Co-authored by Marlena I. Mosbacher, occupational therapy student at Rush University, Chicago, IL USA
Yesterday, Trump advanced his developing autocracy with the signing of an anti-immigration executive order that specifically targets Muslims; the UK’s populist anti-immigration party continues to gain steam, and now, it’s even happening in the Netherlands – the anti-immigrant nationalist Geert Wilders is gaining momentum for the March 15th election. And anti-semitic violence and anti-Muslim hate groups are on the rise.
In the current tide of right-wing populist nationalism and anti-immigrant sentiment, in the US and abroad, it’s even more crucial that we speak out against efforts that further stigmatize and marginalize.
And there is no better place to start, than in environments that we know best ― in higher education settings for the health professions.
Although the general population continues to diversify at a staggering pace with immigrants comprising 14% of America’s population as of last year, the healthcare workforce has remained largely homogenous (i.e., White). In 2015, over 50% of medical school graduates in Illinois identified as White and over 65% of baccalaureate and graduate nursing students in Illinois identified as White, and these statistics aren’t that different from other healthcare fields. Because the demographics of healthcare providers don’t reflect the population at large, there’s a pressing need for curricula in health professions higher education to address this disconnect, a call that, in part, has been attempted by so-called cultural competency training.
Cultural competence is defined as the ability of providers to deliver effective care, which demands a working knowledge of varying social and linguistic needs, to patients who are of a dissimilar culture. Although the educational institutions who train our future healthcare professionals are well-intentioned, cultural competence training often falls way short because it places emphasis on traditional characteristics of minority cultures, and not real, open and frank discussions, about discrimination and oppression. Unfortunately then, the cultural competence model of teaching doesn’t produce culturally aware professionals, but rather, it perpetuates stereotypes by teaching what to expect within certain racial and cultural groups - for example, that Latinx/o/a folks often arrive at the clinic late and/or are joined by several members of their extensive family.
Competence, in medical terms, is defined as the quality or state of being functionally adequate. With this definition in mind, cultural competence suggests that learning how to effectively provide care to minority populations is a linear process with a clear end point, and this is simply not the case. Rather, multicultural training should instead focus on cultural humility which asserts that successful intercultural practice can only be achieved through continuous self-evaluation, correction of unequal power dynamics and formation of non-oppressive community partnerships over the course of a lifetime.
Because diverse populations present opportunities for individuals of different races, cultures and creeds to continuously interact with one another, this creates circumstances in which individuals adopt characteristics, practices and identities that are grounded in more than one culture.
This intersecting of identities, referred to as intersectionality, gives rise to experiences that are far more varied than our current educational models recognize. By sending students into the field with incomplete knowledge about the reality of co-existing identities, for example, of being female, lesbian and Black, we send students into practice without the ability to empathize with the complex and multidimensional nature of the human experience, and without the skills needed to challenge their own personal biases.
Despite the messages conveyed by much of the cultural competency education we see in today’s healthcare curricula, the reality is that most of us don’t have identities that fit neatly into predetermined boxes. Based on this idea we should be teaching our students how to understand, respect and celebrate personal expression of culture, not to see cultural groups as being distinct and mutually exclusive. By changing how we approach educating students about culture, we can equip the healthcare providers of tomorrow with the skills they need for a lifetime of practice in an ever-diversifying world while also teaching students to make known their biases and to continuously challenge their unconscious biases. We must look at patients as people who often define themselves based on their own uniquely personal experiences and intersectional identities.