Understanding cultural humility as part of competence.

The term "cultural humility" was introduced in 1998 as a dynamic and lifelong process focusing on self-reflection, personal critique, and acknowledging one’s own biases.

• Cultural humility encourages ongoing curiosity rather than an endpoint. 
• You can never be fully competent about the evolving and dynamic nature of a patient's experiences, however, you can be intentional and humble in your desire to center identity in the health care you provide. 
• Pairing cultural knowledge, skill, and training with humility means you can make space for learning and not knowing at the same time. 
• Cultural humility allows you to “try on” new ideas, or ways of doing things that might not be what you prefer or are familiar with. This helps build good will with those who think or do things differently. Adapted from Visions Inc. “Guidelines for Productive Work Sessions”

Centering identity through intersectionality.

Cultural humility recognizes intersectionality, which is defined as the acknowledgement of a person's many intersecting social and political identities. These identities combine to create different aspects of discrimination and privilege. 

Spend some time reflecting on your own intersections.

• What identities do you hold?
• How have they created advantages or disadvantages for you in your career? [Personal life, the health care system, larger society?]
• Consider how your identities impact the care you give, or how you may feel when caring for those with identities that are different from your own. 

Acknowledge when discrimination, structural inequities, and implicit bias are at play.

Structural inequities are the personal, interpersonal, institutional, and systemic drivers—such as racism, sexism, classism, able-ism, xenophobia, and homophobia. Reference here. 

• Implicit bias is the tendency for stereotype-confirming thoughts to pass spontaneously through our minds, causing us to overgeneralize and sometimes leading to discrimination even when we think we are being fair. Reference here. 
• Discrimination, implicit bias, and structural inequities create the conditions of our lives, whether we are headed to the grocery store or to the doctor. Acknowledging when they show up in our lives and the lives of our patients is crucial to dismantling them. 
• A common challenge to equitable care is the lack of honest and authentic conversations about systemic or individual biases because they make clinicians feel uncomfortable. It can be helpful to understand that everyone has biases, and that avoiding or concealing them only worsens the problem. Reference here. 
• Instead of avoiding talking about biases, health care institutions and clinicians need to raise them to the surface and become more comfortable with having the necessary uncomfortable conversations to effect change. Reference here. 

Be honest with yourself and your patient.

Spend time reflecting on areas you may not know. For example, if you’ve only ever treated a specific dermatological condition on lighter skin, consider the differences and similarities to treating that condition on darker skin. Seek out the information you’ll need to give quality care to all of your patients. 

• Patients do not expect you to know everything about their identities. However, you should pursue this knowledge when relevant. 
• Sometimes you will be able to do this research and learning before it becomes relevant, but oftentimes you won't and you’ll find yourself in an unfamiliar situation. When this happens the best thing to say to a patient is “I don’t know”. You can always follow it up with, “But I am committed to finding out”, or, “Let's figure it out together”.
• Balance partnering with your patients, without expecting them to do the free labor of providing your education.
• Ask questions like, “Is there anything that has been helpful for you in the past that you’d like to share with me?” Or, “This is what I think would be helpful for me to look into before the next time we meet, anything you feel I am missing?” 

Embodying cultural humility.

Embodying cultural humility means using practices like embodied awareness— connecting to the present moment using the body, the breath, or any other sensory experience to ground ourselves.

• Being able to remain compassionate and grounded in your own body, even when in a place of learning or "not knowing", preserves the therapeutic or patient/clinician relationship.
• Intentional time for processing, embodied awareness, and values clarification supports the practice of cultural humility. Adapted from Rita Molestina, LICSW Embodying cultural humility training. 
• Carve out five minutes before your clinical day to practice grounding techniques, and similarly set aside five minutes after your clinical day to reflect on what difficult interactions may have felt like. Did you have any stress responses (e.g. increased heart rate, tensing muscles, etc.)? Did you feel pressured to “know”? 

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