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Cultural Competence in Healthcare: Humility, CLAS and Examples
Cultural competence in healthcare is the knowledge and skill to give effective, understandable and respectful care to patients of every culture, language and level of health literacy. HHS's National CLAS Standards, 15 action steps from the Office of Minority Health, set out how (Think Cultural Health). Cultural humility adds the habit of questioning your own assumptions, and the AAMC now calls that competency self-awareness (AAMC).
The idea of cultural humility comes from a 1998 paper by Tervalon and Murray-García, who proposed it as a better goal for physician training than competence alone: a lifelong commitment to self-evaluation and to redressing the power imbalance between patient and physician (Journal of Health Care for the Poor and Underserved, read October 31, 2026).
Why cultural competence matters
HHS says CLAS can improve the quality of services for every patient and help reduce health disparities (Think Cultural Health). Language is part of it by law as well as by ethics. Title VI of the Civil Rights Act bars discrimination based on race, color and national origin in programs that receive federal funds (Justice Department). HHS's Section 1557 rule requires covered health programs to take reasonable steps to give meaningful access to people with limited English proficiency, with language help that is free, accurate and timely (45 CFR 92.201).
Cultural competence vs cultural humility
| Cultural competence | Cultural humility | |
|---|---|---|
| Focus | Cultural competence: Knowledge and skills for caring across cultures | Cultural humility: Ongoing self-reflection about your own assumptions |
| End point | Cultural competence: Something you build and keep improving | Cultural humility: No end point, a lifelong habit |
| Risk if done badly | Cultural competence: Treating culture as a checklist or a stereotype | Cultural humility: Reflection with no change in practice |
| In the room | Cultural competence: Using an interpreter, adapting how you explain | Cultural humility: Asking the patient what matters to them, instead of assuming |
The National CLAS Standards
The National Standards for Culturally and Linguistically Appropriate Services (CLAS) in Health and Health Care are a set of 15 action steps meant to improve quality of care and help eliminate health care disparities. Think Cultural Health sums up CLAS as respecting the whole individual and responding to the individual's health needs and preferences (Think Cultural Health).
The principal standard asks organizations to provide care that responds to “cultural health beliefs and practices, languages, health literacy, and other communication needs.” The other standards are grouped under governance, leadership and workforce, communication and language assistance, and engagement, continuous improvement and accountability (the Standards).
What medical schools look for
In 2026 the AAMC renamed two of its premed competencies: cultural humility is now self-awareness and cultural awareness is now understanding others (AAMC). Their definitions describe what interviewers want to hear:
- Self-awareness: reflecting on personal assumptions and how they may influence interactions, and being willing to revise your thinking when new information emerges.
- Understanding others: understanding that people's experiences and backgrounds influence their behavior, and showing curiosity about how others see the world.
- Oral communication: recognizing communication barriers and adjusting your approach.
Our AAMC core competencies guide covers all 17.
Cultural competence examples
| Situation | A culturally competent move |
|---|---|
| A patient's adult son offers to interpret a cancer diagnosis for his mother. | A culturally competent move: Thank him, and use a professional interpreter, in person if possible. The NCI says not to use family members or friends to interpret. |
| A patient wants to fast for a religious holiday while on a diabetes medication. | A culturally competent move: Ask what the fast involves and plan doses and glucose checks around it, rather than telling her not to fast. |
| A family expects the eldest relative to make decisions for the patient. | A culturally competent move: Ask the patient how they want decisions made, and respect that choice if they are capable. |
| A patient uses a traditional remedy alongside your treatment. | A culturally competent move: Ask about it without judgment, check for interactions and keep the conversation open. |
On interpreters, the NCI says clinicians should not use a patient's family members or friends to interpret, and that in-person interpreters are preferable for sensitive information such as bad news or chemotherapy consent (NCI PDQ).
Cultural competence interview questions
- Tell us about a time you worked with someone whose background was very different from yours.
- How would you care for a patient whose beliefs conflict with your recommendation?
- What does cultural humility mean to you?
- What will you bring to a diverse class?
The strongest answers are specific: one moment where you noticed an assumption and changed what you did. For the related essay-style question, see the diversity question in medical school interviews.
Practice question: working across a difference
What makes these answers weak
Listing facts about a culture, or saying you treat everyone the same. Interviewers want curiosity about each patient and evidence that you can change your approach, not a stereotype or a slogan.
“Tell us about a time you worked with someone whose background or beliefs were very different from yours. What did you learn?”
The most common cultural competence question in medical school interviews. A strong answer shows you noticed your own assumption, asked instead of guessed and changed something as a result.
Example answer written by Confetto (the applicant is invented)
At the free clinic where I volunteer, I helped with intake for a Nepali-speaking patient whose daughter usually interpreted for him. One day she could not come, so we used a phone interpreter, and it took much longer than usual.
Halfway through, he told the interpreter he had stopped taking his blood pressure pills weeks ago. He had never said that with his daughter in the room. Afterward the nurse explained that he may not have wanted to worry her, or that it may not have been his place to say it in front of her.
I had assumed that a family member interpreting was a kindness. I learned it can also change what a patient feels able to say. Since then I ask patients early whether they would like a professional interpreter, and I offer it even when family is there.
What I take into medicine is to ask rather than assume, about language, about who should be in the room and about what a patient's choices mean to them.
Sources: HHS Think Cultural Health (National CLAS Standards), 45 CFR 92.201, the Justice Department on Title VI, Tervalon and Murray-García (1998), the AAMC premed competencies and the NCI PDQ, checked October 31, 2026.
Frequently asked questions
What is cultural competence in healthcare?
The knowledge and skills to give good care to patients from different cultures, languages and beliefs. HHS's National CLAS Standards describe the goal as effective, understandable and respectful care that responds to cultural health beliefs, languages, health literacy and other communication needs. See the National CLAS Standards.
What is the difference between cultural competence and cultural humility?
Competence is knowledge and skills you build. Humility is an ongoing habit of reflecting on your own assumptions and learning from each patient. Good care needs both.
Did the AAMC change its cultural competencies?
Yes. In 2026 the AAMC renamed cultural humility to self-awareness and cultural awareness to understanding others, and updated their definitions. See the AAMC premed competencies.
What are the CLAS Standards?
The National Standards for Culturally and Linguistically Appropriate Services in Health and Health Care, from HHS's Office of Minority Health. They are a blueprint for individuals and organizations to provide culturally and linguistically appropriate services. See Think Cultural Health.
Can a family member interpret for a patient?
Best avoided for clinical conversations. The NCI says clinicians should not use family members or friends to interpret, and that in-person interpreters are preferable for sensitive information. See the NCI PDQ summary.