A Systematic Review of Assessment Tools Measuring Cultural Competence Outcomes Relevant to Pharmacy Education

Embedding cultural competency and cultural humility in undergraduate pharmacist initial education and training: a qualitative exploration of pharmacy student perspectives

BACKGROUND

Emphasis has been placed upon embedding equity, diversity and inclusion within the initial education and training of healthcare professionals, like pharmacists. Yet, there remains limited understanding of how best to integrate cultural competency and cultural humility into undergraduate pharmacy student training.

AIM

This qualitative study explored the views of pharmacy students to understand perspectives on, and identify recommendations for, embedding cultural competency and cultural humility within pharmacy education and training.

METHOD

Undergraduate pharmacy students from one UK-based School of Pharmacy were invited to participate in an in-person, semi-structured interview to discuss cultural competency in the pharmacy curriculum. Interviews were conducted between November 2022 and February 2023 and were audio-recorded and transcribed verbatim. Reflexive thematic analysis enabled the development of themes. QSR NVivo (Version 12) facilitated data management. Ethical approval was obtained from the Newcastle University Ethics Committee.

RESULTS

Twelve undergraduate pharmacist students, across all years of undergraduate training, were interviewed. Three themes were developed from the data, centring on: (1) recognising and reflecting on cultural competency and cultural humility; (2) gaining exposure and growing in confidence; and (3) thinking forward as a culturally competent pharmacist of the future.

CONCLUSION

These findings offer actionable recommendations to align with the updated Initial Education and Training standards from the United Kingdom (UK) pharmacy regulator, the General Pharmaceutical Council; specifically, how and when cultural competency teaching should be embedded within the undergraduate pharmacy curriculum. Future research should further explore teaching content, learning environments, and methods of assessing cultural competency.

How cultural competence is conceptualised, developed and delivered in pharmacy education: a systematic review

BACKGROUND

It is important to have a pharmacy workforce that is culturally competent to recognise a patient's health beliefs to improve medication adherence and reduce poor treatment outcomes.

AIM

This systematic review aimed to identify, critically appraise and summarise how cultural competency is conceptualised, developed and embedded in pre-qualification pharmacy education.

METHOD

Medline, Scopus, PsychInfo, Web of Knowledge, CINAHL, and Embase databases were searched for relevant papers published in English between January 2012 and December 2021, following PRISMA guidelines. Data from included papers were thematically analysed. Educational quality of papers was appraised using the GREET criteria. This systematic review was registered on PROSPERO, CRD42021295875.

RESULTS

The review included 47 papers (46 studies) with 18 papers meeting ≥ 9 points on the GREET criteria thus considered of good educational quality. Forty papers focused on educational interventions implemented to pharmacy students only, the remaining included students from different health disciplines. Half of the educational interventions focused on cultural competence in general. Most educational interventions lasted over a week and 21 were compulsory. Cultural competence conceptualisation varied; a focus on knowledge about different cultures or on culturally competent behaviours or a continuum with knowledge at one end and behaviour at the other.

CONCLUSION

There is variation in how cultural competence is embedded in pharmacy programmes, which could be a reflection of the differences in how educators conceptualised cultural competence. Further research is needed to develop a unified understanding of the meaning of cultural competence and how it can be embedded in pharmacy education.

Pedagogical Tools and Strategies for Developing Cultural Intelligence in Pharmacy Students and Educators

OBJECTIVE

To review evidence-based pedagogical tools and strategies used to support the development of cultural intelligence in pharmacy education.

FINDINGS

An exhaustive list of search terms was included to capture the variety of terms for "cultural intelligence" (eg, cultural competence). The search was not limited to any publication year range. Search engines included PubMed, Embase, CINAHL, Scopus, ProQuest Dissertations and Theses, ERIC, and PsycInfo. A total of 639 articles were identified after removing duplicates. Eighty-two articles were included for full review after screening. Year of publication ranged from 2004 - 2021. Two articles (2.4%) described tools for educator development, whereas the rest (n = 80, 97.6%) focused on student development. Examples of tools reported included lectures and workshops. Twenty-seven articles (32.9%) described pedagogical tools for fostering cultural intelligence concurrently with interprofessional development; the remaining articles (n = 55, 67.0%) focused only on pharmacy. Thirty-two articles (39.0%) used quantitative analysis methods, and 13 articles (15.9%) used qualitative analysis methods. Sixty-four articles (78.0%) included outcomes of perceptions, 6 (7.3%) included outcomes of participation, and 33 (40.2%) included outcomes of performance. Although not every study addressed all 4 cultural intelligence framework domains (awareness, knowledge, practice, and desire), each domain was apparent within the included articles.

SUMMARY

Various pedagogical tools have been used to develop cultural intelligence in pharmacy students with some tools used more than others. Findings suggest that integrating various pedagogical methods throughout the curriculum aligns more closely with the dynamic nature of learning and continuous self-refinement required to develop cultural intelligence.

Characteristics of Successful International Pharmacy Partnerships

Recommendations for global pharmacy collaborations are predominately derived from US institutions. This study utilized semi-structured interviews of global collaborators to assess important partnership components. Interviewees stated personal connections and understanding of each other's programs/systems were key components. Additionally, collaborators indicate that mutual benefits between partners can exist without the requirement for bidirectional exchange of learning experiences, and request and value partners and learners who are culturally aware, global citizens. This structured interview approach provided key insight into how to develop mutually beneficial, sustainable partnerships and provides additional confirmation that the five pillars of global engagement align with an international audience.

“We Speak the Same Language, but They Don't Understand Us.” Use and Abuse of Culturalism in Medical Care for Central American Migrants in Transit Through Mexico

This article deals with cultural stereotypes toward Central American migrants in the Mexican healthcare system, which lead to the naturalization of the supposed cultural characteristics of these new users. Based on 21 interviews of health and administrative staff in the state of Nuevo Leon (northeastern Mexico), it shows the first recourse to culturalist explanations to describe any phenomenon related to migrants' health. According to this perspective, the health of migrants, their relation to illness, and their patterns of seeking healthcare would be mainly determined by characteristic cultural traits, which justify their penurious attendance at health centers, and their low adherence to treatments. The culturalist explanation of migrants' health behaviors may influence the care they receive, as well as their adherence to treatment, which ultimately reinforces the health inequalities initially highlighted. This culturalist excess is partly explained by the incorrect understanding of the directives of health authorities in favor of the integration of an intercultural perspective in healthcare. Despite some ongoing training in this area, it does not seem sufficient to correct this situation effectively.