New Perspectives: Reflections on Cultural Competency Training

By Alice Burnand and Sarah Griffiths, University College London

We are Patient and Public Involvement and Engagement (PPIE) co-leads in the research department of Primary Care and Population Health at UCL and are part of a cross-university network of PPIE leads. Based on training needs highlighted by the network, we were funded by the NIHR School for Primary Care Research (SPCR) to attend an online Cultural Competency course run by the Centre for Ethnic Health Research (CEHR). In this blog we reflect on our experiences of attending the course.

About the course

The sessions were held each month (July-Oct) split across 3 half day sessions and the course was highly interactive. The learning outcomes listed for the training were to:

• Understand the components of cultural competence and identify how these help to promote more effective interventions
• Begin to appreciate the complexities involved in self-awareness, knowing communities and understanding culture
• Understand and recognise unconscious bias
• Understand the difference between a stereotype and a generalisation
• Begin the process of identifying and selecting appropriate practical approaches, recognising what is important as knowledge

Some examples of our learning

• We learned a great deal from examining definitions of culture and cultural competency, which vary greatly. We critiqued examples of organisational definitions, some of which we decided were quite ‘othering’ in their language. We agreed that the ‘Diverse Cymru’ definition was more positive: ‘Cultural Competence...is the capacity to provide effective services, taking into account the cultural beliefs, behaviours and needs of people. It is therefore made up of cultural awareness, knowledge and sensitivity as well as the promotion of anti-oppressive and anti-discriminatory policies.’
• It was interesting to learn about the differences between stereotypes and generalisations, in which the latter can sometimes be beneficial and not always something to avoid. While stereotypes can be harmful and are the fixed beliefs that are resistant to change, generalisations note similarities between people but can be descriptive rather than judgemental. It is important to remember that generalisations are just a starting point and should not be used to make assumptions about others. By engaging with people on a personal level, we can develop a deeper understanding of their experiences and make a personal decision about whether the generalisation applies to them. We were also taught about the concept of Stereotype Threat Condition, in which an individual is aware of the stereotypes associated with their identify, which can lead to anxiety and fear of judgement, which then impacts behaviour, and can sometimes reinforce the stereotype.
• We learned about the origins and meaning of the concept of intersectionality a term coined by Kimberlé Krenshaw, American civil rights advocate and critical race theorist. Although familiar with the concept, we were unaware it was based on a road intersection analogy, i.e., if each road is a different race, gender or ethnicity, and each car is a different tool of oppression, the more cars that meet at an intersection, the bigger a crash of systems will be. This learning was supported by discussion around a powerful video.
• The topic of microaggressions sparked an interesting discussion about personal experiences and understanding. Microaggressions are subtle and often unintentional acts of discrimination or prejudice. Whilst the comment or gesture may have been well-intentioned, it can communicate negative messages about a person's marginalised identity, including their race, gender, sexual orientation, or disability. Our discussion highlighted the importance of self-awareness, cultural sensitivity and being mindful of others.
• An important part of becoming more culturally competent is developing a contextual understanding of how world demographics are changing due to globalisation and migration.
• By the end of the course, we had a set of guidance points on developing effective cross-cultural skills, including communication approaches and honest self-reflection. Due to the interactive nature of the course, it felt like we had arrived at these points ourselves.

Our personal reflections

With a group size of ten, a friendly facilitator (Julian) and plenty of time for icebreakers and interactive tasks, a fun and open group dynamic was created. We thought Julian created a really warm and inclusive environment that encouraged open discussion and questions. We found the course incredibly insightful, which challenged our existing perspectives and providing valuable new insights.

We were not sure what the expectations of prior knowledge would be - Would we be tested on our in-depth knowledge of a range of cultures? However, the emphasis was not on learning lists of ‘facts’ about ‘other’ cultures. It was about the personal skills to develop to be able to work with and understand people from a range of diverse cultural and social backgrounds. Personal qualities such as curiosity, willingness to learn, and ability to reflect on unconscious bias were consistently highlighted. Although the course was not about being taught a variety of cultural experiences, Julian gave a fascinating talk on Judaism, which highlighted areas to consider when thinking about culture.  

We were asked to reflect on what culture means to us personally, for instance ‘Think of an example of cultural practice important to you, and how it has changed through time.’ Examples from the group included how experiences of music festivals have changed over time, and a family tradition of sending thank you cards after receiving presents. Sharing these personal reflections was a great way of demonstrating that whilst generalisations can be helpful, cultural experiences are highly individualised.

Further information

If you have any questions about the course, please do get in touch with us (public.advisors@ucl.ac.uk).

If you are interested in attending the course, please contact the Centre for Ethnic Health Research (ethnichealthresearch@leicester.ac.uk).

For those who are applying for research/fellowship funding, we recommend including costs to attend the course. The cost is currently £400 per person for 3 x half day training sessions, not subject to VAT (50% discount for public sector organisations).

Alice Burnand: PhD Student, Primary Care and Population Health, UCL

Sarah Griffiths: Senior Research Fellow, Primary Care and Population Health, UCL