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The Diabetes Educator

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Medical Care Research and Review
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Cultural Competency, Race, and Skin Tone Bias Among Pharmacy, Nursing, and Medical Students

Implications for Addressing Health Disparities

Shelley White-Means

University of Tennessee Health Science Center, Memphis, swhiteme{at}utmem.edu

Zhiyong Dong

University of Tennessee Health Science Center, Memphis

Meghan Hufstader

University of Tennessee Health Science Center, Memphis

Lawrence T. Brown

University of Tennessee Health Science Center, Memphis

The Institute of Medicine report, Unequal Treatment, asserts that conscious and unconscious bias of providers may affect treatments delivered and contribute to health disparities. The primary study objective is to measure, compare, and contrast objective and subjective cognitive processes among pharmacy, nursing, and medical students to discern potential implications for health disparities. Data were collected using a cultural competency questionnaire and two implicit association tests (IATs). Race and skin tone IATs measure unconscious bias. Cultural competency scores were significantly higher for non-Hispanic Blacks and Hispanics in medicine and pharmacy compared with non-Hispanic Whites. Multiracial nursing students also had significantly higher cultural competency scores than non-Hispanic Whites. The IAT results indicate that these health care preprofessionals exhibit implicit race and skin tone biases: preferences for Whites versus Blacks and light skin versus dark skin. Cultural competency curricula and disparities research will be advanced by understanding the factors contributing to cultural competence and bias.

Key Words: health disparities • cultural competency • implicit bias • curricula design • race bias • skin tone bias

This version was published on August 1, 2009

Medical Care Research and Review, Vol. 66, No. 4, 436-455 (2009)
DOI: 10.1177/1077558709333995
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