Multicultural Orientation Training: An Innovative Method to Develop Cultural Humility Among Health Care Providers

The purpose of this pilot study was to trial Multicultural Orientation training among health care providers (HCPs) in a university academic health sciences setting. Multicultural orientation (MCO) is a method for training HCPs to navigate patient cultural values and incorporate these values into their care. The three components of MCO are (a) cultural humility, including self-reflection techniques; (b) identifying cultural opportunities with patients; and (c) increasing the cultural comfort of HCPs to use the identified opportunities to integrate a patient's culture into care. This training method has demonstrated improved patient outcomes in the field of psychology but has not yet been used with other HCPs. The pilot study specifically aimed to 1) to explore the impact of MCO training on the confidence of HCPs in relation to cultural humility, identifying cultural opportunities and facilitating conversations using the identified cultural opportunities; 2) to measure HCP knowledge acquisition of these three training elements through a training session using MCO and 3) to explore the applicability, adaptability and feasibility of using MCO in training HCPs. This quality improvement initiative included a pilot 2-hour MCO training workshop among 11 female HCPs employed by a large urban teaching hospital led by an educational psychologist and cofounder of MCO. Participant self-reported confidence and knowledge acquisition were measured comparing pre and post training scores. Applicability, adaptability and feasibility were assessed by participant feedback in a post-training focus group. Pre and post training scores compared six matched questions demonstrated a 10.6% increase in overall knowledge acquisition and a 40% increase in correctly identifying the three main components of MCO. The Wilcoxon signed rank test was used to compare self-reported confidence levels for each participant using 10 matched items on the pre and posttests. Participants reported a significant improvement in confidence in using and facilitating self-reflection techniques with themselves and peers after a challenging cultural interaction, facilitating conversations around identified cultural opportunities and ratings for cultural humility. Recorded and transcribed focus group data was inductively coded, categorized and revealed themes that indicated the training could be adapted to disciplines, or be interdisciplinary. Recommendations were made for more time within the workshop to engage in the concepts. Participants identified the challenge of time and scheduling for further training and getting buy-in for use of role-play. From this pilot study, results indicate that MCO training can increase HCP confidence in self-reflection techniques and conversing with patients about identified cultural opportunities. Participants indicated that MCO training was innovative, feasible and applicable in a variety of clinical encounters and that it should be expanded to all HCPs. Further research should test the impact of MCO training on patient satisfaction and health outcomes.