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背景和目的美国多元文化的特性与日俱增,尽管有相关的民族政策和标准,但是卫生部门为此作出的改变甚少。医学院在修订他们的课程,但有关教职员工在面对多元文化问题的态度及其适应度还了解甚微。此研究就教职员工对多元文化的态度、适应度、技能的自我认知及跨文化服务中的适任能力相关知识的需求进行调查。方法针对维吉尼亚医学院校的所有教职员工展开调查。调查涉及了教职员工的态度、处理跨文化问题的适应度和技能的自我认知水平、认知需求及对文化能力培训的兴趣。结果针对教育的各个阶段〔医学院、住院医生、继续医学教育(CME)〕,尽管教职员工中有93%认为跨文化服务适任能力的培训重要,但报道在某个阶段接受过正式跨文化服务适任能力教育的不足25%。在处理具有不同文化背景的患者时,58%的教职员工感觉比较适应,但当患者英语熟练程度有限时,会跌至30%。当需要向患者的家人传达坏消息时,“感觉特别不适应”或“一点都不适应”的比例最高(47%),原因是这涉及应对跨文化问题,教职员工在医患沟通中难以把握怎样的表述更合适。教职员工在有医学翻译在场时、在因为跨文化所致的误解而道歉时、促进患者正确认知其健康状态和疾病等方面,感到较易处理。教职员工感觉在提供跨文化的临终关怀服务方面以及处理跨文化冲突方面,技能最为欠缺。结论临床教职员工接受的关于文化能力的教育十分有限,在许多医疗卫生情境中,需要进行具有挑战性的跨文化沟通,他们在这方面的适应能力和技能亟待提高。除非教职员工变得更适应,并且有能力向学员教授这些内容,否则很难对民族政策有关跨文化服务的要求做出积极回应。
Background and Objectives The multicultural character of the United States is increasing day by day with little change in the health sector, despite the relevant national policies and standards. The medical schools are revising their curricula, but little is known about the attitudes and adaptability of faculty to face multicultural issues. The study investigated faculty members’ needs for multicultural attitudes, fitness, self-awareness of skills and competence-related knowledge in intercultural services. Methodology Investigations were conducted for all staff in Virginia Medical School. The survey involved faculty members’ attitudes, self-awareness of adaptability and skills to deal with cross-cultural issues, cognitive needs and interest in cultural competence training. The results targeted at all stages of education (medical school, resident doctor, CME). Although 93% of the faculty considered training for intercultural service competency important, the report received formal cross-culture at some stage Less than 25% of education for service competence. Fifty-eight percent of faculty members felt comfortable adapting to patients with different cultural backgrounds, but fell to 30% when their proficiency in English was limited. When the bad news needs to be communicated to the patient’s family, the highest proportion (47%) of feeling uncomfortable or not at all is due to the fact that it involves coping with cross-cultural issues, Communication is difficult to grasp what kind of statement is more appropriate. Faculty members feel easier to handle when there are medical interpreters in the audience, apologizing for cross-cultural misconceptions, and promoting patients’ correct perception of their health status and illness. Faculty and staff feel that skills are the most scarce in providing cross-cultural hospice and handling cross-cultural conflicts. Conclusion Clinics receive limited education on their cultural skills. In many healthcare settings, challenging cross-cultural communication is required and their adaptive capacity and skills in this area need to be improved urgently. Unless faculty and staff become more adaptive and able to teach students such content, it is difficult to respond positively to the ethnically-ambitious demands of cross-cultural services.