Cultural Competency and Cultural Humility in Simulation-Based Education: An Integrative Review

Cultural humility is endorsed; yet, the state of the science of cultural humility in simulation-based education is unknown. The aim of this integrative review is to provide what is known about cultural competence and cultural humility in simulation-based education to base future efforts in education, research, and policy. Sixteen studies were reviewed and appraised in this integrative review. Four themes of learning outcomes from simulation emerged from the studies: (a) cultural sensitivity and cultural competence, (b) insight and understanding, (c) communication, and (d) confidence and comfort. There were no studies that mentioned cultural humility. Cultural humility in simulation-based education is lacking, signifying a need for educational reform and research. •Examination of educational practices is warranted to improve care of diverse populations.•Not one study was located that described the use of simulation to teach cultural humility.•Diverse simulation curricula with cultural humility training are recommended.•Adding cultural humility as a standard will serve as the impetus to transform simulation environments globally

Influence of gender, race, and education on patient preferences and receipt of cardiac catheterizations among coronary care unit patients

The extent to which a preference for less aggressive care explains the lower rate of invasive cardiac services for women and African-Americans is unknown. A prospective observational study of 272 patients admitted to the coronary care unit was conducted at a tertiary referral teaching hospital and a community teaching hospital. In stepwise multivariate analysis, having less than a college education, poor cardiac function, not having undergone a previous cardiac catheterization, being a patient in a nonreferral community hospital, and current smoking were positively associated with a patient's stating that he or she would disagree with a physician's recommendation for a cardiac catheterization. The stepwise multivariate model with cardiac catheterization as the dependent variable indicated that being a patient in a referral medical center, patient willingness to accept a physician's recommendation for a cardiac catheterization, severe heart disease, and having attended high school were predictive. Women did not differ from men in their preference for or receipt of cardiac catheterization. Patients in the coronary care unit with lower levels of education were less likely to undergo cardiac catheterization. This association was only partly explained by less educated patients' being less willing to accept a physician's recommendation to undergo cardiac catheterization