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A pilot of a framework for a culturally competent university

Creating framework for culturally competent university


A national multicultural health agenda

 Dept of Health and Ageing, Dept of Immigration & Multicultural & Indigenous Affairs, $350,000

Deliverable 1 - A national review of cultural training in medical schools

A survey of Australian medical schools identified current activities, teaching formats, useful resources and staff involved in teaching cultural competence in all the medical schools. It revealed that no overall frameworks existed to guide undergraduate teaching or workforce development in the field of cultural competency.
Stakeholders defined a culturally competent doctor in terms of personal attitudes; knowledge of cultural issues; communication; professional standards; and staff management. Stakeholders identified three sorts of problems that could be alleviated through achieving cultural competence in medical education: quality of care; better health outcomes; and a better retention of doctors.

The medical school respondents’ definitions of cultural competence were (a) performance driven, a ‘cultural toolbox’; and (b) conceptually driven, such as ‘cultural humility’ , embodiment of cultural forces as pathologies, and social capital. A range of social sciences (sociology, medical anthropology, critical theory); and medical humanities, philosophy, religious perspectives, history of medicine, applied linguistics, and human geography were identified. Teaching models included empirical, skills based approaches in Problem Based Learning and cultural skills; cultural safety model; cultural security; cultural determinants of health and disease, the diversity dividend model, and social determinants of health. Another group included power and medical dominance, human rights, and cross-cultural empowerment. Other approaches included illness within a global geopolitical framework and poverty.

Facets of cultural competence currently taught spanned knowledge (target groups, culture and health status, health services, and community and society including refugees – Indigenous groups were usually taught separately); attitudes (promoting self-reflection, recognising stereotyping and personal and institutional racism) and skills (clinical management, professional conduct, communication, target communities and the evidence base). Medical schools advance cultural competence through a number of phases and contexts of learning: student selection, placements, and incorporation into existing streams or domain areas; practice simulation sessions with actors; and electives.

Challenges to the advancement of cultural competence at their medical schools were gaining institutional and faculty recognition and support; gaining student commitment; the logistics of implementing cultural competence in current programs; and challenges in educational development.

A national workshop on cultural competence assembled medical educators, community, government policy makers, professional and educational accreditation representatives from around Australia for the first time. They established some key principles – that working with the community is essential; that there is more benefit in collaboration than the current individual fragmented efforts and that cultural competence training must be conceived of as part of lifelong professional development.  The Workshop led to the development of a network to develop teaching, assessment and evaluation tools such as in areas of gender, rurality, cultural aspects of biological medicine, international health, human rights and social theory.

Deliverable 2 - Infusion of cultural competence in the new undergraduate medical curriculum and, as appropriate, postgraduate courses

A set of student attributes, Principles in Cultural Competence was developed, and a set of student capabilities stratified in relation to course progression, which were adopted by the Faculty for its new undergraduate medical curriculum. Experience of and openness to diversity also became part of new student selection procedures. The use of local community and services was pioneered in writing scenario-based exercises and communication skills teaching materials, identified opportunities for student exposure to diversity after consultation with both ethnic and mainstream organisations and instigated a Family Diaries pilot project.

At the postgraduate level a course in Culture Health and Illness was designed and delivered within the MPH program attended by many health service delivery staff.  In response to demand, a Graduate Certificate in Culture and Health was established.

Deliverable 3 - Benchmarks of cultural competence and best health practice

Benchmarking entails evaluation, accreditation and continual quality review.  Industry acknowledgement of the value of cultural competence is of course an essential first step. The Cultural Competence Network fostered exchange among policymakers, accreditation bodies and service providers to the point where there is agreement on the need for some national ‘guidelines for success’ for cultural competence. This is a first step by industry stakeholders towards endorsement of the concept of benchmarking and quality improvement in this area.  The first move on cultural competency benchmarking for a specific group was made through Aged Care, a Commonwealth priority, through leveraging a project funded by NSW Dept of Ageing, Disability and Home Care to develop policy and a model for cultural competence capacity building in the home and community care system.

An evaluation tool was developed to assess medical practitioner cultural competence. 

Deliverable 4 – Framework for a research agenda in multicultural health

Developing a research agenda focused on the need for culture to inform health decisions stands to improve the Commonwealth’s strategic planning and workforce capacity building.

A detailed multicultural health research agenda for one Area Health Service was produced, the principles and framework were test-bedded in NSW Health Department and elements disseminated nationally.   

Deliverable 5 – Development and dissemination of research products in multicultural health and materials suitable for education in multicultural health across Australia

  • Cultural competence frameworks disseminated nationally through Multicultural Mental Health Australia, with the potential to inform the National Mental Health Plan
  • Research and education in national health priority areas (such as cancer) leading to national workshops and potential to inform Priority Action for National Change #7 prescribed by the National Service Improvement Framework for Cancer the National Health Priority Action Council
  •  Development of cultural competence resources in public health education and the potential to inform the National Public Health Education Framework.

Evaluation of cultural competence

Qin Guo, Maurice Eisenbruch, Tim Earnshaw, Lilanthi Ambanpola and Ilse Blignault

As part of the UNSW New Medical Program the Centre, in consultation with the Program Evaluation and Improvement Group of the Office of Medical Education, developed a comprehensive cultural competence evaluation framework. The framework consists of five components:

  • Education Objectives and Priorities Evaluation,
  • Student Selection Evaluation,
  • Instruction Resource Evaluation,
  • Instruction Process Evaluation and
  • Education Outcome Evaluation.

A questionnaire developed to assess medical student cultural competence was piloted with a sample of students in the first cohort in 2004.


Development of a transcultural mental health focus in undergraduate medicine at UNSW


WSAHS, $20,000

National study of multicultural health nursing

(Project carried out during 2001-2)

Dept of Education, Science & Training, $50,000

Arie Rotem, Donna Waters (Nursing and Health Services Research Consortium), Rosemary Snodgrass ( Health Care Consultant), Reta Creegan (University of Technology Sydney)

The project aimed to explore multicultural health within the context of Australian nursing education, and to map the ways in which current nursing education addresses multicultural health, with a view to recommending strategies for enhancing cultural competence in nursing. Thirty-four universities and Colleges offering undergraduate and postgraduate nursing education were surveyed to determine the breadth of approaches to the multicultural context of nursing education. Twenty-seven responses were received (79 per cent response rate) and in-depth interviews were conducted with spokespersons from seven universities in five states across Australia. Themes arising from the responses were considered within the current policy frameworks of State and Territory Nurses Registration Boards, the Australian Nursing Council and the professional nursing Colleges.

The spectrum of responses ranged from a uni-dimensional view with emphasis on language and ethnicity to one that attempted to interweave culture and diversity into all units of study, including practicum. Curriculum content with regard to both Indigenous health and the health needs of other culturally and linguistically diverse groups remains narrowly focussed in addressing the wider issues of public and primary health care. The requirements for cultural competency are left largely to the discretion of the academic body or institution. Recruitment efforts largely target those nurses who have been educated in a Western system and who are recruited for their capacity to fit rapidly into the Anglo-Celtic nursing workforce, rather than for their diversity as a dividend to enrich the system.

Emergent issues are:

  • Investment in the recruitment and retention of both Indigenous nurses and nurses from other cultures
  • Attention to arrangements for overseas-qualified nurses seeking work in Australia
  • Continuing efforts to engage with other disciplines or communities (including medicine, public health, allied health) in multicultural research and practice
  • It is possible to identify three main streams under which further investigation could enhance cultural competence in nursing:
    • Attracting more students and staff from culturally diverse backgrounds
    • Developing a learning framework that teaches skills in self-awareness, questioning and a commitment to lifelong learning
    • Provide clear and consistent identification of what is required of nurses in terms of cultural competence or safety from governing bodies, faculties, workplaces, other disciplines and clients/patients.

The report has been published by Department of Education, Science and Training (DEST). .

Curriculum development at Royal Phnom Penh University

Eisenbruch, M. (Department of Psychology, Phnom Penh University)
Overseas Service Bureau, $12,200