Cultural Competency

The modern physician’s oath promises to not allow “considerations of age, disease or disability, creed, ethnic origin, gender, nationality, political affiliation, race, sexual orientation, social standing or any other factor” to interfere with the patient relationship. At the same time, it is known that disparities in health and access to care exist among population groups. Health care providers have the power to effect significant change for these Oregonians.

Overview of Cultural Competency

“Cultural Competency” is synonymous with an array of phrases and concepts which are currently in flux and controversial. We can think about this concept on a variety of levels - individual, institutional, cultural, and systemic. There is overlap and dispute here, too.

Oregon defines Cultural Competency as: A life-long process of examining values and beliefs, of developing and applying an inclusive approach to health care practice in a manner that recognizes the context and complexities of provider-patient interactions and preserves the dignity of individuals, families and communities.¹

Disparities in health outcomes related to various demographics are indisputable. These disparities exist in Oregon, in the US, and throughout the world.²

Oregon health care providers frequently do not match the demographics of their marginalized patients. This accounts for miscommunication and discomfort, and perhaps exacerbates health disparities. Because the impacts are happening right now, and demographic changes are constantly evolving, we must take action with limited information and incomplete conceptions. Health care providers have tremendous power to transform patient experience, health, and lives by increasing their own skills in cultural competence.

Engagement in ongoing professional development around culturally competent practice is therefore essential.

Please see the Oregon Medical Board's Statement of Philosophy on Cultural Competency.

Mandatory Cultural Competency Continuing Education

In 2019 (HB 2011), the Oregon Legislature mandated cultural competency continuing education for health care professionals starting July 1, 2021. Under the requirement, Oregon Medical Board licensees must complete cultural competency continuing education as a condition of licensure as required in OAR 847-008-0077.

Licensees required to comply: All Oregon physicians, physician assistants, and acupuncturists whose license is at a practicing status must meet this requirement. The only exceptions are licensees in residency training and volunteer camp licensees. Licensees with a “retired" status do not have to meet the requirement because their license is not at a practicing status.

Number of hours: Licensees must complete an average of at least one hour of cultural competency education per year during an audit period. An audit period is two renewal cycles, for example every four years for most licensees. Required hours will be based on the number of years licensed during the audit period; any portion of a year licensed will require one hour of cultural competency education. For example, a licensee who has been licensed for 3.5 years during the audit period will be required to obtain four hours of cultural competency education. Hours may be obtained at any time during the audit period. For example, either one four-hour experience, or four one-hour courses taken annually, would satisfy the requirement.

Educational opportunities: The law was written broadly to allow a wide array of courses or experiences. The content must teach attitudes, knowledge, and skills that enable a health care professional to care effectively for patients from diverse cultures, groups, and communities. Courses or opportunities may include:

Courses delivered in-person or electronically/online (does not have to be accredit CME)
Accredited continuing medical education (CME), Category 1 or 2
Experiential or service learning
Cultural or linguistic immersion
Volunteering in a rural clinic (OMB licensees are not able to apply compensated time for practicing in a rural clinic)
Employer's cultural competency training
Training on implicit bias in health care
Events with members of an underserved community to discuss health care access issues
Courses on the OHA Cultural Competence Continuing Education (CCCE) webpage.

Tracking completion: Licensees may track educational hours on an OMB record keeping form. During license renewal (annually or biennially depending on the license), licensees will attest to completing the required hours by checking a box and reporting the number of hours obtained. The OMB will audit for compliance every other renewal cycle with the first audit being conducted during the Fall 2023 renewal cycle. The cultural competency audit will be included within the existing audit for CME compliance. Beginning in 2023 and every other renewal cycle thereafter, audited licensees will be asked to also produce documentation of their cultural competency educational experiences. Documentation may be a course certificate, the OMB record keeping form, or other documentation.

Fall 2023: For the first audit period during the Fall 2023 renewal cycle, licensees will be required to report 2 hours of cultural competency education. Licensees may report hours for courses or experiences completed during the calendar year starting January 1, 2021.

Continuing Education Resources

American Medical Association Recognizes Racism as Public Health Threat

A new policy from the American Medical Association (AMA) acknowledges racism's role in perpetuating health inequities and inciting harm against historically marginalized communities and society as a whole. Specifically, the policy recognizes racism in its systemic, cultural, interpersonal, and other forms as a serious threat to public health, to the advancement of health equity, and a barrier to appropriate medical care. Read more about the AMA's policy here.

The Legacy of Dr. Unthank

DeNorval Unthank, MD, was an African American doctor who lived life boldly facing adversity and improving the lives of Oregonians. Dr. Unthank graduated from high school at the age of 16, attended the University of Michigan for his undergraduate studies, and went on to Howard University where he earned his medical degree in 1926.

Dr. Unthank moved his family to Portland, Oregon, in 1929 where he would be the only African American doctor for over 10 years of his medical career. Dr. Unthank persistently served the Portland area and went from not being allowed in hospitals to eventually being on staff at four Portland area hospitals. The Oregon State Medical Society named him Doctor of the Year in 1958. Dr. Unthank retired from his practice in 1970 having served a richly multicultural group of patients.

Alongside an influential medical career were Dr. Unthank's numerous contributions to Civil Rights. He cofounded the Portland Urban League in 1945 and was accepted as the first African American member of the Portland City Club. Additionally, he was a driving force behind the Oregon Civil Rights Bill passed in 1953. In 1977, Dr. Unthank passed away having greatly impacted medicine and Civil Rights in Oregon.

¹ Oregon Health Equity Alliance. (n.d.). HOPE Coalition 5-Year Plan Final (p. 4, Rep.). doi:http://www.oregonhealthequity.org/wp-content/uploads/2012/04/HOPECOALITION-FIVE-YEAR-PLAN-FINAL_-Sept-26.docx

² Cultural Competence Continuing Education Brief (p. 1, Issue brief). (2014). Portland, OR: Oregon Health Authority. doi:https://www.oregon.gov/oha/oei/Documents/Cultural%20Competence%20CE%20Brief_FINAL.pdf