The cultural and linguistic competency (CLC) and implicit bias (IB) definitions reiterate how patients’ diverse backgrounds may impact their access to care.
CULTURAL & LINGUISTIC COMPETENCY (CLC)
The ability and readiness of health care providers and organizations to humbly and respectfully demonstrate, effectively communicate, and tailor delivery of care to patients with diverse values, beliefs, identities and behaviors, in order to meet social, cultural and linguistic needs as they relate to patient health.
IMPLICIT BIAS (IB)
The attitudes, stereotypes and feelings, either positive or negative, that affect our understanding, actions and decisions without conscious knowledge or control. Implicit bias is a universal phenomenon. When negative, implicit bias often contributes to unequal treatment and disparities in diagnosis, treatment decisions, levels of care and health care outcomes of people based on race, ethnicity, gender identity, sexual orientation, age, disability and other characteristics.
Having many different forms, types or ideas; showing variety. Demographic diversity can mean a group composed of people of different genders, races/ethnicities, cultures, religions, physical abilities, sexual orientations or preferences, ages, etc.
Business and Professions (B&P) Code Section 2190 required CMA to develop standards for CLC and IB for inclusion in CME activities. B&P 2190 is codified through Assembly Bill (AB) 1195 (Coto, 2005) and AB 241 (Kamlager-Dove, 2019).
The CLC and IB definitions reiterate how patients’ social determinants of health impact their access to care. In an effort to reduce health disparities, AB 1195 and AB 241 intend to encourage physicians and surgeons to meet the cultural and linguistic concerns” of California’s diverse patient population.
Medical education is to analyze and incorporate the CLC components that best serve the provider’s patient population, as well as address how IB affects perceptions and treatment decisions that lead to disparities in health outcomes. IB in decision-making may contribute to health care disparities by shaping behavior and producing differences in medical treatment along lines of race, ethnicity, gender identity, sexual orientation, age, socioeconomic status, or other characteristics. A key step toward ensuring the incorporation and understanding of CLC and IB toward meaningful action that leads to changes in professional practice, reductions of health disparities and improvements in health care outcomes, is securing diversity in perspectives during the planning of educational interventions such as in planners, speakers, etc.
Business and Professions Code 2190.1 exempts activities which are dedicated solely to research or other issues that do not contain a direct patient care component. Activities with no applicable CLC or relevant IB content must be documented.
Based on the patient population, the educator is to:
- Identify what CLC factors are likely to be relevant to them.
Some guiding questions could include:
- What are the commonalities and differences among individuals in this population?
- Would an individual in this population be likely to experience any specific barriers in communication?
- Would an individual in this population be likely to have cultural or linguistic needs or expectations that would be appropriate for a clinician to address?
- Identify the disparities in care that the patient population is experiencing or is at risk of experiencing.
Some guiding questions could include:
- What are some populations and/or groups who frequently experience disparities in care?
- Is there overlap between those populations and this patient population?
- What factors determine the type and level of care that this patient population receives?
- Are those determining factors susceptible to implicit bias?