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Primary care resident, faculty, and patient views of barriers to cultural competence, and the skills needed to overcome them


: Johanna Shapiro, Department of Family Medicine, 101 City Drive South, Route 81, Building 200, Orange, CA 92868–2198, USA. Tel. 00 1949 8243748; Fax: 001 714456 7984; E-mail:


Introduction  Primary care residencies are expected to provide training in cultural competence. However, we have insufficient information about the perceptions of stakeholders actually involved in healthcare (i.e. residents, faculty and patients) regarding commonly encountered cross–cultural barriers and the skills required to overcome them.

Method  This study used a total of 10 focus groups to explore resident, faculty and patient attitudes and beliefs about what culturally competent doctor-patient communication means, what obstacles impede or prevent culturally competent communication, and what kinds of skills are helpful in achieving cultural competence. A content analysis was performed to identify major themes.

Results  Residents and faculty defined culturally competent communication in terms of both generic and culture-specific elements, however, patients tended to emphasize only generic attitudes and skills. Residents and patients were liable to blame each other in explaining barriers; faculty were more likely to consider systemic influences contributing to resident-patient difficulties. All groups emphasized appropriate skill and attitude development in learners as the key to successful communication. However, residents were sceptical of sensitivity and communication skills training, and worried that didactic presentations would result in cultural stereotyping.

Discussion  All stakeholders recognized the importance of effective doctor−patient communication. Of concern was the tendency of various stakeholders to engage in person−blame models.

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