Cultural Competence Education for Practicing Physicians - Lessons in Cultural Humility, Nonjudgmental Behaviors, and Health Beliefs Elicitation

Oct 3, 2026

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Cultural competence training for practicing physicians remains debated in effectiveness, with limited emphasis on training and evaluating real-world clinicians. A skills-based course for culturally competent diabetes care was developed and tested in a controlled trial among primary physicians serving Medicaid patients. Physicians completing the course reported higher cultural humility-related nonjudgmental attitudes/behaviors and greater likelihood of eliciting patient diabetes beliefs and treatment preferences, while aggregate scores and some subscales showed no change or decreased self-awareness.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages11

Reading Time28 min

AccessFree to download

Introduction

Cultural disparities in diabetes care

Rationale for cultural competence training in practice

Patient-provider relationship and outcomes

Gaps in continuing medical education evidence

Cultural Competence Education for Practicing Physicians:Lessons in Cultural Humility,Nonjudgmental Behaviors,and Health Beliefs Elicitation RANDA M.KUTOB,MD,MPH;JoHN BORMANIS,PHD;MARJORIE CRAGO,PHD;JoHN M.HARRIS,JR.,MD,MBA;JANET SENF,PHD;CATHERINE M.SHISSLAK,PHD Introduction:Although numerous studies have examined cultural competence training,debate still exists aboutefficacious approaches to this training.Furthermore,litle focus has been placed on training and evaluating prac-ticing physicians. Methods:A skills-based course on culturally competent diabetes care was developed and subsequently testedin a controlled trial of primary physicians caring for patients enrolled in one state's Medicaid program.We hy-pothesized that physicians completing the course would show higher levels of self-reported cultural competenceas measured by a Cultural Competence Assessment Tool(CCAT)than those in the control group.Diferences inCCAT subscale scores were also compared. Results:Ninety physicians completed the study,with 41 in the control and 49 in the intervention group.Most werefemale (66%),with an average age of 44,and 12 years in practice.There were no significant diferences on totalCCAT score(212.7±26.7 for control versus 2172±28.6 for intervention,p=.444)or subscales measuring culturalknowledge.There were significant positive diferences on the subscales measuring physicians'nonjudgmentalatitudes/behaviors(subscale score 2.38±0.46 for control versus 2.69±0.52 for intervention,p=.004)and futurelikelihood of eliciting patients'beliefs about diabetes and treatment preferences(3.11±0.53 for control versus 3.37±0.45 for intervention,p=.014).There was,however,a significant negative difference on the subscalemeasuring cultural self-awareness (3.48±0.36 for control versus 3.26±0.48 for intervention,p=.018). Discussion:A predominantly skills-based approach to training physicians did not change aggregate measuresof cultural competence,but did affect key atitudes and behaviors,which may better reflect the goals of culturalcompetence training. Key Words:cultural competency;diabetes mellitus,type 2;patient-physician relations;continuing medical edu-cation Disclosures:The authors report this research was supported by a grant fromthe National Institute of Diabetes and Digestive and Kidney Diseases(R41DK62569)and by the Arizona Area Health Education Centers'Clinical Out-comes and Comparative Effectiveness Research Fellowship. Dr:Kutob:Assistant Professor,Department of Family &CommunityMedicine,College of Medicine,University of Arizona;Dr:Bormanis:Inde-pendent Healthcare Consultant,Tucson,Arizona;Dr:Crago:Research As-sociate (retired),Department of Family &Community Medicine,Collegeof Medicine,University of Arizona;Dr:Harris:Director,Office of Con-tinuing Medical Education,College of Medicine,University of Arizona;Dr:Senf:Professor Emeritus,Department of Family &CommunityMedicine,College of Medicine,University of Arizona;Dr:Shisslak:Profes-sor,Department of Family &Community Medicine,College of Medicine,University of Arizona. Correspondence:Randa M.Kutob,College of Medicine,University of Ari-zona,PO Box 245052,Arizona Health Sciences Center,Tucson,Arizona85724;e-mail:rkutob@email.arizona.edu. # Introduction Among the most troubling trends in health disparities isthat diabetes care indicators continue to worsen for minor-ity populations.African Americans,American Indians,andHispanics/Latinos have higher rates of diabetes,diabetescomplications,and mortality than White,non-Hispanics.2-5The prevalence of diabetes among Mexican Americans is 1.7 times higher,³and US Latinos also have higher ratesof renal disease and retinopathy.African Americans have2 to 4 times higher rates of renal disease,blindness,andamputations.⁴Adequate control of blood glucose can prevent diabetes complications,⁶but environmental,socioeconomic,and provider-and patient-related barriers can make this dif-ficult to achieve. groups and general concepts of cross

FAQs

What training intervention was tested in the study?

A skills-based course focused on culturally competent diabetes care was developed and delivered to primary physicians for evaluation in a controlled trial.

Did the training change overall cultural competence scores?

No significant difference was found on the total Cultural Competence Assessment Tool score between the intervention and control groups.

Which specific outcomes improved after the training?

The intervention group showed significant positive differences in nonjudgmental attitudes/behaviors and in the future likelihood of eliciting patients’ beliefs about diabetes and treatment preferences.

Were there any negative or mixed effects?

Yes. A significant negative difference was reported on the subscale measuring cultural self-awareness, indicating lower scores in the intervention group versus control.

Oct 3, 2026

Uploaded by SANS