Blye Frank

Measures of Cultural Competence: Examining Hidden Assumptions

Purpose The authors critically examined the quantitative measures of cultural competence most commonly used in medicine and in the health professions, to identify underlying assumptions about what constitutes competent practice across social and cultural diversity. Method A systematic review of approximately 20 years of literature listed in PubMed, the Cumulative Index of Nursing and Allied Health Literature, Social Services Abstracts, and the Educational Resources Information Center identified the most frequently used cultural competence measures, which were then thematically analyzed following a structured analytic guide. Results Fifty-four instruments were identified; the 10 most widely used were analyzed closely, identifying six prominent assumptions embedded in the measures. In general, these instruments equate culture with ethnicity and race and conceptualize culture as an attribute possessed by the ethnic or racialized Other. Cultural incompetence is presumed to arise from a lack of exposure to and knowledge of the Other, and also from individual biases, prejudices, and acts of discrimination. Many instruments assume that practitioners are white and Western and that greater confidence and comfort among practitioners signify increased cultural competence. Conclusions Existing measures embed highly problematic assumptions about what constitutes cultural competence. They ignore the power relations of social inequality and assume that individual knowledge and self-confidence are sufficient for change. Developing measures that assess cultural humility and/or assess actual practice are needed if educators in the health professions and health professionals are to move forward in efforts to understand, teach, practice, and evaluate cultural competence.

Making interprofessional education work: the strategic roles of the academy.

Faculties (i.e., schools) of medicine along with their sister health discipline faculties can be important organizational vehicles to promote, cultivate, and direct interprofessional education (IPE). The authors present information they gathered in 2007 about five Canadian IPE programs to identify key factors facilitating transformational change within institutional settings toward successful IPE, including (1) how successful programs start, (2) the ways successful programs influence academia to bias toward change, and (3) the ways academia supports and perpetuates the success of programs. Initially, they examine evidence regarding key factors that facilitate IPE implementation, which include (1) common vision, values, and goal sharing, (2) opportunities for collaborative work in practice and learning, (3) professional development of faculty members, (4) individuals who are champions of IPE in practice and in organizational leadership, and (5) attention to sustainability. Subsequently, they review literature-based insights regarding barriers and challenges in IPE that must be addressed for success, including barriers and challenges (1) between professional practices, (2) between academia and the professions, and (3) between individuals and faculty members; they also discuss the social context of the participants and institutions. The authors conclude by recommending what is needed for institutions to entrench IPE into core education at three levels: micro (what individuals in the faculty can do); meso (what a faculty can promote); and macro (how academic institutions can exert its influence in the health education and practice system).

The tyranny of surveillance: male teachers and the policing of masculinities in a single sex school

This paper draws on research into male teachers in one single sex high school in the Australian context to highlight how issues of masculinity impact on their pedagogical practices and relationships with boys. The study is situated within the broader international field of research on male teachers, masculinities and schooling in Australia, the UK and the US and provides further knowledge about the gendered dimensions of male teachers’ pedagogical practices in secondary schools. The authors argue for the urgent need to interrogate the impact of masculinities in male teachers’ lives at school, given the call for more male role models to ameliorate the supposed feminizing and emasculating influences of schools on boys’ lives. A particular Foucauldian perspective, which draws on surveillance and its key role in practices of gender subjectification, is used to provide insight into how two male teachers learn to police their masculinities and to fashion pedagogical practices under the normalizing gaze of their male students.

Contradictions and Tensions: Exploring Relations of Masculinities in the Numerically Female-Dominated Nursing Profession

The feminization of nursing constitutes a significant barrier to men choosing to enter nursing, and in part accounts for the low numbers of men in the profession. Men who choose non-traditional occupations such as nursing are at greater risk than their women counterparts of being unsupported, devalued, and even ridiculed for engaging in gender-inappropriate behavior. For the small number of men who defy prevailing gender norms by engaging in this work, the perception of a spoiled masculinity reflects the gendered and sexed relations within the profession. Men nurses are faced with the reality of defending their career choice, their contribution to nursing, and their sexuality. As a consequence, men who do nursing work are continually reminded that they are different from other men. The experience of eight men registered nurses in Nova Scotia, Canada, reveals the tensions and contradictions of mens lives in a non-traditional occupation.

Twelve tips for preparing residents as teachers

Background: Residents are frequently identified by medical students as their most frequent and memorable teachers; residents also teach their peers, junior and senior colleagues, other health professionals, and their patients. Many will teach in their future practice. Developing the skills to become a teacher is an important part of postgraduate education, and warrants a systematic, planned approach that may include many complementary learning opportunities. Aims: Our purpose is to describe one such approach: a 4-week elective experience in medical education offered to postgraduate learners. Method: The paper describes the background and goals for the elective, and the various steps in planning, implementing, and evaluating such a course, drawing on the literature and mining our own experience for examples. Specifically, we address the following: needs assessment; the determination and selection of content, sequence, and teaching and learning methods; the experiential learning opportunities offered; and the emphasis on the participants’ developing self-awareness of themselves as teachers, and as part of a community of teachers. Results: The program implementation, program evaluation, and response to feedback received are described. Conclusion: A 4-week elective experience in medical education was positively received by participants.

Masculinity and Health in Late Life Men

Masculinity is a social construction that defines itself according to context. Older men constitute an unseen minority when it comes to their health, and thus the study of masculinity as it relates to health in older men requires deeper understanding. This article offers insights into how gender, health, and ageing interact for older men and explores how men negotiate the concept of masculinity in later life. The findings from two complementary studies are presented and discussed. The first study, a qualitative analysis of focus group discussions held with 48 community-dwelling older men, indicates that the desire to uphold hegemonic ideals of independence, self-reliance, and imperviousness to pain and illness are embedded in older men’s health-related beliefs and behaviors. Ill health and help seeking are often perceived as a threat to the masculine identity, and taking action for health is considered only when health status jeopardizes independence. In the second study, more than 2,000 men aged 55 to 97 years responded to a postal survey on health behaviors and masculinity. Results of the survey indicated that age predicts health behaviors and health care seeking better than scores on a masculinity index, which tended to remain stable regardless of age. Both the qualitative and quantitative findings support the hypothesis that with age men will succeed in incorporating actions into their daily lives in a way that does not conflict with their perceived resilience to frailty and weakness, even if such actions involve seeking help for illness or adopting healthier lifestyle behaviors.

Beyond the ‘four Ds of Multiculturalism’: taking difference into account in medical education

Initiatives such as ‘Social Accountability: A Vision for Canadian Medical Schools’ ‘Healthy People 2010: Understanding and Improving Health’ and ‘Tomorrow’s Doctors: Recommendations on Undergraduate Medical Education’ recognise that, as medical educators, we are in a position to make a contribution to the reduction of health disparities through the education and professional development of competent doctors who offer accessible and equitable care. Well-intended diversity education initiatives and interventions have been developed in response. While we commend medical educators for acknowledging and addressing these inequities, this commentary offers a cautionary note about approaching diversity education from a noncritical perspective.

Boys and Underachievement in the Canadian Context: No Proof for Panic

Over the last fifteen years there has been an increase in scholarly work internationally in the area of boys, masculinities and schooling (Davison, 1996, 2000a, 2000b; Frank, 1987, 1990, 1993, 1994, 1997a and b; Epstein et al., 1998; Kenway, 1995, 1998, 2000; Mac an Ghaill, 1994a, 1994b, 1996; Martino, 1994, 1995, 2000, forthcoming). This work, heavily influenced by feminist research on gender and education, has investigated, and often problematised, the complexities of the lives of boys in schools. It has focused on homophobia and heterosexism, bullying, sexual harassment, violence and underachievement. Over the last ten years in the United Kingdom and Australia there has been an outcry in the popular press about a crisis in the education of boys (Epstein et al., 1998). Newspaper headlines have asked questions such as: ‘Are Schools Failing our Boys?’ ‘What about the Boys?’ and ‘Do Boys Need More Male Teachers?’

Patient-centredness in a context of increasing diversity: Location, location, location

The concept of ‘patient-centredness’ is increasingly central inmedical education curriculum (Richards & Inglehart 2006;Tsimtsiou et al. 2007); yet, it is also well-recognised that thepatients whom we serve are becoming increasingly diverse. Inthis edition, Gustafson and Reitmanova (2010) call ourattention to the fact that the Canadian population is becomingincreasingly diverse, and the make-up of that diversity hasshifted over the past decades. This shift has significantinfluence in terms of how medical education is conceptualised,planned and delivered. Therefore, our commentary beginswith a question for consideration: What does it mean to bepatient-centred in a context of increasing diversity?Patient-centred care (PCC) (Stewart et al. 1995; Tsimtsiouet al. 2007) is an approach that privileges the social aspects byacknowledging that a patient is more than her or his biology,symptoms, and/or body. It is often defined by what it is not:‘technology centred, doctor centred, hospital centred, diseasecentred’ (Stewart 2001, p 444) and occurs ‘when medicalmanagement comprises more than a single pill’ (Bauman et al.2003, p 253).Despite institutional attempts to apply a patient-centredapproach, these remain frequently uncritically, or superficially,realised in medical education (Tsimtsiou et al. 2007).A dualistic sorting of knowledge into two main categories:objective (disease, evidence-based, competence) and subjec-tive (illness, social, caring) (Good & Good 1993; Morris 2000)is common in medical education. Despite calls for patient-centredness, patients’ accounts of the illness experiencefrequently fall under the subjective, thus untrustworthy,domain. In contrast, medical tests and laboratory reports areconsidered ‘factual’ because of their presumed objectivity. Thisreinscribes traditional relations of power in the physician–patient relationship.One knows, the other feels; one prescribes, the othercomplies; one is paid, the other pays. Although thissharp division has begun to blur under the pressureof postmodern innovations such as the ubiquitousmalpractice suit, the old conceptual infrastructurethat sustained it is still, confusingly, in place. (Morris2000, pp 37–38)Traditionally, medical education has been constitutedthrough the study of disease, understanding sickness as abreakdown of the machine that is the body. Toombs (1993,1995) encouraged a shift calling for an approach that considersillness an interruption of participation in the social world. Ifengaged in educational settings, such an understanding hasthe potential to transform medical practice, making the patient,not the disease, the focus of diagnosis and treatment.However, such a shift would require thoughtfulness aboutthe patients, and their multiple complexities.

“You’ve Gotta Be That Tough Crust Exterior Man”: Depression and Suicide in Rural-Based Men:

Suicide rates in Canada are highest among rural men. Drawing on photovoice interviews with 13 women and two men living in a small rural Canadian town who lost a man to suicide, we inductively derived three themes to describe how contextual factors influence rural men’s experiences of depression and responses to suicidal thoughts: (a) hiding depression and its cause, (b) manly self-medicating, and (c) mobilizing prevention. Further discussed is how gender relations and ideals of masculinity within rural milieu can inhibit men’s acknowledgment of and help seeking for mental illness issues. Participants strongly endorsed a multifaceted approach to the destabilization of dominant ideals of masculinity that likely contribute to depression and suicide in rural men.