Two-year evaluation of the Office of Minority Health cultural competency curriculum modules (CCCMs)

Significant research documents the existence of racial and ethnic disparities in health. For example, the 2005 National Healthcare Disparities Report finds that while some disparities are diminishing, health disparities continue to exist “across all dimensions of quality of healthcare.”

In December 2000, the Office of Minority Health (OMH) at the U.S. Department of Health and Human Services released the National Standards for Culturally and Linguistically Appropriate Services in Healthcare (CLAS) to address inequities that exist in the provision of health services and to provide a framework for common understanding and guidance regarding cultural competence in healthcare. OMH then commissioned the development of the Cultural Competency Curriculum Modules (CCCMs) as a tool to equip physicians with the competencies required to improve the quality of care for minority, immigrant, and ethnically diverse communities.

A two-year evaluation of the CCCMs' impact on physicians' knowledge, attitudes, and skills in the provision of culturally competent care was completed in January 2007. A repeated measures design was used to examine changes between before- and after-curriculum knowledge of cultural competency. Qualitative data from focus groups, questionnaires, and open-ended questions supplemented quantitative data.

2,213 physicians who participated in the curriculum between December 2004 and December 2006 were included in this study. Quantitative data find that although physicians appear to enter the CCCMs with a reasonable understanding of cultural competency, curriculum participation is consistent with meaningful score increases on cultural competency knowledge tests. Overall, we find effect sizes to be large and above 0.90 on average.

Qualitative results offer evidence that curriculum participation renders a positive impact on practice behavior. Physicians mentioned that as a result of taking the course, they attempted to be more cognizant and sensitive to cultural differences, took more time with patients, and asked more patient-centered questions. Our analyses further reveal that after curriculum participation, physicians express sympathy for diverse patients whose clinical encounters have been negatively impacted by cultural or language barriers. There is also strong evidence that curriculum participation results in enhanced self-awareness of cultural competency concepts.

While these are suggestive results, the CCCMs' ultimate impact on patient care and the potential to reduce health disparities hinges on the degree to which physicians translate knowledge into behavior change in the clinical environment. Limitations of this study include the use of physician self-report data and concerns as to whether knowledge tests accurately capture physicians' practice behavior.