3 Dimensions of Cultural Humility Commitment to lifelong learning & critical self reflection Recognize & challenge power imbalances Advocate for institutional accountability/implement

Dimension 1: Lifelong learning & Critical Self Reflection For the Practitioner: Understanding your own story Naming & owning your own identity Reflecting on and acknowledging cultural & family history, personal biases Inventorying both privileges & struggles, strengths & vulnerabilities In what ways do I experience power and privilege? In what ways do I experience discrimination and disenfranchisement? What assumptions do I have about this patient’s culture? What might be my limitations in serving this patient (what I don’t know or think I know)? What might be my strengths in serving this patient? Commitment to lifelong learning. Asking questions. Discovering cultural & honoring cultural differences.

Dimension 2: Recognize & Challenge Power Imbalances Provider/Patient power imbalance: Who has control of the medical encounter? Who should have control over what? Gender power imbalances: History of discrimination against women Minimizing female’s medical complaints (e.g., hysteria) Lack of respect for the female body Overtones of abortion/contraceptive debate: Why don’t women get to decide what kind of medical care they receive to control fertility? Cultural power imbalances Immigrant, American Indian, African American, Latinx, Religious minorities & ethnic minorities may have beliefs & practices in contradiction to biomedical model Racial power imbalances—Minority providers are under-represented in medicine:

Distribution of U.S. Population by Race/Ethnicity, 2010 Total U.S. Population = 308.7 million SOURCE: 2010 U.S. Census

Disproportionate Minority Providers in the US Updated 2014

US Medical Students accepted, enrolled and graduated (2010 & 2015) Total U.S. Enrollees = 18,665 (2010) 2015 SOURCE: AAMC Data Warehouse: Applicant Matriculant File as of October 4, 2010. https://www.aamc.org/download/152934/data/enrollment_data_2010.pdf. Accessed 1/20/12.

Dimension 3: Institutional Accountability An organizational culture of Reflection Oakland Children’s Hospital: Creating spaces and policies that allow diverse patient families to heal and recover in culturally relevant ways Tom Waddell Clinic: Transgender Tuesdays—created designated clinic time for transgender patients. Trainings Staff trainings in intercultural communication & health beliefs Policies & Protocols How to handle non-traditional requests. How to practice with an ear and heart for cultural differences. How to bridge the patient culture & the clinical culture. Patient Voice & Community Responsiveness Patient advocates & patient advisory boards. Surveying patients with an ear for cultural appropriateness of care.