TABLE PCD-2 Examples of Advice Given to Health-Care Providers That Can Reinforce Stereotypes

  • Sexual problems and venereal diseases can be difficult topics for Arab American patients to discuss (Purnell and Paulanka, 1998).

  • An Albanian patient may expect the need for medication in order to become healthy (University of Washington Medical Center, 1999).

  • Avoid using phrases such as “you people” or “culturally deprived,” which may be considered culturally insensitive (University of Michigan Health System, 2003).

Hafferty and Frank (1994) described a hidden and unintentional curriculum in classrooms or clinical settings where faculty unwittingly present case reports to illustrate concepts that may convey images perpetuating a variety of stereotypes. Stories and jokes shared by students and faculty are often part of the shared culture of medicine and can be an enormously influential component of medical education. As students move from the classrooms to the stressful, arduous clinical training environment, they may cope with their stress by dehumanizing patients, transforming them into objects of work and sources of antagonism and assigning disparaging labels such as “hits” and “gomers” to their patients.

Finally, there are times when advice given to health-care personnel, although accompanied by documentation, can unwittingly reinforce stereotypes or aim so low as to elicit a negative response from the recipients (examples of a few of these are listed in Table PCD-2). This advice, which is generally available to all faculty, staff, practitioners, and their students in academic medical settings, can undermine educational goals rather than foster efforts to appreciate and understand the diverse cultures and complex health care needs represented in the patient population.

The pedagogy that is currently in place in many U.S. medical schools to ensure that graduating medical students are culturally competent tends to focus on the acquisition of accurate knowledge, respectful attitudes, and appropriate behaviors for interacting with patients. Although some medical schools report approaches that are designed to help students reflect on how their biases and prejudices may influence the quality of care they provide to patients, (e.g., Tervalon, 2003; Crandall et al., 2003), by and large, the approach taken at most medical schools to teaching cultural competence is consigned to courses in cultural sensitivity or provider-patient communication (Chin and Humikowski, 2002).

Current Status of Medical Education

If internal and external goals and standards requiring graduating medical students to be culturally competent in caring for patients are to be

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