Poster Presentations (Group I)

Background: Few tools exist for measuring the general attitudes, knowledge and skills required in order to deliver patient-centered care to diverse populations. Many existing CC evaluation tools are linked to specific course content, and therefore cannot be used to measure clinicians’ cultural competence more generally. Tools that have attempted to measure more general constructs such as intercultural sensitivity have not addressed issues specific to the clinical context, such as the clinicians’ sense of responsibility to bridge differences, knowledge of social and cultural barriers to health care or specific cross-cultural communication techniques.
Methods: We developed a self-administered questionnaire to measure clinicians’ cultural competence attitudes and knowledge, and two detailed patient “stories” or scenarios which were incorporated into an internet-based, interactive program (VIPS) designed to test clinical skills. The questionnaire was mailed to random samples of 600 hospital physicians, 600 private physicians and 250 medical students. All those who responded to the questionnaire were invited to conduct the two virtual consultations, accessible via internet.
Results: Overall, medical students and younger physicians were found to have more attitudes and knowledge generally associated with cultural competence, although they may be less at ease with specific cultural competence skills than more experienced physicians. Few respondents had received cultural competence training, but previous training was associated with higher scores. The most frequent causes of difficulty in caring for migrant patients were language barriers, unfocussed complaints, illness-related beliefs that contradict medical knowledge, and lack of time. In caring for immigrant patients, older, male respondents gave more importance to general medical resources (medical record, availability of effective treatment, previous experience with the medical condition), while medical students, women and those who had received cultural competence training gave greater importance to understanding the patient’s psycho-social context. Self-rated cultural competency was higher among women, those with a greater proportion of migrant patients and those who had received cultural competence training. A correlation was found between knowledge of social and cultural factors affecting health care and their exploration in virtual patient scenarios.
Lessons learned: The questioning formats used in this study appear to be feasible and appropriate. However, a number of challenges remain regarding the measurement of clinical cultural competence skills in a research context. W feel that self-evaluations of cultural competence should be conducted with caution, as our study suggests that at least for some topics they are not well correlated with knowledge of good practice. We also feel that while an advantage of the virtual patient scenarios was that physicians could access the program at their convenience via internet, the artificial nature of the interaction leads to questions about the validity of results. In addition, many physicians were not at ease with computers and the internet, which affected both response rates and the quality of responses.