© 2016 N. Chernyak
Summary: The article compares the terms intercultural competence and cultural humility that are currently used to formulate the objective of medical students training. The author suggests a variant of translation from English into Russian for the term cultural humility. It is concluded that researchers oftentimes underestimate the dynamic nature of intercultural competence and ignore the evidence of its development through life.
Keywords: intercultural competence, cultural humility, medical students
Medical ethnocentrism is recognized as one of the obstacles to high-quality health care. It is manifested in the physician’s conviction that provided medical services are universal. In reality, physicians encounter patients from various cultural backgrounds (Khukhlaev, Chibisova 2010: 172) who need to be approached differently. In the modern multicultural society, doctors are expected to demonstrate not only effective (in terms of achieving an objective), but also appropriate (in terms of meeting patients’ expectations) behavior based on the existing knowledge, skills, attitudes, and experience of intercultural communication in the context of a health care institution.
Patient-doctor communication is being studied by scientists from different fields. Linguists highlight the importance of the doctors’ ability to cope with language and culture barriers that exist in intercultural communication with patients (Champaneria, Axtell 2004: 2142). Psychologists recognize the necessity of physicians’ readiness to adapt to another culture (Davis, Finney 2006: 318). Medical anthropologists emphasize the role of medical pluralism for medical students training (Betancourt 2004: 954; Echeverri, Brookover et al. 2010: 7). Medical pluralism in defined as the “coexistence of various medical paradigms: ethnic/folk medicine, New Age movement medicine, biomedical/official, great traditional medical systems such as Tibetan or Chinese” (Dobkin de Rios, Rakovski 2012: 3).
Such interdisciplinarity led to terminological inconsistency in publications on this subject (Gibson, Zhong 2005: 622; Chun, Young et al. 2009: 368). Several related terms are used interchangeably in academic journals: cross-cultural competency (Greer, Park et al. 2007: 1112), intercultural communicative competence (Gibson, Zhong 2005: 621), transnational competence, cultural awareness (Majumdar, Browne 2004: 162, Griswold, Zayas et al. 2007: 55, Hamilton, Woodward-Kron 2010: 560), cultural competency (Hobgood, Sawning et al. 2006: 1288; Ho, Yao et al. 2008: 719; Chun, Young et al. 2009: 368; Murray-Garcia, Tervalon 2017: 19), and cultural competence (Campinha-Bacote 1997: 260; Betancourt 2004: 953; Champaneria, Axtell 2004: 2142; Brathwaite, Majumdar 2006: 470; Davis, Smith 2009: 503; Hudelson, Perron et al. 2011: 1; Castiglioni 2013: 26).
The most frequently used term is cultural competence (Murray-Garcia, Tervalon 2017: 19). However, a number of recent studies devoted to different aspects of medical students training criticize the term intercultural competence for being static (Murray-Garcia, Tervalon 2017: 19). Thus, researchers doubt that it is rational to adopt competency-based approach to intercultural training. It is believed that competency-based training describes culture as static and stable (Kleinman, Benson 2006: 1673).
The term cultural humility was introduced as an attempt to overcome the static nature of the term intercultural competence of health care providers (Tervalon, Murray-García 1998: 117; Loue 2012: 1). Cultural humilty could be translated from English into Russian differently. Currently, there is no generally accepted variant of translation. The term kulturnaja bespristrastnost is suggested as the most appropriate.
In general, cultural humilty is understood as a lifelong commitment to self-evaluation in situations of intercultural communication with patients (Campinha-Bacote 2007: 26). Components of cultural humilty are self-reflection, the ability to learn from patients through active listening, the ability to develop mutually respectful partnerships, and the orientation towards lifelong learning (Tervalon, Murray-García 1998: 123; Cheng 2007: 36; Griswold , Zayas et al. 2007: 59; Murray-Garcia, Tervalon 2017: 22).
The central role in the development of cultural humilty in future doctors is assigned to faculty of medical schools, namely the ability to recognize their own communicative mistakes in the presence of medical students, as well as the ability to discuss their own prejudices that can unconsciously emerge in discourse or actions (Murray-Garcia, Tervalon 2017: 26). Thus, teachers become for medical students a model of behavior in situations of professional intercultural communication.
Some authors define cultural humilty as a structural component of intercultural competence of health care professionals (Campinha-Bacote 2007: 25). In this case, cultural humility facilitates lifelong learning aimed at intercultural competence development (Cheng 2007: 41).
Other authors understand these terms as independent and argue that unlike intercultural competence cultural humilty does not imply the achievement of the moment of full mastery (Butler, Swift et al. 2011: 223). The acquisition of cultural humilty is not a final goal, but an active process and a style of interaction with others. Thus, this term is perceived as more dynamic in comparison with intercultural competence (Tervalon, Murray-García 1998: 120; Lipponen 2005: 1).
Nowadays, cultural humility is oftentimes viewed as a more appropriate term for designating the objective of training in comparison to intercultural competence (Lipponen 2005: 120; Anand, Lahiri 2009: 390; Loue 2012: 1). However, in our opinion, in such cases authors underestimate the dynamic nature of intercultural competence and ignore numerous studies that advocate for the development of intercultural competence throughout life.
Anand, R., Lahiri, I. (2009) Intercultural competence in health care: developing skills for interculturally competent care. D. K. Deardorff (ed.), The SAGE Handbook of Intercultural Competence, Thousand Oaks, CA: Sage Publications, Inc., p. 387–402.
Betancourt, J. R. (2004) Cultural competence – marginal or mainstream movement? New England Journal of Medicine, № 351 (10), p. 953–955.
Brathwaite, A. C., Majumdar, B. (2006) Evaluation of a cultural competence educational programme, Issues and innovations in nursing education, № 53 (4), p. 470–479.
Butler, P. D., Swift, M., Kothari, S., Nazeeri-Simmons, I., Friel, C. M., Longaker, M. T., Britt. L.D. (2011) Integrating cultural competency and humility training into clinical clerkships: surgery as a model, Journal of Surgical Education, Vol. 68, № 3, p. 222–230.
Campinha-Bacote, J. (1997) Cultural competence: a critical factor in child health policy, Journal of Pediatric Nursing, Vol. 12 № 4, p. 260–262.
Campinha-Bacote, J. (2007) The Process of cultural competence in the delivery healthcare services: the journey continues, Cincinnati, OH: Transcultural C.A.R.E. Associates, 5th edition, 135 p.
Castiglioni, I. (2013) Constructing intercultural competence in Italian social service and healthcare organisations. Pedagogical design, effectiveness research, and alternative visions for promoting ethnorelativism: academic dissertation to be publicly discussed, Jyväskylä, Finland: University of Jyväskylä, 121 p.
Champaneria, M. C., Axtell, S. (2004) Cultural competence training in US Medical Schools, Journal of the American Medical Association, Vol. 291 № 17, p. 2142.
Cheng, L. L. (2007) Cultural Intelligence (CQ): a quest for cultural competence, Communication Disorders Quarterly, Vol. 29 № 1, p. 36–42.
Chun, M. B. J., Young, K. G. M., Jackson, D. S. (2009) Incorporating cultural competency into the general surgery residency curriculum: a preliminary assessment, International Journal of Surgery, № 7, p. 368–372.
Davis, B. H., Smith, M. K. (2009) Infusing cultural competence training into the curriculum: describing the development of culturally sensitive training on dementia communication, Kaohsiung Journal of Medical Sciences, Vol. 25 № 9, p. 503–509.
Davis, S. L., Finney, S. J. (2006) A factor analytic study of the cross-cultural adaptability inventory, Educational and Psychological Measurement, № 66, p. 318–330.
Dobkin de Rios, M., Rakovski, T. (2012) Medical Anthropology as a Scientific Direction in Russia and the West, Medical Anthropology and Bioethics, Vol. 3.
Echeverri, M., Brookover, C., Kennedy, K. (2010) Nine constructs of cultural competence for curriculum development, American Journal of Pharmaceutical Education, № 74 (10), p. 1–11.
Gibson, D., Zhong, M. (2005) Intercultural communication competence in the healthcare context, International Journal of Intercultural Relations, № 29, p. 621–634.
Greer, J. A., Park, E. R., Green, A. R., Betancourt, J. R., Weissman, J. S. (2007) Primary care resident perceived preparedness to deliver cross-cultural care: an examination of training and specialty differences, Journal of General Internal Medicine, № 22, p. 1113–1107.
Griswold, K., Zayas, L. E., Kernan, J. B., Wagner, C. M. (2007) Cultural awareness through medical student and refugee patient encounters, Journal of Immigrant Health, № 9, p. 55–60.
Hamilton, J., Woodward-Kron, R. (2010) Developing cultural awareness and intercultural communication through multimedia: a case study from medicine and the health sciences, System, № 38, p. 560–568.
Hobgood, C., Sawning, S., Bowen, J., Savage, K. (2006) Teaching culturally appropriate care: a review of educational models and methods, Academic Emergency Medicine, Vol. 13 № 12, p. 1288–1295.
Ho, M., Yao, G., Lee, K., Beach, M. C., Green, A. R. (2008) Cross-cultural medical education: Can patient-centered cultural competency training be effective in non-Western countries? Medical Teacher, № 30, p. 719–721.
Hudelson, P., Perron, N. J., Perneger, T. (2011) Self-assessment of intercultural communication skills: a survey of physicians and medical students in Geneva, Switzerland, BMC Medical Education, № 11 (63), p. 1–9.
Khukhlaev, O. E., Chibisova, M. Y. (2010) Theoretical and practical issues of intercultural communication: modern trends, Electronic Journal “Psychological Science and Education”, No. 5, p. 168–179.
Kleinman, A., Benson, P. (2006) Anthropology in the clinic: the problem of cultural competency and how to fix it, PLoS Medicine, Vol. 3 Issue 10 e294, p. 1673–1676.
Lipponen, K. (2005) What is intercultural communication competence in the context of the European Parliament?: Perceptions about the required intercultural skills from the perspective of Finnish members of the European Parliament: a pro gradu thesis, Jyväskylä, Finland: The University of Jyväskylä, 136 p.
Loue, S. (2012) Sandplay: identity, diversity, and cultural humility, The Journal of Sandplay Therapy, Vol. 21 № 2.
Majumdar, B., Browne, G., Roberts, J., Carpio, B. (2004) Effects of cultural sensitivity training on health care provider attitudes and patient outcomes, Journal of Nursing Scholarship, № 36 (2), p. 161–166.
Murray-Garcia, J., Tervalon, M. (2017) Rethinking intercultural competence: Cultural humility in internationalising higher education. D. K. Deardorff, L.A. Arasaratnam-Smith (eds.), Intercultural Competence in Higher Education: International Approaches, Assessment and Application, Routledge, p. 19–31.
Tervalon, M., Murray-García, J. (1998) Cultural humility versus cultural competence: a critical distinction in defining physician training outcomes in multicultural education, Journal of Health Care for the Poor and Underserved, Vol. 9 № 2, p. 117–125.