Perceptions of Cultural Competency Among Premedical Undergraduate Students

BACKGROUND: Cultural competence is a difficult skill to teach, as it has several operational definitions as well as limited and unstandardized training procedures. Currently, there is no formal cultural competency training at the undergraduate level for students who seek to become a medical doctor. The purpose of this study is to explore perceptions of cultural competence among premedical undergraduates by assessing how they define and understand cultural competency and their knowledge (and sources thereof) of sociocultural realities in health and medicine. METHODS: Structured in-depth interviews took place in 2016 and 2017 at a medium-sized private college in the Midwestern United States. Twenty premedical students were interviewed. The interviews were transcribed and thematically coded following an inductive, iterative, and systematic process. RESULTS: Most students can provide a definition of cultural competence that includes at least one component of how it is conceptualized by the Association of American Medical Colleges. However, students focus largely on defining cultural competence as individual attitudes and interaction rather than systemic or structural realities that produce inequalities in health care. When explicitly asked, students varied in the level of detail provided in explaining the social determinants of health (such as race or ethnicity, sex, gender, and socioeconomic status) and varied in the accuracy of their definitions of traditional health practices. Each student noted the importance of training on cultural competence and many placed patients’ health at the center of their reason for doing so rather than focusing on their own training as a motivation. Students discussed various aspects of sociocultural differences and the need for physicians to understand patients’ outlooks on health care and be able to communicate to patients the purpose of suggested medical treatment, as well as the inherent tension in balancing patients as individuals and members of sociocultural groups. Premedical undergraduate students see their own cultural competence as an informal skill that is gained through social interactions across various areas of life, such as work, family, friends, and school. CONCLUSION: This study traces the sources of sociocultural information that premedical students will bring to their medical training as well as places where cultural competence can be further explored, practiced, and formally integrated in premedical education.