In Their Shoes: Cultural Competence in Pharmacy Education

By Brittany R. Smith, Pharm.D.

As a pharmacy student I was exposed to diverse cultures through classroom lectures, but those experiences were nothing like my daily experiences as a second-year pharmacy resident practicing in an ambulatory care setting. During this residency, I have been exposed to a variety of patient populations presenting with unique cultural and social differences. Through my educational career and first year of residency training, I was well-trained to address the complex, medication-related problems in multiple disease states. My brief exposure to different cultures through classroom-based lectures and simulated case-based scenarios introduced me to the concept of cultural competence; however, I was largely unaware of the cultural and social complexities with which patients present.

How do we better prepare pharmacy students and residents to recognize cultural and social complexities presented through the variety of patients in all avenues of pharmacy practice?

What does cultural diversity look like in a practice setting?
Pharmacy practice is constantly expanding and evolving, and pharmacists are providing services in more settings than ever before. A focus of community health centers (CHC) is improving access to affordable health care. Many CHC patients are non-English speaking who present for basic health care needs, like work and school physicals. At my residency practice site, Bluegrass Community Health Center, about 50% of the established patient population is non-English speaking, and many of our patients are being integrated into the United States healthcare system for the first time. Communication differences, both linguistic and cultural, are a major barrier to patient care. Some patients come from areas where there is no health care system, like African refugees, and others come from areas with a health care system that differs from the United States, like Mexican migrant farm workers.

How do students view their cultural competence?
On the Self-Assessment of Perceived Level of Cultural Competence (SAPLCC) questionnaire, an assessment identifying student perceptions of cultural competence, pharmacy students rated their knowledge and skills lower than their attitudes, abilities, and awareness.1 Living in a multicultural society provides students with the attitudes, abilities, and awareness to integrate themselves into different cultures, but they lack the skills and knowledge about these different cultures to fully treat and care for these populations. As millennials, most of today’s student pharmacists have grown up in a world of diversity and inclusion, so most are aware of the differences between cultures. Most are not, however, trained adequately to understand the different perceptions on health care between different cultures.1

The extent to which colleges and schools of pharmacy have implemented cultural competence training into pharmacy curricula is varied.2 Formal introduction into cultural competence is often given in the classroom, and some exposure to diverse populations occurs in the experiential setting. Cultural competence may be overlooked or not emphasized during practice experiences, leaving students with a missed opportunity to deepen their cultural understanding of the diverse populations in which they are immersed.2

All pharmacy schools are held to a standard of education through the accreditation brought by the Accreditation Council for Pharmacy Education, but does more emphasis need to be placed on those areas focusing on cultural competence?3  

What is a personal perspective on the transition into a culturally complex environment?
I would consider myself a practitioner who uses a holistic approach with each patient. In my first year of residency training, most of my patient population fit into a demographic and cultural category similar to what I had been exposed to in pharmacy school through experiential training. I admit that when I first started at Bluegrass Community Health Center, I struggled to understand new cultures and their social complexities. I had to take initiative to do my own research and discuss with the providers about approaches to treatment and other considerations during patient encounters. I continue to learn each day about cultural differences, but I did feel like I was at a disadvantage not having had previous focus on cultural competency during experiences where I was exposed to diverse patient populations in an experiential setting.

Future Focus
To enhance cultural competence in pharmacy education, more of the focus should shift towards identifying experiences pharmacy students have while on experiential rotations in culturally diverse environments and emphasizing cultural competence as more of a focus and desired outcome during student experiential rotations. The variety of demographics in culturally and socially diverse patient populations, like at a CHC, can serve as a great resource to emphasize and identify pharmacy practice in these areas. Can we consider working towards a methodical approach to be able to identify and take advantage of the experiences in culturally diverse populations and to discuss the cultural diversity in these areas?

What are your thoughts?
Let’s continue to conversations below. As the communities we live in continue to become more diverse, how do we properly prepare future healthcare practitioners to manage the variety of cultural and social complexities? Should we require experiences with specific populations, like we do for specific practice settings to meet these educational needs?

Special thanks to Holly Divine, Pharm.D., BCACP, BCGP, CDE, FAPhA, and Jeff Cain, EdD, MS at the University of Kentucky College of Pharmacy for their guidance on this article.


  1. Echeverri M, Brookover C, Kennedy K. Assessing Pharmacy Students’ Self-Perception of Cultural Competence. J Health Care Poor Underserved. 2013;24:64-92.
  2. Cooper LA, Padiyara R, Quinones-Boex A. Pharmacy Students’ Perceptions of Cultural Competence Encounters During Practice Experiences. Am J Pharm Educ. 2014;78(2):Article 31.
  3. Accreditation Council for Pharmacy Education. Accreditation Standards and Key Elements for the Professional Program in Pharmacy Leading to the Doctor of Pharmacy Degree. 2015.

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Brittany R. Smith is a PGY2 Ambulatory Care Pharmacy Resident at the University of Kentucky College of Pharmacy and Bluegrass Community Health Center. Educational scholarship interests include cultural competency, interprofessional education, and experiential education. In her free time, Brittany enjoys spending time with her family and friends, traveling, and cheering on the Kentucky Wildcats.

Pulses is a scholarly blog supported by Currents in Pharmacy Teaching and Learning

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