IV Education in Ethnogeriatrics

Incorporating Ethnogeriatrics into Training Competencies

Natasha N. Harrison

Cultural Competency and Cultural Humility

The American Medical Association (AMA) defines cultural competency in clinical care as “the knowledge and interpersonal skills that allow providers to understand, appreciate and work with individuals from cultures other than their own. Cultural competence involves an awareness and acceptance of cultural differences, selfawareness, and knowledge of the patient’s culture and adaptation of skills.” (2) The Association of American Medical Colleges (AAMC) defines cultural competence as the ability to demonstrate an awareness of others’ needs, goals, and feelings. Both of these definitions reflect the importance of social and behavioral cues in determining a successful therapeutic relationship and interaction with those we provide care.

Within ethnogeriatrics, these definitions are specifically focused on those 65 years and older with a diverse cultural background, a currently heterogeneous population. Those from immigrant and older minority populations are at risk for limited English proficiency and low health literacy. When teaching a trainee, about selfawareness and adaptation of skills they will need to understand family and social involvement which differs among cultures. This greatly affects patients’ outcomes, such as medication choices and patients’ medical decision making on choosing or refusing care. Besides being focused on discussing diagnoses and side effects of medications, trainees need to be observant of how they are communicating and how the patient is receiving the information.

The concept of cultural humility further explores the natural history of how this communication can take place. In [1], Tervalon and Murray-Garcia introduced the tenants of cultural humility. This includes a lifelong commitment to learning and critical self-reflection, recognizing and challenging power imbalances in the

N.N. Harrison, M.D. (*)

Department of Geriatrics and Extended Care, Greater Los Angeles Veterans Healthcare System, 11301 Wilshire Boulevard, Los Angeles, CA 90073, USA e-mail: This email address is being protected from spam bots, you need Javascript enabled to view it

© Springer International Publishing Switzerland 2017 L. Cummings-Vaughn, D.M. Cruz-Oliver (eds.), Ethnogeriatrics, DOI 10.1007/978-3-319-16558-5_12

physician-patient relationship, and institutional accountability. The difference between cultural competence and humility is that competence implies all-knowing whereas humility is the understanding of not knowing and being open to learning all the time. Cultural humility cannot be offered as a class or part of a curriculum, but a continued process of evaluation of social environment and how that has affected one’s experience [12].

In 2007, Kumas-Tan reviewed the most frequent cultural competence measures which mostly included ethnicity and race but left out other components, such as gender, class, geographic location, country of origin, and sexual preference. Cultural incompetence results from lack of knowledge of the other; therefore, formal education is vital in developing cultural competence.

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