competency and of health disparity knowledge levels.
Abstract and Introduction
Abstract
Objective. To assess the change in the level of cultural competency and knowledge of health disparities among students in the third year of the doctor of pharmacy (PharmD) program at the University of Florida and to explore the demographic correlates.
Methods. A cross-sectional survey was conducted in 3 consecutive academic years. Chi-square tests, analysis of variance (ANOVA), and multivariate regression were used for data analysis.
Results. Following the inclusion of relevant instruction, there was some increase in knowledge of health disparities and self-awareness, but no significant increase in cultural competency skills. More students reported receiving relevant instruction within the pharmacy school curriculum than outside the curriculum.
Conclusion. Current effort to incorporate cultural competence and health disparities instruction into the pharmacy curriculum has met with some success. However, there is a need to establish standards on how much relevant training is required and further explore ways to effectively incorporate it into pharmacy education.
Introduction
One of the core components of quality health care is patient centeredness. The Institute of Medicine (IOM) describes the patient-centered approach to health care as encompassing "qualities of compassion, empathy, and responsiveness to the needs, values, and expressed preferences of the individual patient." This requires a shift from focusing on the medical condition to regarding each patient uniquely and delivering of health care accordingly. With the patient-centered approach, the health care process becomes a partnership that takes into account both provider and patient perspectives and encourages patients to participate in their own care. Patient-centered care is driven by effective provider-patient communication. Good communication facilitates patient understanding and ensures that patient needs and desires are well understood and adequately addressed. This approach to care improves health outcomes and quality of health care.
In the United States, disparities in health care are associated with the increasing racial and ethnic diversity of the population. The United States is currently one of the most culturally diverse societies, with minority populations constituting 34% of the total population. Projections by the US Census Bureau place the minority population at approximately half of the US population by the year 2050. Compared to non-Hispanic whites, minority populations are disproportionately affected by many disease conditions and generally tend to have poorer health outcomes. To eliminate health disparities, health care providers, including pharmacists, need to be aware of such disparities in health care and recognize cultural diversity as a key factor. Meeting the health care needs of different patient populations requires that providers take into consideration the influence of culture on patient perceptions, attitudes, and health-related behavior. They also need to work with cultural differences between different populations and integrate this knowledge into their delivery of patient care. Essentially, health care providers need culturally competency training.
In 2006, the Accreditation Council for Pharmacy Education (ACPE) responded to this need by including a cultural competency component in its accreditation standards and guidelines. Moreover, cultural competency levels improve among pharmacy students following relevant educational training. However, until recently, there was no consensus on how this training could be effectively incorporated into the curriculum, which specific knowledge and skills should be taught, and the relevant competencies students should have acquired by program completion. To address some of these gaps, the approved ACPE standards and guidance document have included more directives. Key elements of educational outcomes now include cultural sensitivity (Standard 3.5) and self-awareness (Standard 4.1). The new guidelines call for the incorporation of and exposure to cultural factors in didactic and experiential curricula. The guidelines acknowledge the difficulty in defining and evaluating these outcomes and encourage the culture of sharing best practices for assessment.
Along similar lines, the Center for the Advancement of Pharmacy Education (CAPE) 2013 Educational Outcomes recognize and emphasize the importance of developing professional skills and cultivating attributes that enhance the delivery of pharmaceutical care. This version of the CAPE outcomes was expanded to include the affective domain, the purpose of which is to ensure the integration of basic scientific knowledge with relevant skills, attitudes, and approaches to facilitate effective practice and patient-centered care. One outcome expectation outlined by the 2013 CAPE Outcomes is cultural sensitivity, in recognition of the role that social determinants play in health disparities and their contribution to inequities in access to quality care. Learning objectives to achieve this outcome include the recognition of cultural differences, demonstration of a respectful attitude to different cultures, assessment of health literacy and tailoring communication to the patient's specific needs, and appropriate incorporation of cultural beliefs and practices into the patient's care plan without compromising safety. This study observes efforts made to meet these standards and outcomes and assesses the changes in students' knowledge of health disparities and cultural competency over a 3-year period as a result of incorporating such efforts.
The long-term goal of this research is to foster a curriculum that adequately equips pharmacists with skills to effectively deliver care to diverse patient populations. In a previous study, we evaluated the level of clinical cultural competency and health disparities knowledge among third-year PharmD students in two public schools in the state of Florida. We also explored the demographic correlates (age, gender, race/ethnicity, institution, and country of birth) of cultural competency level and health disparities knowledge. For this study, our objectives were: (1) to assess the change in the level of cultural competency and knowledge of health disparities among students in the third year of the PharmD program over time following the inclusion of relevant instruction in the curriculum; (2) to assess the level of awareness among students in the third year of the PharmD program of cultural competence instruction in the pharmacy school curriculum; and (3) to explore the demographic correlates (age, gender, race/ethnicity, country of birth, multiple-language proficiency) of cultural competency and of health disparity knowledge levels.