The need for Cultural & Linguistic Competency (CLC) in healthcare begins with a concern about how to prevent, reduce, and eliminate disparities in health and the healthcare system as a whole. There are a growing number of studies that document that the patient-provider relationships influence quality of care, and consequently, patient health outcome. Thus the goal of incorporating CLC topics into CME is to provide opportunities for healthcare professionals to strengthen their understanding of and communication with patients in ways that impact care delivery and health outcomes for all patients. The idea of identifying physicians’ performance and competence gaps as a means to address underlying deficits in the quality of care has been one of the key evolutionary points of the CME paradigm, and it is the fundamental motivation behind the movement to incorporate CLC into CME.
A few pioneering states including California has a bill that mandates all CME activities provided within the state to include CLC components. In the California healthcare system, CLC is interpreted as “a set of integrated attitudes, knowledge, and skills that enables a health care professional or organization to care effectively for patients from diverse cultures, groups, and communities.*”
The terms “attitude, knowledge, and skills” include such practical components as: 1) linguistic accommodations, 2) information to establish therapeutic relationships, and 3) cultural and ethnicity data in diagnosis, treatment, and overall process of clinical care. Likewise, “cultures, groups, and communities” can also be based on a wide range of ideas and characteristics including (but are not limited to): 1) religion/faith/spirituality, 2) nationality, 3) race/ethnicity, 4) sexuality, 5) gender roles/identities/presentations, 6) age, and 7) geographical associations.
The important point about culture that must be acknowledged when planning CME activity is that “culture” in this context includes dimensions beyond commonly used demographic categories. Culture must be approached as a dynamic concept that is not mutually exclusive, each component inter-related in a non-linear fashion. This is because often those who are affected the most by disparities identify with multiple cultural identities. Culture also pervades every aspect of our lives including the way health and wellbeing manifest. Some examples include (but are not limited to) disproportionate differences and/or disparities in:
• Risks
• Disease burden
• Susceptibility
• Treatment adherence
• Rates of diagnosis
• Incidence & prevalence
• Access
• Policies
Some of these key areas of disparity may be prevented at a clinical level, through appropriate physician training and education that would improve patient-provider relationship. It is essential to recognize the diversity of the community that the US physicians serve, and be able to accommodate and offer care for patients from all walks of life.
To learn further about national effort to reduce health disparities through incorporating CLC into CME, please visit:
US DHHS Office of Minority Health - Think Cultural Health: Bridging the Healthcare Gap Through Cultural Competency Continuing Education Programs
For an example of a regional effort to reduce health disparities through CLC training in CME, please visit:
UCSF Center for the Health Professions: The Network for Multicultural Health
For additional information on CLC and CME, please visit the resources page of our website:
*California Assembly Bill Number 1195 amending Division 2, Chapter 5, Article 10, Section §2190.1 of the Business and Professions Code. (2005).
The IMQ CLC program is funded by the California Endowment, a private, statewide health foundation that is working to expand access to affordable, quality health care for underserved individuals and communities in California, and to promote fundamental improvements in the health status of all Californians. For more information, please visit their website.
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