Cultural Competence for International Medical Graduate Physicians: A Perspective

Abstract

In an influential and broad definition, cultural competence is 'a set of congruent behaviors, attitudes, and policies that come together in a system, agency or among professionals and enable that system, agency or those professions to work effectively in cross-cultural situations'. More narrowly, an individual healthcare professional is considered culturally competent if he or she demonstrates the ability to value diversity and similarities among all peoples, understand and effectively respond to cultural differences, and engage in cultural self-assessment. The adaptive value of automatic (i.e., unconscious) categorization of others into socially meaningful groups (e.g., in-group versus out-group members); its unique neural basis; the pervasive nature of automatic mental processes in daily life; and the persistence of social prejudice despite growing societal and legal sanctions (at least in Western industrialized countries) argue strongly for the evolved and possibly universal nature of the very processes and behaviors that oppose the goals implied by cultural competence. In other words, the default cognitive and behavioral tendency of humans is to make distinctions between 'us' and 'them'. Why discuss cultural competence in a book aimed at medical educators working with IMG physicians? What is the evidence, if any, that cultural competence is relevant to IMG physicians as IMG physicians, as opposed to any physician? More to the point, are IMG physicians more likely than non-IMG physicians to exhibit problems of cultural competency? If so, what can medical educators, institutions, and IMG physicians themselves do to improve this situation? In an attempt to answer these questions, the goal of this chapter is to perform an environmental scan and a focused review of the literature to provide tentative answers to those questions, highlight gaps in the literature, and propose an educational research and policy agenda for the future. (PsycINFO Database Record (c) 2017 APA, all rights reserved)