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LETTER TO THE EDITOR

Cultural humility: treating the patient, not the illness

P atient populations across the world are becoming

increasingly diverse, introducing a variety of health

behaviours that are influenced by a patient’s cultural

background. Tomorrow’s Doctors guidelines state that all

qualified doctors must respect patients ‘without prejudice’,

irrespective of ‘diversity of background and opportunity,

language, culture and way of life’ (1). Are medical students

currently being fully supported to acquire this fundamen-

tal skill?

A suggested definition of culturally competent care

assumes that healthcare providers can ‘learn a quantifiable

set of attitudes and communication skills’ that will allow

them to work effectively within the cultural context of

the patients they come across (2). However, the broad

nature of cultural competency limits its integration into

an already intense medical curriculum (3). So, how can

developments in medical education overcome this chal-

lenge? It can be done by promoting cultural humility.

In the medical context, cultural humility may be defined

as a process of being aware of how people’s culture

can impact their health behaviours and in turn using this

awareness to cultivate sensitive approaches in treating

patients (4).

Unlike cultural competency, there is no specific end

point to cultural humility as we are not being asked to

demonstrate a ‘quantifiable set of attitudes’. This concept

is a continual process, one that requires self-reflection and

self-critique. Developing cultural humility in itself is a

prerequisite to cultural competency. It does so by forming

a foundation for students to consider possible power

imbalances that may arise between a doctor and patient

when cultural differences may have an impact on the poten-

tial clinical outcome for the patient. Subsequently, the

student may be encouraged to develop approaches and skills

that could contribute to a harmonious dynamic of the

doctor�patient relationship (5). Patient care is individua- lised as we take time to consider a patient’s personal beliefs

rather than attempting to place them under a cultural label.

Developing cultural humility will therefore allow students

to appreciate someone’s culture as a dynamic entity.

Drawing upon the philosophy of Daoism, which is

based on the concept of humility leading to the attain-

ment of knowledge, Chang et al. argue that cultural

humility can greatly increase the student’s receptiveness to

learn about their own attitudes (5). Chang et al. further

describes the concept of cultural humility in which the

elements of self-questioning, immersion into an individual

patient’s point of view, active listening, and flexibility

all serve to confront and address cultural biases or

assumptions a student may hold. In clinical practice,

lack of awareness of our cultural perceptions introduces

the risk of subconscious imposition of our beliefs during

patient interactions (6).

To facilitate this skill amongst medical students, en-

gagement with the humanities, for example, literature,

art, or poetry, may be encouraged. Reading a book that

explores another culture may enable us to reflect on our

own reactions to the content of the book, rather than simply

learning about another culture’s practices (7). Cultural

humility is a concept that admittedly does not easily lend

itself to generic methods of assessment producing pass or

fail results. Methods of assessment should therefore in

some way complement the dynamic nature of developing

the skill, for example, engaging in reflective writing or

participating in group discussions with peers after reading

a book that explores cultural issues. Reflective pieces of

writing can consequently be discussed with a communica-

tion skills tutor, for example, who might also play a role in

facilitating peer group discussions. A level of self-assessment

may also be suitable, for example, through questionnaires

that explore a student’s ideas about different cultures (8). If

such activities are weaved into the medical school curricu-

lum, for example, by integrating them into existing com-

munication skills teaching sessions, the potential strain on

time and resources may be alleviated.

Investigating methods of teaching and assessing cul-

tural humility have been explored in small residency

programmes in the United States, for example, by Juarez

et al., which demonstrate positive outcomes with regard to

patient satisfaction (8). Whilst this letter has proposed

promoting cultural humility in the medical school system,

it also seeks to highlight that further evidence needs to

be collected in order to assess the strength of the impact

of cultural humility on patient encounters and the long-

term effects on a student’s professionalism in a culturally

diverse patient setting.

Increased awareness of cultural humility and its inte-

gration into the medical student curriculum would have

universal benefits for medical students and patient care.

Further work on fully establishing the utility of culture

humility within medical education should be welcomed.

Ultimately, it presents itself as an ethos in medical educa-

tion that requires further promotion, as it can facilitate the

development of culturally sensitive doctors who deliver a

standard of care patients deserve.

Medical Education Online�

Medical Education Online 2016. # 2016 Sunila J. Prasad et al. This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material for any purpose, even commercially, provided the original work is properly cited and states its license.

Citation: Med Educ Online 2016, 21: 30908 - http://dx.doi.org/10.3402/meo.v21.30908 (page number not for citation purpose)

http://creativecommons.org/licenses/by/4.0/

http://www.med-ed-online.net/index.php/meo/article/view/30908

http://dx.doi.org/10.3402/meo.v21.30908

Sunila J. Prasad