Emerging Issues

Commonwealth Fund Report Suggests Medical Residents Lack Sufficient Cross-Cultural Training A Commonwealth Fund report released May 2 indicates that many medical residents feel unprepared to treat minority patients and calls for an increased focus on cultural competency during graduate medical training. To determine whether U.S. medical residents are adequately prepared to care for diverse patient populations, researchers surveyed 2,047 residents specializing in internal medicine, surgery, pediatrics, obstetrics/gynecology, emergency medicine, psychiatry and family medicine. While nearly all respondents thought it was important to consider patients' cultures when providing care, most felt unprepared to treat patients with certain cultural characteristics. Specifically, residents reported feeling unease when faced with patients who mistrust the U.S. health care system, believe in practices at odds with Western medicine or have limited English skills. In addition, many respondents said poor cross-cultural interactions negatively affect caregiving by lengthening office visits and increasing the risk for patient noncompliance, consent delays and unnecessary tests. Some residents attributed their lack of preparedness to the dearth of instruction on cross-cultural care delivery and infrequent evaluation of residents' cultural competence. To promote equitable, patient-centered care delivery, researchers suggest integrating formal and informal lessons on cross-cultural care into graduate medical education. They note that formal modules could impart practical skills, such as how to use an interpreter and strategies to avoid stereotyping, while informal education could include case study reviews and evaluations. Researchers also recommend integrating cross-cultural education into faculty development and creating tools to evaluate the programs' success in preparing residents to deliver culturally competent care, with hopes that such data will ultimately yield uniform standards for all graduate medical education programs (Betancourt et al., Commonwealth Fund report, 5/2/07).

Patients with Limited English Skills More Likely to Suffer Harm from Adverse Events, Study Finds A study published in the April issue of the International Journal for Quality in Health Care finds that patients with limited English proficiency (LEP) treated in U.S. hospitals are more likely than their English-speaking counterparts to experience adverse events that result in physical harm. To examine care disparities affecting the LEP population, researchers from the Joint Commission on Accreditation of Healthcare Organizations (Joint Commission) analyzed 1,083 adverse event reports from six facilities. The researchers found that 49.1 percent of adverse events involving LEP patients resulted in some physical harm, compared with 29.5 percent of adverse events involving English-speaking patients. LEP patients were also more likely to experience a greater degree of harm, ranging from moderate temporary harm to death. Moreover, a greater proportion of adverse events experienced by LEP patients stemmed from communication lapses such as questionable assessment of patient needs, compared with adverse events experienced by English-speaking patients. Organizational errors, including inadequate knowledge transfer or facility protocols and processes, also disproportionately contributed to adverse events involving LEP patients. In light of the findings, the researchers conclude that language barriers appear to escalate patient safety risks, adding that LEP patients should be given access to culturally competent linguistic services. They also emphasize the importance of collecting data on patients' native language and communication needs so hospitals can tailor improvement efforts to their patient populations (Divi et al., International Journal for Quality in Health Care, April 2007 [subscription required]; Commonwealth Fund release, 4/10/07).