New Doctors Face Cultural Care Issues

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Ask a new doctor to perform a medical test or procedure, and most can handle it confidently. But ask them to talk to a patient from another culture, and they’re a little more hesitant.

That’s the finding of a survey of about 2,000 new doctors. Virtually all (96 percent) stated that culture counts in health care. But many indicated that they weren’t totally sure how to handle that.

To fix that, cultural issues should be a priority in medical schools, write Joel Weissman, PhD, and colleagues in The Journal of the American Medical Association. Weissman works at the Institute for Health Policy and department of medicine at Boston’s Massachusetts General Hospital.

The researchers note America’s growing diversity and health care gaps between people of different backgrounds. Those issues are already challenging today’s doctors and await students heading to medical school.

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New Doctors’ Views

Surveys were completed by about 2,000 medical residents.

The doctors were in their final year of training for a variety of specialties (emergency medicine, family practice, internal medicine, obstetrics/gynecology, pediatrics, psychiatry, or general surgery).

Only 8 percent stated that they thought they were generally unprepared to care for patients from cultures other than their own. But many had specific concerns.

—One in four stated that they were unprepared to care for patients with health beliefs that conflict with Western medicine.

—One in four noted that they weren’t prepared to care for new immigrants.

—One in five stated that they were unprepared to care for patients whose religious beliefs affect treatment.

—Nearly one-third reported no good role models in cross-cultural care.

—Two-thirds noted no meaningful evaluation of their cross-cultural patient communication skills.

Many also noted no training in cross-cultural medical care. That was true of 43 percent of the family medicine residents and 83 percent of those in surgery and obstetrics/gynecology.

Very few (1 to 2 percent) expressed doubts about their technical know-how in their specialty.

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Mixed Messages

The bottom line: There is “substantial room for improvement” in training new doctors to care for diverse patients, write the researchers.

“Our results suggest that residents may be receiving mixed educational messages,” they write.

“On the one hand, they perceive that cross-cultural care is important and that it has implications for delivering efficient and high-quality care. On the other hand, residents indicate that they do not have the time nor the mentors to deliver effective cross-cultural care and are not evaluated on their ability to do so,” they continue.

New doctors have a lot to learn; caring for people of different backgrounds should go on that list, the researchers state.

“These findings have implications for how residency training programs prepare physicians to provide high-quality care to an increasingly diverse nation,” they write.

By Miranda Hitti, reviewed by Michael W. Smith, MD

SOURCES: Weissman, J. The Journal of the American Medical Association, Sept. 7, 2005; vol 294: pp 1058-1067. News release, JAMA/Archives.