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Abstract: Researchers and program developers in medical education presently face the challenge of implementing and evaluating curricula that teach medical students and house staff how to effectively and respectfully deliver health care to the increasingly diverse populations of the United States. Inherent in this challenge is clearly defining educational and training outcomes consistent with this imperative. The traditional notion of competence in clinical training as a detached mastery of a theoretically finite body of knowledge may not be appropriate for this area of physician education. Cultural humility is proposed as a more suitable goal in multicultural medical education. Cultural humility incorporates a lifelong commitment to self-evaluation and self-critique, to redressing the power imbalances in the patient-physician dynamic, and to developing mutually beneficial and nonpaternalistic clinical and advocacy partnerships with communities on behalf of individuals and defined populations.
Key words: Medical education, minority populations, multicultural, racism, underserved populations.
he increasing cultural, racial, and ethnic diversity of the United States compels medical educators to train physicians who will skill.fully and respectfully negotiate the implications of this diversity in their clinical practice. Simultaneously, increasing attention is being paid to nonfinancial barriers that operate at the level of the physician/patient dynamic. This dynamic is often compromised by various sociocultural mismatches between patients and providers, including providers' lack of knowledge regarding patients' health beliefs and life experiences, and providers' unintentional and intentional processes of racism, classism, homophobia, and sexism.
Several recent national mandates calling for innovative approaches to multicultural training of physicians have emerged from various sources. The Pew Health Professions Commission, specifically seeking to give direction to health professions education for the twenty-first century, stated that "cultural sensitivity must be a part of the educational experiences that touches the life of every student."4 The Institute of Medicine defines optimal primary care as including "an understanding of the cultural, nutritional and belief systems of patients and communities that may assist or hinder effective health care delivery"5
The necessity for multicultural medical education provides researchers and program developers with the challenge of defining and measuring training outcomes and proving that chosen instructional strategies do indeed produce these outcomes. However, in the laudable urgency to implement and evaluate programs that aim to produce cultural competence, one dimension to be avoided...