- Winter 2006-

Even Limited Training Key to Communication With Diverse Patients

Simple classroom lectures about different religious holidays, such as the Muslim tradition of fasting during Ramadan, or Spanish language lessons focused on common medical terms really work to help health care providers connect with patients from different cultures and improve patient satisfaction, according to a pair of reports from Johns Hopkins researchers.

But the latest study, published in the journal Academic Medicine online this summer, still falls short of showing any direct link between such training and the improvements in health of cultural and racial minorities.

“Far more rigorous testing is needed to prove that the training does more than just facilitate better interactions between caregivers and patients,” says study co-lead investigator Eboni Price, M.D., M.P.H., a senior clinical research fellow in the Welch Center for Prevention, Epidemiology and Clinical Research at The Johns Hopkins University School of Medicine.

The Johns Hopkins analyses are believed to be the first detailed review of steps taken by academic medical institutions to address cultural differences with patients, since a series of national reports from the Institute of Medicine (IOM) brought about mandatory cultural competency training of health professionals in 2004. The IOM reports called for training as a key tool in reducing racial disparities in health status between minorities and whites.

“Communicating with a physician or nurse from a different ethnic background, someone with different traditions or who speaks a different language, is a growing fact of life for many Americans,” says study co-lead investigator and internalmedicine specialist Mary Catherine Beach, M.D., M.P.H., an assistant professor of medicine, and health policy and management at the Johns Hopkins Welch Center, School of Medicine and Bloomberg School of Public Health. “While more than one quarter of the general population is from black, Hispanic or Asian descent, the vast majority of physicians are white.”

According to Beach, racial inequities in health status persist, in part, because of a failure in communication and lack of trust between the physician and the patient—it is a bigger problem than the ability to speak the same language and extends into perceptions of cultural differences, where the patient can feel underappreciated or misunderstood by physicians or nurses.

“We know, for example, that over a broad range of medical conditions and clinical settings, the diagnostic tests performed, and the quality of diagnosis made and treatment options offered are lower for black Americans and other minorities than they are for whites,” she says. “All health professionals have a duty to provide good care to patients so that they feel good about their relationship, trust the medical advice provided and want to show up for their next appointment.”

In a related study, published in the journal Medical Care this past April, the Johns Hopkins team found that cultural competency training significantly improved health care providers’ knowledge of patients’ different cultures and also improved patients’ satisfaction with their physician. However, insufficient evidence was found to prove that training improved how patients took their medicines or followed their physician’s advice, or that training improved the health status of patients or saved money.

“Now that medical schools have to provide cultural competency training, we decided to critique the evidence that training makes a real difference to physicians, nurses and patients, and how well the research stands up to tough criticism,” says Price.

“Our evaluation of the research shows that training is clearly having an effect, that physicians and nurses are learning more about the cultures of their patients,” concludes senior study author Lisa Cooper, M.D., M.P.H., an associate professor of medicine, epidemiology, and health policy and management at the Welch Center and Johns Hopkins’ School of Medicine and Bloomberg School of Public Health. “Researchers and educators who perform the training will have to work more closely to implement more effective, methodologically sound studies to determine the full impact and value of cultural competency training.”

Back to the News Index