News and Commentary Macy Faculty Scholar Wrenetha Julion on Cultural Competency Training

Wrenetha Julion, PhD, MPH, RN, FAAN, associate professor at Rush University College of Nursing, discusses her work to develop a cultural competency course for health professions students.

Macy: Why have you chosen to focus on cultural competency in health professions training as a Macy Faculty Scholar?
So much of our accrediting process in nursing speaks to the importance of cultural competency, but I don’t think we’ve really focused on formal training. Usually, it’s just a text book. These books provide guidelines for caring for different racial and ethnic groups. They say things like “This group does this and that group does that.” Their intent is to help people understand different cultures better, but what they actually do is make generalizations about groups of people, which leads to further stereotyping. That rubric teaches us that people fit into boxes, when they don’t. There’s so much real world variability that just can’t be taught in books. That’s why I think a formal course is necessary.

A big piece of cultural competency is getting people to recognize that there is no one model for everybody; people are individuals within every group. Cultural competency is about listening and learning from patients and respecting their individuality. A big part of my work will be helping students understand themselves—what beliefs they hold and what perspective they themselves are coming from, and how that colors their perceptions and knowledge and the way they behave and the assumptions they make on the job.

What motivates you personally to do this work?
One of my pet peeves is when confronted in the classroom with the idea of health disparities, students almost always think that the answer is teaching the patients how to take better care of themselves. When I hear that, I always say, “Okay, and how is that going to solve the problem?” Helping patients understand that they need to eat more nutritious food isn’t going to help them access that food in their neighborhood if they live in a food desert. It won’t help them afford that food. I try to get my students to think about the barriers patients face in their communities and the circumstance of their lives that can inhibit them from leading a healthier lifestyle.

I’ve been on the other side of it, so to speak, more than many of my colleagues and students. I grew up about five miles from the Rush University Medical Center and have lived in inner city Chicago my whole life. Many of our students haven’t had much exposure to the community around here; they’re uncomfortable in new and unfamiliar situations with patients.

My goal for the cultural competency curriculum is to really help students connect the dots. I want to help them get a broader perspective and learn that there’s nothing to be afraid of.

What will your curriculum look like?
My plan is to develop a cultural competency course for all health professions students. I’m starting with students in the College of Nursing because that’s where I am, and then plan on expanding to the Colleges of Medicine, Health Sciences, and Health Systems Management. Part of the challenge is that we have different academic calendars—nursing is on a trimester system, another school is on semesters, and another is on quarters. So I am thinking that this will have to be an online course in order to accommodate the three different calendars.

I also intend to connect the program with a service learning component. What we really need to do is get students out of the academic environment to relate to real communities. That experience will do more to increase students’ comfort and expand their thinking than anything else. So, while the students are completing the course, and have a chance to connect with and learn about the community, they’ll be tasked with designing and implementing a service learning project that is based upon the needs that are identified by the communities themselves.

How does diversity factor into cultural competency?
A. Nursing has gotten better when it comes to diversity, but I would love to see more diversity among our nursing students. Rush has made great strides in diversifying the student body in the last five years, but we’re still not at a critical mass yet. Not only do students not look enough like their patients, but they look too much like each other—they need to see more diversity in the faces around them in school as well as in practice.

But cultural competency is not just about diversity—just because you are a member of a group doesn’t always make you comfortable with that group. I worked with a grant to hold parenting classes in daycare centers. We hired a young African American woman to recruit families into the study, and she was very uncomfortable in the inner city. In fact, she was as stressed as someone who was from a different race or ethnicity might have been. So it’s not your color it’s the way you think. We need to open it up and break it apart and examine it from all angles.

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