No Longer Invisible: A Scoping Review of Cultural Competence Content in United States Medical Education

Abstract

Introduction: Cultural competence curricula (CCC) in medical schools are imperative for preparing future physicians to improve quality of care for the variety of patients they will encounter. The objective of this review was to determine whether historically invisible health disparities in the United States have been adequately represented in the evolving array of CCC content.Methods: This scoping review analyzed 77 papers published between 1989-2023 describing LCME-mandated CCC in U.S. medical schools. Data was categorized by curricular inclusion of seven Identity Groups and nine Cultural Concepts.Results: Findings reveal that racial/ethnic groups dominated the content, appearing in 77% of programs, while LGBT+, disability, religious, socioeconomic, gender, and local groups were represented in fewer than 50% of curricula. After 2012, the percentage of programs including social concepts such as systemic bias, individual bias, and social determinants of health increased by at least 20%.Conclusions: The underrepresentation of LGBT+, disability, religious, socioeconomic, gender, and local groups relative to racial/ethnic groups suggests programs prioritized teaching concepts applied to race/ethnicity and focused less on other cultural groups. After 2012, the substantial increase in included social concepts without change in the distribution of included cultural groups suggests programs maintained representation of identity groups while attempting to address systemic issues for groups already represented in CCC content. Incorporating intersectionality through a “dimensions of identities” approach may allow students to extend systemic concepts to the less visible groups in need of conversation about their disparities.