Introduction: Cultural competence, according to the U.S. Department of Health and Human Services, is ‘a set of congruent behaviours, knowledge, attitudes, and policies that come together in a system, organisation, or among professionals that enables effective work in cross-cultural situations.’’ Cultural competence training of health care providers is needed to help address health disparities experienced by Indigenous and minority communities. The Department of Native Hawaiian Health at the University of Hawai’i John A. Burns School of Medicine has created innovative cultural competency training initiatives for faculty, staff, and students. While activities are rooted in Native Hawaiian culture and focus on the health and wellbeing of Native Hawaiians, many of the lessons are relevant for other cultures in Hawai’i.
Methods: ‘Native Hawaiian Health, Past, Present, Future’ is a course offered to first year medical students that incorporates cultural competency training. Curricular content was guided by our culture and our community. Essential components included having a strengths based curriculum and a holistic framework for Hawaiian health involving the balance between mind, body, spirit and mankind, nature and Akua (God, or our higher powers). This framework was recognised to be best taught outside the confines of the medical school. Students went out into ‘community classrooms’ where teachers included Elders (kupuna), traditional healers, cultural practitioners, and community and government organisations involved in health and aina (land/environment) based work. In these ‘‘community classrooms,’’ students learned that health, land and community cannot be separated. In addition, physical health must be balanced with emotional and mental health. The curriculum was deliberately experiential. Giving back in exchange for learning was critical.
Results: 63% of the students were Hawai’i residents (22% were Native Hawaiian). Qualitative analysis of reflection papers showed that students valued the course and their experiences were aligned with course objectives. 76% addressed the relationship between culture and health, 60%, the connection between land and health; 56%, the course’s impact on their future practice; and 52%, the holistic approach to Native Hawaiian health. Importantly, community partners valued interacting with the students and appreciated the ability to positively impact physician training.