Berger and Miller raise important considerations regarding the ongoing relevance and use of cultural competency in medical education. In particular, the authors critique the United States’ L...

We agree with Berger and Miller that the focus on cultural competence in medical education fails to name or confront key drivers of health inequity such as structural racism, social determin...

Berger and Miller’s “Health Disparities, Systemic Racism, and Failures of Cultural Competence” supports the claim that “cultural competence” as endorsed by the AAMC and operationalized in me...

Berger and Miller assert that race and ethnicity based cultural competence is a failure because medicine grounds its conceptualization of cultural competence on a “flawed” understanding of r...

Racism is a complex problem in the US that is institutionalized, personally mediated, and internalized. Within medical education the recognition and response to structural racism is be...

Berger and Miller argue that contemporary medical education directed toward “cultural competency” fails to address the structural inequities and systemic racism underpinning health dispariti...

The purpose of cultural competence education for medical professionals is to ensure respectful care and reduce health disparities. Yet as Berger and Miller (2021) show, the cultural competence framework is dated, confused, and self-defeating. They argue that the framework ignores the primary driver of health disparities—systemic racism—and is apt to exacerbate rather than mitigate bias and ethnocentrism. They propose replacing cultural competence with a framework that attends to two social aspects of structural inequality: health and social policy, and institutional-system activity; (...) and two psychological aspects of structural inequality: the clinical encounter, and the epistemic. -/- We agree with the structural approach. To that end, we think it would be fruitful to include attention to physical contributors to structural inequality, namely the material artifacts used in medicine. Devices, tools, and technologies can materialize biases, perpetuate oppression, and contribute to health disparities. Granted, not everything that interests philosophers can be squeezed into medical education. Nevertheless, there are compelling reasons for including the study of material artifacts in education designed to reduce health disparities. First, devices and tools often carry forward biases from the past, and keep biases hidden from plain sight. Second, by studying these artifacts, future clinicians can begin to see themselves as part of a larger sociotechnical system. Finally, as medicine becomes increasingly tech-laden, it’s important for clinicians to see how material artifacts (including algorithms) connect individuals to structures. This will help to undermine oversimplified narratives according to which objective tools and technologies can correct for the bias and subjectivity of flawed human beings. (shrink)

The health system is, in particular ways, a microcosm of society and both reflects and contributes to its ills of racism, inequities, and disparities. As such, the house of medicine is obligated to...

Berger and Miller argue that cultural competency as an educational tool for physicians-in-training fails to address structural inequality and systemic oppression. Instead, it focuses on “cul...