Beyond cultural competency: Using literature to foster socially conscious medicine
J. Ernest Aguilar
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For at least the past three decades, training programs in cultural competency have enjoyed increasing popularity in medical schools and in continuing medical education. Proponents of cultural competency generally hold that when physicians and other health-care professionals are trained in cultural issues, there will be a reduction in race-based disparities in both the access to and the quality of health care. Yet there has been little evidence to support this claim. Further, a conceptual analysis of cultural competency suggests that this type of training may serve only to maintain or further aggravate the current state of affairs faced by cultural and racial minorities. New pedagogical models are needed. These models will need to include an opportunity (and the support) for the unlearning of old patterns of viewing society. Participants will need to reflect on the social factors and structures that are more likely to lead to race-based disparities. These factors include but are not limited to a legacy of interracial hostility and mistrust, the unjust distribution of social power, and a defective understanding of the proper posture to be taken towards the one that is other. Educational theories that promote participatory, transformative, and reflective learning experience must be used to shape new educational efforts. Reforms in medical education can draw more heavily from the theories developed by scholars in literature and medicine. These theorists argue that the development of narrative skills contributes to improved communication across interpersonal differences. Further, many scholars agree that reading well-written works of literature contributes to the skill required for recognizing injustice and engaging in the moral and ethical reflection needed to address it.