New Jersey: Cultural Competency Training

New Jersey has recently enacted legislation, signed into law by Governor Codey in March 2005, mandating that physicians in the state receive cultural competency training.[1] It is the first state to attempt such an initiative. State policymakers hope that this training will:

• enable physicians to better treat and diagnose conditions more prevalent in minority communities (e.g., HIV/AIDS, asthma); and
• improve physicians' abilities to respond to cultural and language barriers and thereby improve communication and interaction with patients.

Arizona, Illinois, and New York are considering similar bills. California, which passed legislation in 2003 to set up voluntary linguistic and cultural competency programs for physicians, is considering two bills that propose mandating such training. Robert Like, M.D., M.S., associate professor and director of the Center for Healthy Families and Cultural Diversity at the University of Medicine and Dentistry of New Jersey, argues that "the fact that the legislation has taken off in New Jersey and now is being looked at in other states is testimony to the idea that current education is viewed as not doing the trick."

The New Jersey bill cites a recent New England Journal of Medicine study that found that physicians were less likely to refer African Americans and women than white males with identical complaints of chest pains to heart specialists for cardiac catherization.[2] This report is among a growing body of medical research that finds racial and gender-related disparities in health care, with cardiovascular disease being one of the main conditions for which such disparities exist.

New Jersey has more than 1 million Hispanics and African Americans and more than 500,000 Asians. According to the 2000 Census, 129 languages are spoken in the state.

The cultural training for New Jersey physicians will be developed in consultation with the state's Commission on Higher Education and the Association of American Medical Colleges. Currently, the New Jersey State Board of Medical Examiners is drafting the law's regulatory details, including setting the number of credits and educational formats and determining who should develop the training.

Cultural competency training will be integrated into the curriculum in all of New Jersey's medical schools and diplomas will not be issued unless students have taken the training. For physicians already licensed in New Jersey, the training will be a mandatory condition for renewing their licenses.

Like believes cultural competency training can succeed, but will not be attained through a "cookbook approach to care. We have to see this as different from other types of CME courses," he says. "It has to be a process of how we continue to learn about the diverse populations we're caring for as well as our own personal and professional biases, values, beliefs, and behaviors—I don't think taking a one- or two-hour course is going to be effective." He also argues that cultural competency training should extend to all health care workers, including nurses, dentists, physical therapists, pharmacists, psychologists, social workers, and other allied health professionals.

References
[1] P.L. 2005, c. 53 (N.J.S.A. 45:9-7.2 et seq.)

[2] Schulman KA et al. "The Effect of Race and Sex on Physicians' Recommendations for Cardiac Catheterization." New England Journal of Medicine 1999; 340 (8): 618–626.

For More Information, Contact: Robert Like, M.D., Associate Professor and Director of the Center for Healthy Families and Cultural Diversity, University of Medicine and Dentistry of New Jersey, [email protected]. Joanne Fuccello, Consultant, [email protected].