Field Epidemiology
 

From Cultural Competency to Structural Competency: A Narrative Humility Approach

Originally presented on March 30, 2015

Speaker:
Sayantani DasGupta, MD MPH
Assistant Clinical Professor of Pediatrics and core faculty member of the Program in Narrative Medicine at Columbia University

This webinar begins within a discussion on how cultural competency has long been the educational mainstay in training health care workers to attend to the needs of diverse populations. This type of training, sometimes called cultural sensitivity or diversity training, usually involves learning about the beliefs and practices of those communities deemed racial and ethnic minorities in the U.S.: African Americans, Latinos/as, Asian and Pacific Islanders and Native Americans.

The framing of a mainstream ‘us’ learning about a racially different ‘them’ – may potentially re- scribe the same power hierarchies and social divisions it seeks to address by reducing people of color communities to a set of homogenous, identifiable and quantifiable ‘teaching points.’ In the late 1980’s, medical educators Tervalon and Murray-Garcia suggested the term ‘cultural humility’ as opposed to ‘cultural competency’ in teaching for the needs of diverse populations. They defined cultural humility as a process of inward looking and self-reflection, such that practitioners were urged to look at their own biases, assumptions and frames of listening as opposed to solely learning about the practices of cultural ‘others.’

This webinar expands the notion of cultural humility to suggest that all stories health care workers encounter have elements of the unknowable – and that all such stories must be approached from a stance of self-examination and narrative humility. This webinar also proposes that while it may not be reasonable or socially just to assume clinicians become ‘competent’ regarding any particular culture or cultures, however we must train ourselves to be competent regarding the structural issues of oppression, injustice and social violence that so deeply impact health care disparities across the spectrum.

Learning Outcome
As a result of this activity, the learner will be able to enhance their knowledge and competence on the topic of cultural competency to include structural competency, which seeks to have the practitioner take into consideration the social determinants of health.

Learning Objectives
After viewing this webinar participants will:

  • Recognize the pitfalls of a traditional cultural competency approach to health care education.
  • Explain the potential benefits of a structural competency approach to health.
  • Apply narrative techniques to identify their own frames of clinical listening.
  • Identify community partners and resources to help connect their own clinical work with broader social justice advocacy.

CE Credits for this activity expired on July 31, 2021. We encourage you to take the evaluation as it helps us plan future activities. Thank you!