With the U.S. population becoming increasingly more diverse and strong evidence that racial and ethnic disparities persist in our health care system and in health outcomes, in 2000, the Liaison Committee on Medical Education introduced a standard for cultural competence in medical schools. Faculty and students are expected to “demonstrate an understanding of the manner in which people of diverse cultures and belief systems perceive health and illness and respond to various symptoms, diseases, and treatments.”1
Other national medical organizations, such as the Institute of Medicine and the American Medical Association, also recognized the need for increased awareness and understanding of the cultural differences that influence the quality of health care services and treatment.2,3
Cultural competence in our health care and medical education systems typically focuses on cultural sensitivities related to racial, ethnic, and gender factors; yet many medical schools are not sufficiently addressing the pertinent communication and linguistic aspects of cultural competence.4
Due to their unique communication and linguistic issues, incorporating deaf people, who are members of every racial and ethnic group, into cultural competence education at medical schools might help to bridge this particular gap in cross-cultural education.
Recent survey research on deaf people’s experiences with the U.S. health care system reflects the consequences of neglecting a misunderstood community. An analysis of the 1990–1992 National Health Interview Surveys revealed that deaf adults who became deaf before age three, similar to other linguistic minority groups, had fewer physician visits and were less likely to have seen a physician in the preceding two years.5
In 2006, Steinberg and colleagues conducted focus groups with 91 deaf adults who communicated in American Sign Language (ASL) in three U.S. cities.
Findings from these focus groups indicated that the deaf participants had difficulty communicating, and described their experiences in our health care system with words such as “fear, mistrust, and frustration.” These communication difficulties were mitigated by the presence of experienced, certified interpreters, health care practitioners fluent in ASL, and health care providers who made an effort to improve communication with deaf patients.6
In addition to these communication barriers, many deaf people also have cultural perspectives different from those of hearing people, which might have an impact on their experiences with our health care system. For example, a significant portion of deaf adults view the medical and scientific community’s attempt to discover a cure or a “fix” for deafness as a strong rationale for not partaking in health research and services. Health services researchers and providers who are not aware of deaf people’s communication and cultural issues are likely to have difficulty when working with this population.7,8
In an attempt to reduce health disparities for this underserved, linguistic minority population, the Centers for Disease Control and Prevention funded the Rochester Prevention Research Center’s National Center for Deaf Health Research (NCDHR) in 2004, which uses a community-based participatory research approach to bridge the trust gap between the local deaf community and the University of Rochester Medical Center (URMC) to improve the health of deaf and hard-of-hearing people.9,10
As a result of this collaboration, NCDHR leaders conducted one of the first health surveys of deaf people who use ASL. Their findings indicated that deaf people in Rochester experience some specific health disparities that are not being adequately addressed by the health care system, including increased cardiovascular risks, intimate partner violence, and suicidal ideation.9
Such findings confirmed the urgent need for all health care providers, regardless of location or specialty, to be culturally competent in caring for their deaf patients.
The Deaf Strong Hospital (DSH) program was created in conjunction with URMC and the Deaf Wellness Center in January 1998.11
The DSH program exposes first-year medical students to communication, linguistic, and cultural issues that are relevant to providing effective patient care and to establishing multicultural sensitivity early in their medical education. Health care providers’ increased sensitivity toward and awareness of deaf people’s culture and ASL will help to bridge the trust gap between the deaf community and our health care system and will improve deaf people’s health outcomes. Furthermore, exposing medical students to deaf people’s visual communication needs within the health care context is likely to sensitize medical students to the advantages of using visual communication to help convey complicated health information to patients who are not fluent in English.
This article describes the DSH program curriculum, shares findings from both medical students’ short-term and long-term post-program evaluations, and provides a framework for the implementation of a broader cultural and linguistic sensitivity training program specific to working with and improving the quality of health care among deaf people.