Medical Residents Lack Comprehensive Training in Cultural Competency
A report from the Accreditation Council for Graduate Medical Education (ACGME) presents data from medical residency and fellowship programs, which shows that clinical learning environments (CLEs) vary widely in their application of strategies to address healthcare disparities. Among other findings, the data demonstrate a lack of comprehensive training in cultural competency.
From the report:
Across most CLEs, education and training on health care disparities and cultural competency was largely generic, and often did not address the specific populations served by the institution. Generally, across CLEs, residents and fellows reported that learning about health care disparities and cultural competency was happening in an ad hoc manner.
Hispanic Women More Likely to Die of Breast Cancer
Breast cancer is the leading cause of death in Hispanic women in the U.S. While Hispanic women are less likely to contract breast cancer, once they are diagnosed they are 20% more likely than white women to die of the disease. They are often diagnosed in later stages of the disease, when tumors are larger. Many factors contribute to the disparity, including a lack of fluency in English, the inability to take time off work for medical appointments, less knowledge about breast exams and nutrition, and less discussion about breast cancer in the Hispanic community.
From the article:
Doctors, nurses and advocates for patients blame the disparity on factors both medical — higher rates of diabetes — and sociological: cultural differences, language barriers and a desire to stay under the radar as anti-immigrant sentiment in the United States increases. All these factors have created obstacles that prevent women from getting screened, diagnosed and treated.
“Sometimes they have different ideas about breast cancer and screening and treatment,” said Kim Schmulowitz, a spokeswoman for Susan G. Komen Maryland. “A lot of times it is about educating them about when to get screened and dispelling some of the myths they might have about breast cancer.”
Online Patient Portals Show Digital Divide
Data from 44,590 cancer patients treated at the University of Texas Southwestern Medical Center show that a growing number of patients are signing up for online access to medical records—but fewer are actually checking their results. Black patients are about half as likely as white patients, and Spanish speakers are 63% less likely than English speakers, to check their records online. This points to a "digital divide," with certain groups having less access to the internet.
From the article:
While results from patients at a single cancer center in Texas might not reflect what would happen everywhere, the findings do suggest that doctors should consider the possibility that information communicated via online portals may not necessarily reach patients, the authors conclude.
Particularly for nonwhite or non-English speakers, this means the portals may not have the intended effect of making medical information more transparent and supporting shared decision making between doctors and patients.
Segregated Housing Leads to Health Disparities
Although segregated housing developments and neighborhoods are no longer official policy in America, many of our cities and towns maintain clear racial and ethnic divides. A history of low investment has left non-white neighborhoods with more limited food options, lower-quality healthcare, and more stress from poverty and violence. The city of Chicago, with its starkly defined black and white neighborhoods, illustrates the health disparities that result from segregated housing. In Chicago, black residents are 30% more likely to die of cancer, 70% more likely to die of stroke, and 80% more likely to die of diabetes than white residents, according to the Chicago Department of Public Health.
From the article:
To show what [segregation] looks like today, [David Ansell, Senior Vice President for Community Health Equity at Chicago’s Rush University Medical Center] drives through Chicago’s West Garfield Park, an almost entirely black neighborhood with high crime and unemployment rates.
Life expectancy here is 69 years — the same as Iraq, and nearly a decade below the city average of 78. If he drives five miles northeast, to the wealthy, white River North area, life expectancy skyrockets to 85.
“That’s a 16-year gap,” says Ansell. “That gap is bigger than the gap between Haiti and the United States. And it’s seven El stops away.”