Revisiting cultural competence.

BACKGROUND Although the importance of developing health care trainees and trainers' cultural competence is widely acknowledged, limited information is available on what elements of cultural competence should be taught. A lack of theoretical clarity and consensus over what constitutes the competence attributes is a key hurdle in faculty development (FD). This results in patchy cultural education across health schools globally. Based on a literature review, we propose a new framework that may inform clinical cultural education and the development of clinical educators in this area. METHODS A critical interpretive synthesis was carried out on articles extracted from Medline, CINAHL and Web of Science. Sixty-nine articles were included for analysis, through which we engaged with the reconceptualisation of cultural competence in order to provide theoretical clarity and pedagogical guidance for FD in clinical cultural education. RESULTS The synthesis illustrates that an ecological system is required to achieve comprehensive cultural competence development. We therefore composed a discursive multi-level framework to highlight the needs of achieving cultural competence at the individual, team, organisational and systemic levels. Affective, cognitive and behavioural domains are to be achieved at the individual level. Leadership skills training is a key component in achieving higher level competences. Successful FD needs to cover these developmental areas. DISCUSSION This review offers a multi-level approach to developing cultural competence, which can be useful for clinical educators to improve their clinical practice and education in diverse cultural contexts. More research is needed to evaluate the effectiveness of the proposed framework and the methods.