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Queen's University

Cultural Competency

  “Cultural competency” within one’s professional practice means having the skills to support clientele of all ethnicities, genders, sexual/gender identities, of all cultural and socio-economic backgrounds, abilities and beliefs.

 The theory is, of course, that understanding how your client may differ from you in terms of any of these areas makes it possible for you to serve that client better. Recognizing that you live your own life out of various sets of cultural assumptions, and holding those assumptions up so that you can become conscious of them, is always a part of developing your cultural competency, as is learning about other people’s sets of cultural assumptions.

 As recently as 2003, an abstract of an article on a cultural competency program at Wake Forrest medical school began this way: “Although literature suggests that providing culturally sensitive care promotes positive health outcomes for patients, undergraduate medical education currently does not provide adequate cultural competency training. At most schools, cultural competency, as a formal, integrated, and longitudinal thread within the overall curriculum, is still in its infancy.” That was in 2003. A decade later, many more schools have undertaken to offer some sort of training in cultural competency to those who will be practicing medicine.

 This fall, Queen’s became one of them, when the department of psychiatry decided to pilot a cultural competency module as part of the training required of its residents in psychiatry.

 The cultural competency module was developed by Dr. Sarosh Khalid-Khan (the Associate Professor who is Deputy Head of the Department) and Dr. Margo Rivera (the Director of Psychotherapy Training for Psychiatry Residents and the Clinical Leader for the Personality Disorders Service at Providence Care). Together, they created and presented a two-hour introductory segment in the fall. That was followed by a segment on Cultural Competency regarding sexual and gender diversity (which is where I come in); this winter, another segment on cultural competency with regard to ethnicity and race will complete the series.

 In developing and presenting the segment on sexual and gender diversity, I had the privilege of working with Dr. Julie Darke, who is a psychotherapist with the Personality Disorders Service at Providence Care and, as some of you will know, who was also my predecessor in the Human Rights Office as an advisor specializing in the area of sexual and gender diversity.

 Together, we offered two three-hour seminars for the residents in psychiatry.

 We asked them to look at their own experience of cultural norms in the area of sexual and gender diversity and how that may impact their practice.

  • We asked them to consider the cultural norms of the patients they see.
  • We asked them to gain awareness of how the patients they see may choose to identify themselves in terms of sexual orientation and gender identity and what mental health issues may be particularly important to be aware of in treating such patients.
  • We asked them to gain some understanding of human rights law in Canada and what their legal obligations may be in this area if they practice here.  This is important for all practitioners, of course, but may be of particular concern where, as in our department of psychiatry at Queen’s, many of the residents are not from Canada, but are planning to practice here.

 The seminars were a mix of lecture and discussion, liberally sprinkled with vignettes and case studies.

 We began by asking people to share in conversation something about the beliefs and attitudes concerning sexual and gender diversity with which they had grown up, at home or in their larger communities. We also provided an opportunity for each resident to use modified, short-form gender-mapping and sexual orientation tools to explore their own identities in this area.

 Then we looked at what the law in Canada has to say about discrimination and harassment as well as the impact of discrimination and harassment on psychological functioning and made use of several vignettes illustrating some of the ways that patients might present.

 We did a segment on queer communities in North America, the nature and history of these sub-communities, and the sometimes radically different communities that have formed in non-western cultures. We looked at the criminalization and then decriminalization of diverse sexual and gender behaviors in western history and at the contemporary legal status of these behaviors around the world.  There was also a segment on the medicalization and pathologizing of various behaviors and how that has been changing, with particular attention to two areas, transvestism and gender dysphoria, which have not at present been completely de-pathologized.

 We completed the module by looking at applications of all of this to the practice of psychiatry, using several case studies to bring home various points.

 We found the residents to be engaged and very willing to discuss the materials presented. Our pre- and post-testing demonstrated some increase in knowledge of the materials, and we were very pleased to have the students themselves indicate they had found the seminars worthwhile—it is no small thing to have a positive reaction from very busy residents in medicine. Some practical issues concerning scheduling need to be resolved, but it is currently the plan to incorporate this piece of cultural competency training into the training for residents in psychiatry on an ongoing basis.

 The Department of Family Medicine last year held a Grand Rounds on the subject of health issues specific to people identifying in the queer community and has offered our Positive Space information session to faculty, staff, and students several times over the last year. Family Medicine is now also expressing interest in the possibility of modifying the seminars on cultural competency for use with residents in family medicine.

Kingston, Ontario, Canada. K7L 3N6. 613.533.2000