The Shift From Cultural Competency to Culturally Responsive Teaching in Pharmacy Programs

By: Kafayat Badmos, PharmD candidate  

Have you ever listened to a presentation with commentary to add or a relatable example to give? I know I have. One time in pharmacy school, a professor presented their experience with a patient who came from an African background. The professor explained how a language barrier existed and how they navigated through that barrier. However, they still had difficulty keeping the patient’s diabetes under control. My African background had me shaking my head the whole time I was listening. Not because the professor did anything wrong but because I understood that language might not have been the only barrier; other cultural elements were playing a role as well.

For this counseling example, a set of guidelines specific to a certain culture was used, but sometimes it’s difficult to use the same guidelines to inform habits of another culture. Although guidelines are helpful, we must remember one size does not fit all. For instance, some cultures believe in using herbal or primitive products to treat a wide span of diseases. This example about diabetes control brought questions to mind I would have asked based on my knowledge of the patient’s culture. For example, the patient likely eats a lot of spinach, but what are they eating it with? (Because eating spinach alongside foods high in carbohydrates like rice, can increase blood sugar levels.) Is western or allopathic medication used where the patient comes from? (Knowing this would influence patient education regarding how allopathic medication works and its importance versus solely relying on herbal or traditional medicine.)

What effect does culture have on health outcomes?

We often associate language as the barrier to not achieving optimum outcomes, but sometimes the issue is due to other cultural factors. A review article written by Gabriela and Carlota states that “understanding and experiencing a patient’s culture may be equally, if not more, important in pursuing meaningful and successful health care outcomes.” These authors suggest culture influences a patient’s health by affecting lifestyle, beliefs on the causes of diseases and remedies, as well as their perceptions on what is considered to be a health problem, symptoms of a disease, and ultimately healing”.² I have personally observed situations where a patient becomes more receptive when they share the same culture with the pharmacist or are welcomed to share their culture during counseling activities. Trust increases, and patients become more invested in their health care goals. 

Is the cultural competency approach enough? 

It is increasingly important to purposefully train student pharmacists and pharmacists to meet the healthcare needs of culturally diverse populations because the multicultural population of the United States is rapidly expanding.¹ In addition to the changing demographics, the presence of health disparities also plays a role in cultural differences. 

To address this, colleges of pharmacy have adapted the “cultural competency” approach through service-learning opportunities, rotational experiences in rural areas, and global health outreach.¹ This demonstrates progress in efforts, but it can be difficult to quantify the impact of these experiences. This approach teaches appreciation for diverse beliefs, values and behaviors as a way to tailor patient care based on cultural needs. The downside is that students are trained in a fixed body of skills, knowledge, and attitudes, lacking cognitive flexibility in various cultural contexts. Additionally, cultural competency is taught in close association with health disparities which may lead to students relating knowledge of cultural diversity to negative experiences. 

How can we better prepare students to provide care to patients of culturally diverse backgrounds?

I understand we cannot be knowledgeable about and fully understand every culture. However, we can equip students with the skills to improve their approach when engaging patients as partners in creating health outcome goals. Examples include:

• Encouraging pharmacists and student pharmacists to consult colleagues who share commonalities with patients to provide optimal care.
• Adopting culturally responsive teaching strategies, which is an integration of cultural humility (lifelong commitment to learning and self-reflection) and cultural competency. 
• Creating learning environments that allow students to gain practice in navigating discussions around cultural differences. This way rotational experiences are not the first for such conversations. For example, students can participate in a counseling activity with peers that involves learning the culture of fellow classmates. 

Pharmacy programs need to help students recognize that cultural barriers exist beyond language differences and help devise ways to address and overcome these barriers. This way we can ensure that pharmacy students are receiving the appropriate training to provide optimum patient care.

Have you been the healthcare provider who has encountered a culture barrier, or did you think culture played a role in achieving optimum health outcomes? Have you been the patient and felt unseen, unheard, or unknown because of your cultural beliefs or differences?  Would love to hear your ideas, opinions, and experiences in the comments below.

Acknowledgments 

I would like to thank Dr. Jimmi Hatton Kolpek, Dr. Jeff Cain, and Dr. Jordan Kelley for their encouragement, guidance, and support of this article.

References

1. Cipriano G, Andrews C. The Hispanic pharmacist: Value beyond a common language. SAGE Open Medicine, 2015. 3:205031211558125.

2. Rockich-Winston N, Wyatt T. The Case for Culturally Responsive Teaching in Pharmacy Curricula. American Journal of Pharmacy Education, 2019. 83(8): 7425.

3. Egede, Leonard E. Race, ethnicity, culture, and disparities in health care. Journal of general internal medicine. 21(6): 667.

4. Prescott G,  Nobel A. A Multimodal Approach to Teaching Cultural Competency in the Doctor of Pharmacy Curriculum. American Journal of Pharmacy Education, 2019. 83(4): 6651. 

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Author Bio:

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Pulses is a scholarly blog supported by a team of pharmacy education scholars