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What DEI Training Can Learn From Cultural Competency In Medical Education

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A 2022 Hue report found that around 80% of HR professionals believe that their industry does a good job of implementing diversity-related initiatives. Yet, the study also reported that nearly 85% of employees surveyed do not think that their employers made any meaningful progress for BIPOC employees. The study also reported that 40% of BIPOC employees said they experienced workplace discrimination, and about one-third felt disempowered to speak out against workplace discrimination.

Even when intentions are good and companies sincerely want to promote DEI initiatives in their organizations, part of their ineffectiveness stems from a lack of training of DEI officers. Another reason is that DEI initiatives do not occur as part of an integrated strategy of professional development and organizational culture management. Rather, trainings are typically scheduled annually or in reaction to a particular event. For DEI programs to be successful, trainings must look to develop all components of interpersonal and organizational decision making, from becoming aware that an issue is present to evaluating potential resolutions to being motivated to initiate change and, finally, to developing an effective strategy to implement that change so it sticks. Because each of these components are skills-oriented as much as knowledge-based, DEI programs can learn a lot from the ways in which cultural competency education is instituted in medical education.

Cultural competency is a well-known term in healthcare settings. It refers to the ability for clinicians “to function effectively... within the context of the cultural beliefs, practices, and needs of their patients and their communities,” according to the Association of American Medical Colleges. While the emphasis of cultural competency education is on how to serve patients from different backgrounds, the framework of the education provides a good model for DEI training, because it specifically breaks down the training into various skills-oriented components, such as developing the right attitude, having sufficient knowledge or awareness of different cultures, and possessing the right skills to engage in cross-cultural interactions respectfully.

The success of cultural competence training in medical schools is dependent on how well the curriculum delineates the various components of each subcompetency and how it devises education and assessments to speak directly to what it is supposed to achieve. Its success is also highly correlated with how well it is integrated into general clinical training rather than being separate and distinct, as if it were an add on. Similarly, for DEI initiatives to change organizational culture and improve interpersonal interactions between colleagues, it has to do more than teach about diversity and support wide-scale organizational change. It must facilitate the development of skills and attitudes conducive to DEI goals so that they become second nature to company employees.

In his new book, Digital, Diverse & Divided: How to talk to racists, compete with robots, and overcome polarization, David Livermore introduces the idea of cultural intelligence, by which he means the ability to relate and work effectively with people who have different backgrounds. It is specifically defined as a skill set—a “knowing how” rather than simply a “knowing that.” Cultural Intelligence (CQ) consists of four related competencies—motivation (CQ Drive), cognition (CQ Knowledge), metacognition (CQ Strategy) and behavior (CQ Action). It is easy to see how these subcompetencies work together. Without the motivation to relate to others from different backgrounds, a person will not develop the knowledge or means to do so. Without the awareness and ability to plan for multicultural interactions (CQ Strategy) or the ability to adapt to multicultural contexts (CQ Action), no amount of knowledge or motivation can automatically make those interactions easier.

The benefit of separating CQ into separate subcompetencies is that it highlights the point that each factor consists of a different set of skills to hone. Therefore, like a physical trainer who, through a particularized regimen, can focus on those specific parts of the body that need more attention, through the framework of cultural intelligence, DEI trainings can focus on strengthening the particular skills individuals may need to relate better and work more effectively with people of different backgrounds.

Regarding how to develop one’s CQ Knowledge, Livermore adopts Dorothy Holland’s concept of “figured worlds.” A person’s figured world is the context through which their experiences make sense to them and the background out of which their identity and self-perceptions emerge. Figured worlds are not simply the natural or social environments in which we are born or live, though Livermore does acknowledge that that “five of the most polarizing worlds stem from the places we call home, the race/s with which we identify, and our gender, faith and political identities.” Figured worlds are also created out of the social or organizational groups in which people participate on a day-to-day basis, such as one’s office “world.” As Holland and her co-authors explain in Identity and Agency in Cultural Worlds, when people work or live together, they have shared experiences and create a shared frame of reference by virtue of the goals and activities that they have in common.

The idea of figured worlds is similar to Kimberlé Crenshaw’s concept of intersectionality in that both terms recognize that people have overlapping identities that affect their experiences. The difference between the two is in their focus. Intersectionality gives language to how overlapping and interdependent systems reinforce and multiply discrimination or disadvantage. The notion of figured worlds, on the other hand, conceives of individuals living in different “worlds,” which create cultural disparities and opportunities for discrimination, while, at the same time, people may be able to find commonality and solidarity with each other through the shared “world” of their collaborative experiences.

Employing this concept rather than intersectionality can have two major advantages for DEI work. First, because intersectionality has become such a culturally divisive term, using the concept of figured worlds can allow people to appreciate how overlapping identities can compound discrimination without the pushback of intersectionality’s political connotations. Second, the notion of figured worlds gives inclusion strategies a way to overcome polarization by coming together to address shared problems. The shared world created provides a means for people to see each other as members of the same group even when they also have different identities. It is a means to incorporate belonging into DEI.

Using the concept of figured worlds to address diversity in an organization can also cultivate a culture of self-reflection and empathy. When people consider their own figured worlds, i.e. the factors that influence their beliefs and preferences, they can begin to imagine the possibility of alternative viewpoints emerging given different influences or social factors. The simple consideration that one’s gut reaction may be primed by certain circumstances can lead to examining whether one’s reaction is appropriate to the situation at hand or whether there may be a better way, given the figured worlds of the various stakeholders of the issue.

Moreover, when people appreciate that their colleagues live in different figured worlds, they can learn how to see their colleagues for who they are through curiosity and decentering. Curiosity provides the motivation to learn about others—i.e. it is a CQ Drive skill. Decentering is when people take themselves out of the center of focus to perceive the experience of another without imposing themselves upon the other. Out of empathy one asks, “What must life be like for that person?” Not, “How would life be for me if I were to live in their shoes?”

When DEI trainings focus on competency development, those abilities will not be limited only to instances that traditionally fall within the domain of DEI. They can be applied to all areas of one’s personal and professional life. Employees who develop a strong CQ—and who then become more self-reflective and empathetic towards others—will be better collaborators on teams and more thoughtful in how they consider their modes and methods of working. In the end, DEI training will no longer be seen as an add on to professional development or organizational culture. It will be an integral part of how professionals work together and how a company lives up to its values and purpose.

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