Research Article: Baseline cultural competence in physician assistant students

Date Published: April 23, 2019

Publisher: Public Library of Science

Author(s): Melanie M. Domenech Rodríguez, Paula B. Phelps, H. Cathleen Tarp, Carl Richard Schneider.


Cultural competence is a critical component in health care services. The relationship between health disparities and prejudice and discrimination is well documented. Prejudicial attitudes and discriminatory behavior are modifiable through training yet few programs have evidence-based training. No published data has reported on baseline levels of cultural competencies in medical trainees which is necessary for tailoring programs appropriate to the audience. This manuscript fills that gap by reporting on data from three cohorts of first-year Physician Assistant (PA) students (N = 216). We examined students’ baseline levels with special attention to differences in cultural competence constructs across age, gender, and ethnicity.

Students completed self-report measures for ethnic identity, ethno-cultural empathy, multicultural orientation, attitudes about diversity, health beliefs attitudes, colorblind racial attitudes, and burnout at the beginning of their first year. They completed the measures online (Qualtrics) during class time, prior to a lecture on cultural competence.

Data indicate a correlation between cultural competence constructs supporting the validity of the battery of tests as a cohesive unit to measure cultural competence. There were statistically significant differences between age, gender identity, and ethnic groups across cultural competence variables.

Data provide baseline data that may be used to tailor educational programs. Findings suggest that our measures show promise for future educational research measuring effectiveness of cultural competence training.

Partial Text

Cultural competence is a bona fide occupational qualification for medical and mental health providers broadly [1–3]. There is overwhelming evidence that health disparities are related to prejudice and discrimination broadly [3]. And while expectations are clearly stated, little is known about how to clearly meet them in assessment [4] or training [5] activities. The purpose of this manuscript is to provide information regarding one program’s evaluation of cultural competence in their first-year students across three cohorts and examine students’ baseline levels across years with special attention to differences in cultural competence constructs across age, gender, and ethnicity. The aim of this study is to measure baseline cultural competence in first year PA students using self-measurement tools and to determine factors that may affect these baseline measures.

Participants were first year students in a Physician Assistant Studies Department in the western United States. Students participated in assessment that were in the graduating classes of 2017, 2018, and 2019. Each year 72 students completed the assessment (N = 216) and a total of 204 consented to research for a participation rate of 94.44%. Students were 22 to 50 years of age (M = 28.71, SD = 5.67). Although an inclusive item asked about gender identity broadly [23], all participants identified as cisgender and predominantly female (n = 119, 58.3%). Students were married (n = 91, 44.6%), single (n = 61, 29.9%), in a committed relationship (n = 43, 21.1%), or cohabiting (n = 9, 4.4%). Only 3 participants reported they currently provided services to patients. The vast majority of participants identified as White American (n = 175, 85.8%) with the remainder identifying as Asian or Asian American (n = 11, 5.4%), Hispanic/Latino (n = 7, 3.4%), mixed ethnic (n = 4, 2.0%), and Black or Black American (n = 1, 0.5%). An additional four students selected “other” ethnicity and two did not provide ethnicity information.

PA students show relatively low levels of burnout, average colorblindness [15], high levels of ethnocultural empathy, personal acceptance, and health beliefs. These scores make sense in the context of students at the beginning of their graduate program and, although relatively good, there is evidence of room for improvement. Furthermore, important differences emerged across groups by age, gender identity, and ethnic minority status that are important for programs to consider. Structural diversity, that is accepting students who are from different age, gender identity, racial/ethnic, and other backgrounds, may play an important role in bringing diversity of thought and experience into the classroom. This is consistent with established findings on the relationship between structural diversity and classroom learning [24]. Representation of ethnic minorities in PA studies is already low [25] and was even lower than expected in our sample. One simple way to intervene to increase cultural competence may be to work to change the composition of the student body along gender and ethnic lines. That can be an incredibly challenging task, especially in rural locations that have little ethnic diversity in surrounding communities.

Culture and language are critical to how health care services are delivered and received, as they define the limits and effectiveness of the working relationship between the health care provider and the patient. If health professions programs wish to produce more providers who choose to work with underserved populations, it is imperative that they prepare students who are sensitive to the needs and preferences of culturally diverse patients. Overall, this manuscript contributes important knowledge regarding baseline levels of various cultural competence constructs in three cohorts of PA students. As the field tries to address the need for cultural competence training and, with it, the assessment of training efforts, these data suggest that our measures show promise for future use.