Brenda L. Beagan

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.

`It's Just Easier for Me to Do It': Rationalizing the Family Division of Foodwork:

While women continue to do the lions share of foodwork and other housework, they and their families appear to perceive this division of labour as fair. Much of the research in this area has focused on families of European origin, and on the perceptions of women. Here we report findings of a qualitative study based on interviewing multiple family members from three ethno-cultural groups in Canada. Women, men and children employed similar rationales for why women did most of the foodwork, though explanations differed somewhat by ethno-cultural group. Explicitly naming foodwork as womens work was uncommon, except in one ethno-cultural group.Yet more individualized, apparently gender-neutral rationales such as time availability, schedules, concern for family health, foodwork standards, and the desire to reduce family conflict were grounded in unspoken assumptions about gender roles. Such implicit gender assumptions may be more difficult to challenge.

The patient as text: a challenge for problem-based learning.

Objectives  To explore the values and assumptions underlying problem‐based learning (PBL) cases through narrative analysis, in order to consider the ways by which paper cases may affect student attitudes and values.

Everyday classism in medical school: experiencing marginality and resistance.

Objective  To explore the medical school experiences of students who self‐identify as coming from a working‐class or impoverished family background.

'Is this worth getting into a big fuss over?' Everyday racism in medical school

Introduction  Faced with an increasingly diverse student body, educators in the health professions struggle for ways to foster equality and understand racism. The concept of ‘everyday racism’ provides an important tool for examining subtle processes that construct a racialised climate in medical schools and other institutions.

Cryopreserved Human Embryos in Canada and Their Availability for Research

OBJECTIVE To determine the number of cryopreserved human embryos at all Canadian in vitro fertilization (IVF) clinics, the number of these embryos that have been donated to research, and the consent processes regarding the disposition of embryos no longer required for reproductive purposes. METHODS A questionnaire was mailed to 24 fertility clinics identified as conducting IVF and cryopreservation, inviting completion of the questionnaire by telephone. Thirteen clinics (response rate 54%) completed the survey. RESULTS As of August 2003, all 13 clinics cryopreserve embryos not required for intrauterine transfer; in total, 15,615 embryos are currently in storage in these clinics. Nine clinics specifically offer patients the option of donating embryos to research; in total, 299 embryos have been allocated for research, about 2% of all embryos stored by these 13 clinics. All 9 clinics routinely seek consent for research use of embryos, with 7 clinics currently using such embryos for research to improve clinic practices. CONCLUSION The results highlight the difficulties of gathering accurate data on assisted human reproduction and related research in a context where there is no legislation governing these practices. Nonetheless, the data suggest there are very few cryopreserved embryos in Canada available for research and that even fewer of these may be potentially eligible for research due to incomplete or inadequate consent processes.

'Food is culture, but it's also power': the role of food in ethnic and gender identity construction among Goan Canadian women

Foodwork and womens primary responsibility for foodwork have long been interpreted by feminist scholars as a site of gender oppression for women; yet the gendered meanings of foodwork are complicated when race, diaspora and ethnic identity are also taken into account. This article examines the meaning of food and foodwork for Goan women in Toronto, Canada, and the role of food in creating and maintaining distinctly gendered ethnic identities. Catholic Goan identity, born from Portuguese colonization of an area in what is now Western India, has few unique markers of ethnic distinction from other Indians. In this context Goan cuisine takes on a particular symbolic significance. In this qualitative study with first-generation Canadian Goan women (N = 13) the gendered role of women in foodwork was seen as having particular power or ‘currency’ within the family and community, valued for fostering and supporting Goan identity. We argue that the same foodwork practices that constitute gendered oppression for women may simultaneously confer a form of ‘culinary capital’ within the social arena of their own diasporic community.

Occupations of Masculinity: Producing Gender through What Men Do and Don't Do

Abstract While gender shapes engagement in occupations, occupations are also means through which we construct gender. Based on qualitative interviews with 11 young men in Newfoundland, Canada, this paper explores the ways they produce masculinity through particular occupations focused on bodies. They strive to construct muscular bodies through cardiovascular exercise, weight‐training, and ‘eating right.’ These occupations hold explicit meanings for them, such as increasing their heterosexual desirability, peer respect and popularity. They also have less obvious meanings that concern displaying and reinforcing masculinity. At the same time, men may engage in much less visible occupations that help produce masculinity: constant (but unacknowledged) bodily comparisons with other men, monitoring their speech to ensure its masculinity, actively hiding the effort required to produce a particular image, and concealing the fact that they care about their appearance at all. Gender is more than an influence on occupation; it is produced through occupation.

Being a ‘good mother’: Dietary governmentality in the family food practices of three ethnocultural groups in Canada

In this qualitative study with three ethnocultural groups in two regions of Canada, we explore how official dietary guidelines provide particular standards concerning ‘healthy eating’ that marginalize other understandings of the relationship between food and health. In families where parents and youth held shared ways of understanding healthy eating, the role of ‘good mother’ was constructed so as to include healthy eating expertise. Mothers expressed a perceived need to be personally responsible for providing skills and knowledge about healthy eating as well as guarding children against negative nutritional influences. Governing of family eating practices to conform to official nutritional advice occurred through information provision, monitoring in shopping and meal preparation, restricting and guiding food purchases, and directly translating expert knowledges into family food practices. In families where parents and youth held differing understandings of healthy eating, primarily families from ethnocultural minority groups, mothers often did not employ the particular western-originating strategies of conveying healthy eating information, or mentoring healthy meal preparation, nor did they regulate or restrict children’s food consumption. Western dietary guidelines entered into the family primarily through the youth, emphasizing the nutritional properties of food, often devaluing ‘traditional’ knowledge about healthy eating. These processes exemplify techniques of governmentality which simultaneously exercise control over people’s behaviour through normalizing some family food practices and marginalizing others.

People Are Just Becoming More Conscious of How Everything's Connected': 'Ethical' Food Consumption in Two Regions of Canada

In this qualitative study with three ethnocultural groups in two regions of Canada, we explore the ways reflexivity and tradition may help explain regional differences concerning ‘ethical consumption’ in relation to food. We argue that ‘reflexive modernity’ cannot be said to apply unambiguously in contemporary Canada. The food concerns of Punjabi British Columbian and African Nova Scotian participants centred more on cultural traditions than on ethical consumption. While European Canadians in British Columbia (BC) and Nova Scotia (NS) appear similar on the surface, British Columbians expressed strong commitment to discourses of ethical consumption, while those in Nova Scotia displayed almost no engagement with those discourses. In contrast, tradition was a more prominent concern in food decision-making. Availability of resources for ethical consumption both shaped and was shaped by local discourses. Differing relationships to community may contribute to reflexive ethical consumption.