1. Understanding and Implementing the CLAS Standards
Cultural Competence Curricula and Trainers
Curricula and Training Programs
At this time, there is no standard curriculum for training healthcare providers in how to plan and deliver culturally competent
Academic settings. Within academic settings, cultural competence education may be anything from a course that lasts for an entire term to distinct components within a broader course of study. For example, some medical and nursing schools offer only single 2- or 3-hour sessions on cultural competence during a student’s entire education. To further the goals of incorporating cultural diversity programming into medical education, the Association of American Medical Colleges (AAMC) provides its dedicated Group on Diversity and Inclusion (https://www.aamc.org/members/gdi/), and the Society of Teachers of Family Medicine has developed guidelines for teaching culturally competent healthcare to providers of primary care (Like RC, Steiner RP, Rubel AJ; Recommended Core Curriculum Guidelines on Culturally Sensitive and Competent Health Care. Available at: http://www.stfm.org/group/minority/guidelines.cfm).
Nonacademic settings. For healthcare staff in nonacademic facilities, training in cultural competence may be handled via continuing education courses that may be anywhere from several hours to a few days in length. However, education that is continuing is fundamental—that is, not limited to one-time events. This serves 2 purposes:
Furthermore, continuing education reflects the reality that cultures are dynamic—ongoing education enables staff members to maintain knowledge and skills that fit the dynamics realities of the communities that they serve.
A cultural competence training program must suit the needs of the communities that a healthcare facility serves. This means that input and participation from those communities should be sought and included in planning and conducting training. Early participation of community representatives will help those who develop and conduct trainings better appreciate the needs, culture, and attitudes of the groups that the facility serves. Community input can provide valuable information about community members’ particular health issues, subtleties of language usage, and beliefs and practices surrounding health and healthcare. In addition, it can shed light on community members’ attitudes toward the healthcare facility and its staff. A further benefit may be an opportunity to learn about potential local funding sources, which can be especially important for community-based organizations and clinics.
Cultural competence training programs can also be tailored to address the unique needs of particular types of facilities (eg, community-based clinics), ethnic groups (eg, Hmong women), or health issues that are special concerns of specific population groups (eg, diabetes in Native Americans). Engaging community-based organizations in trainings can provide direct experiences with and opportunities to learn from individuals who are most affected by whatever concern is being addressed.
Other factors to consider when planning CLAS training include:
Cultural Competence Trainers
Cultural competence trainers and consultants come with widely varying credentials. Some may have formal academic training, including advanced degrees, in cross-cultural fields like medical anthropology or transcultural psychology. Others may draw on previous diversity trainings they received from human resources personnel. Some have no specific training or educational background.
Because of this lack of a standard credentialing process, ensuring that CLAS trainers can in fact deliver the services that they offer can be a challenge. Managers and others charged with planning cultural competence training should keep in mind the wide range of trainers and the focuses of their approaches—some may focus primarily on how to eliminate prejudices or differences in values, whereas others may present theories of cross-cultural health or general information about specific cultural groups.[ Kleinman A, Benson P. Anthropology in the clinic: the problem of cultural competency and how to fix it. PLoS Med. 2006;3:e294. Teal CR, Street RL. Critical elements of culturally competent communication in the medical encounter: a review and model. Soc Sci Med. 2009;68:533-543. Betancourt JR. Cultural competency: providing quality care to diverse populations. Consult Pharm. 2006;21:988-995.]
Until certification boards and credentialing agencies agree on a set of standards for cultural competence trainers, a healthcare organization can take some steps to determine the competence of trainers: