Breaking through: improving equality in the NHS workforce.

The virtues that constitute medical professionalism have been aptly described in multiple position statements from professional organizations and individuals. These professional virtues depend on particular moral community traditions to undergird and sustain them. Attempts to ground these virtues in narratives intrinsic to medical practice--in the moral consensus of physicians or patients, in the self-regulating character of medicine as a profession, in the Hippocratic tradition, or in the physician-patient encounter--have been unsuccessful. Modern medicine must, therefore, look outside its own methodological and clinical practices for grounding narratives sufficient to sustain the professional virtues set forth in the recently published professionalism statements. These professionalism statements are written to capture consensus, and they rarely acknowledge the external moral traditions on which the virtues depend, because doing so would, in a pluralistic culture, entail the risk of moral disagreement and division. The authors argue that meaningful education in professionalism must look beyond the consensus statements and deeply engage the particular cultural traditions external to the practice of medicine that sustain the professional virtues. Medical professionalism curricula should embody an open pluralism, giving voice to diverse moral communities, encouraging critical self-exploration and discussion about the truth claims of these communities, and, if possible, facilitating the integration of students' professional development with their ongoing participation in these communities. Engagement with and participation in these sustaining moral communities would promote the cultivation of virtue capable of withstanding the economic and social threats to professionalism that are inherent in modern medical practice.

Cultural Diversity↗

PubMed2006

Psychometric analysis of a scale assessing self-efficacy for cultural competence in patient counseling.

BACKGROUND: The Accreditation Council for Pharmacy Education adopted revised accreditation standards and guidelines for the PharmD degree program in January 2006. The revised standards mandate the inclusion of cultural competence in pharmacy curricula. Assessment tools to evaluate the impact of training are needed. OBJECTIVE: To examine the psychometric properties of a 12 item scale designed to estimate the impact of cultural competence training on pharmacy students' self-efficacy in providing culturally appropriate patient care. METHODS: A 12 item scale to assess the impact of an elective course on pharmacy students' (N = 175; 173 analyzable) perceived self-efficacy in providing culturally competent patient care was used before and after students completed the training. Principal components analysis was conducted to examine the underlying structure of the scale, and the Cronbach alpha statistic was computed as an estimate of internal consistency. Pre-versus posttraining responses for each item and for the total scale scores were compared as an indicator of concurrent validity. RESULTS: The principal components analysis yielded a one-component solution, "self-efficacy for cultural competence," which included all 12 contributing items and accounted for 46% of the total variance. Item communalities ranged from 0.25 to 0.58. Component loadings ranged from 0.50 to 0.76. Overall, the scale exhibited a Cronbach alpha estimate of internal consistency of 0.89. Posttraining scores were significantly higher than pretraining scores for both the total scale scores (posttest and pretest mean +/- SD score = 47.96 +/- 5.15 and 34.21 +/- 6.19, respectively; p < 0.001) and for each item (p values < 0.001). These comparisons provide evidence of concurrent validity. CONCLUSIONS: Our results suggest that our 12 item scale exhibits acceptable psychometric properties and is a useful tool for estimating the impact of cultural competence training on pharmacy students' perceived self-efficacy for providing culturally competent care and services.

Cultural Diversity↗