Cultural and Linguistic Competency, and Implicit Bias in Health Care
The University of California, San Francisco is committed to building a broadly diverse community, nurturing a culture that is welcoming and supportive, and engaging diverse ideas for the provision of culturally competent education, discovery, and patient care. It is therefore necessary that content planners and evaluators of continuing education be well-versed in the design of education that promotes cultural and linguistic competency and awareness and diversion of unconscious biases.
In addition, the California Business and Professions (B&P) Code Section 2190 requires the California Medical Association (CMA) to develop standards for Cultural and Language Competence (CLC) and Implicit Bias (IB) for inclusion in CME activities. B&P 2190 is codified through Assembly Bill (AB) 1195 (Coto, 2005) and AB 241 (Kamlager-Dove, 2019). See the actual legislation using the links above.
Definitions follow, and a list of resources and ideas to incorporate CLC and IB in your CE activities is available here.
AB-1195: Continuing education: cultural and linguistic competency (2005-2006)
The Law: Associations that accredit continuing medical education courses [such as UCSF] shall develop standards before July 1, 2006, for compliance with the requirements. The associations may develop these standards in conjunction with an advisory group that has expertise in cultural and linguistic competency issues.
In order to satisfy the requirements, continuing medical education courses shall address at least one or a combination of the following:
Cultural competency. For the purposes of this section, “cultural competency” means a set of integrated attitudes, knowledge, and skills that enables a health care professional or organization to care effectively for patients from diverse cultures, groups, and communities. At a minimum, cultural competency is recommended to include the following:
(A) Applying linguistic skills to communicate effectively with the target population.
(B) Utilizing cultural information to establish therapeutic relationships.
(C) Eliciting and incorporating pertinent cultural data in diagnosis and treatment.
(D) Understanding and applying cultural and ethnic data to the process of clinical care.
Linguistic competency. For the purposes of this section, “linguistic competency” means the ability of a physician and surgeon to provide patients who do not speak English or who have limited ability to speak English, direct communication in the patient’s primary language.
Note that educational activities that are dedicated solely to research or other issues that do not include a direct patient care component are exempt from this requirement.
AB-241: Implicit bias: continuing education: requirements
The Law: Associations that accredited continuing medical education courses shall develop standards before January 1, 2022, for compliance with the requirements. The associations may update these standards, as needed, in conjunction with an advisory group established by the association that has expertise in the understanding of implicit bias.
Implicit bias, meaning the attitudes or internalized stereotypes that affect our perceptions, actions, and decisions in an unconscious manner, exists, and often contributes to unequal treatment of people based on race, ethnicity, gender identity, sexual orientation, age, disability, and other characteristics.
Implicit bias contributes to health disparities by affecting the behavior of physicians and surgeons, nurses, physician assistants, and other healing arts licensees.
Evidence of racial and ethnic disparities in health care is remarkably consistent across a range of illnesses and health care services. Racial and ethnic disparities remain even after adjusting for socioeconomic differences, insurance status, and other factors influencing access to health care.
Implicit gender bias also impacts treatment decisions and outcomes. Some examples: Women are less likely to survive a heart attack when they are treated by a male physician and surgeon. LGBTQ and gender-nonconforming patients are less likely to seek timely medical care because they experience disrespect and discrimination from health care staff, with one out of five transgender patients nationwide reporting that they were outright denied medical care due to bias.
In order to satisfy the requirements, continuing medical education courses shall address at least one or a combination of the following:
(1) Examples of how implicit bias affects perceptions and treatment decisions of physicians and surgeons, leading to disparities in health outcomes.
(2) Strategies to address how unintended biases 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.
Note that educational activities that are dedicated solely to research or other issues that do not include a direct patient care component are exempt from this requirement.
