MCQ Quiz: Cultural and Structural Humility

Providing equitable, patient-centered care requires more than just clinical knowledge; it demands a deep understanding of cultural and structural humility. As emphasized throughout the Pharm.D. curriculum in courses on patient care, skills labs, and professional development, pharmacists must be adept at recognizing and addressing the diverse factors that influence a patient’s health. This quiz explores the core principles of cultural humility—a lifelong process of self-reflection and learning—and structural humility, which involves recognizing the systemic barriers that create health disparities. Test your understanding of these critical concepts and how they apply to building trust and providing effective care for all patients.

1. Cultural humility is best described as:

• a) Mastering the facts about every culture to become an expert.
• b) A lifelong process of self-reflection and self-critique whereby the individual learns about another’s culture and examines their own beliefs and cultural identities.
• c) A checklist of cultural traits to be used during patient interviews.
• d) The belief that one’s own culture is superior to others.

Answer: b) A lifelong process of self-reflection and self-critique whereby the individual learns about another’s culture and examines their own beliefs and cultural identities.

2. How does cultural humility differ from the older concept of “cultural competence”?

• a) There is no difference; the terms are interchangeable.
• b) Cultural competence implies a discrete endpoint of learning, while cultural humility assumes learning is a lifelong process.
• c) Cultural competence focuses only on language, while cultural humility focuses on religion.
• d) Cultural humility is less patient-centered.

Answer: b) Cultural competence implies a discrete endpoint of learning, while cultural humility assumes learning is a lifelong process.

3. A pharmacist recognizes that a patient’s inability to afford their medication is not a personal failing but is linked to their socioeconomic status and lack of insurance. This recognition is an example of:

• a) Clinical inertia
• b) Structural humility
• c) Therapeutic equivalence
• d) A medication error

Answer: b) Structural humility

4. The PPD syllabi list “cultural awareness” and “cultural sensitivity” as key pharmacist attributes. This directly relates to the practice of:

• a) Pharmacokinetics
• b) Cultural humility
• c) Sterile compounding
• d) Inventory management

Answer: b) Cultural humility

5. A patient from a different cultural background repeatedly avoids eye contact during counseling. A culturally humble pharmacist would:

• a) Assume the patient is being dishonest or disrespectful.
• b) Demand that the patient make eye contact.
• c) Recognize this may be a cultural norm and continue the conversation in a respectful manner without judgment.
• d) End the counseling session immediately.

Answer: c) Recognize this may be a cultural norm and continue the conversation in a respectful manner without judgment.

6. A patient mentions they are using a traditional herbal remedy from their culture alongside their prescribed medication. A culturally humble response would be:

• a) “You must stop taking that immediately as it is not a real medicine.”
• b) “That sounds interesting. To make sure it’s safe, can you tell me more about it so we can check for any potential interactions with your prescription?”
• c) “I cannot continue to be your pharmacist if you use herbal remedies.”
• d) To ignore the comment and continue talking about the prescribed medication.

Answer: b) “That sounds interesting. To make sure it’s safe, can you tell me more about it so we can check for any potential interactions with your prescription?”

7. “Social Determinants of Health” are conditions in the environments where people are born, live, learn, work, and play. Which of the following is an example?

• a) Genetic predisposition to a disease.
• b) A patient’s age.
• c) Access to safe housing and nutritious food.
• d) The patient’s blood type.

Answer: c) Access to safe housing and nutritious food.

8. The “Accessibility and Belonging Statement” found in multiple course syllabi emphasizes that the college intends to present materials respectful of diversity in:

• a) Gender and sexuality
• b) Race and ethnicity
• c) Socioeconomic status and disability
• d) All of the above

Answer: d) All of the above

9. A pharmacist asks a patient, “Tell me what you think is causing your illness.” This open-ended question is a technique to understand the patient’s:

• a) Financial status.
• b) Health beliefs and explanatory model of illness.
• c) Adherence to their last prescription.
• d) Educational level.

Answer: b) Health beliefs and explanatory model of illness.

10. Implicit bias in healthcare refers to:

• a) The conscious and intentional discrimination against a patient group.
• b) Unconscious attitudes or stereotypes that can affect our understanding, actions, and decisions.
• c) Hospital policies that are explicitly discriminatory.
• d) A patient’s preference for a specific clinician.

Answer: b) Unconscious attitudes or stereotypes that can affect our understanding, actions, and decisions.

11. The first step in mitigating your own implicit bias is:

• a) To deny that you have any biases.
• b) To become aware that everyone has biases and engage in self-reflection to identify them.
• c) To blame the healthcare system for your biases.
• d) To assume your biases do not affect your patient care.

Answer: b) To become aware that everyone has biases and engage in self-reflection to identify them.

12. A patient with limited English proficiency requires counseling. The best practice is to:

• a) Use a family member, especially a child, as an interpreter.
• b) Speak loudly and slowly in English.
• c) Use a professional, certified medical interpreter.
• d) Use simple gestures and hope the patient understands.

Answer: c) Use a professional, certified medical interpreter.

13. The PPD curriculum’s focus on “self-awareness” is the foundation of:

• a) Cultural humility
• b) Pharmacoeconomics
• c) Drug delivery systems
• d) Medicinal chemistry

Answer: a) Cultural humility

14. A pharmacist who says, “I treat all my patients the same, regardless of their background,” may be unintentionally:

• a) Practicing perfect cultural humility.
• b) Ignoring the unique needs, beliefs, and structural barriers that different patients face.
• c) Violating pharmacy law.
• d) Providing the best possible care.

Answer: b) Ignoring the unique needs, beliefs, and structural barriers that different patients face.

15. Structural humility requires a healthcare professional to recognize the role of _________ in creating health disparities.

• a) Patient non-adherence alone
• b) Poor lifestyle choices alone
• c) Systemic issues like poverty, racism, and inequitable policies
• d) Genetic differences alone

Answer: c) Systemic issues like poverty, racism, and inequitable policies

16. A patient repeatedly misses appointments. Instead of labeling the patient as “non-compliant,” a structurally humble approach would be to first assess for barriers such as:

• a) A simple lack of interest.
• b) Lack of transportation, inability to get time off work, or caregiver responsibilities.
• c) A desire to waste the clinic’s time.
• d) The patient’s preference for a different clinic.

Answer: b) Lack of transportation, inability to get time off work, or caregiver responsibilities.

17. The patient-centered communication skills taught in the skills lab, such as using open-ended questions and demonstrating empathy, are essential for practicing:

• a) Financial management.
• b) Cultural humility.
• c) Inventory control.
• d) Aseptic technique.

Answer: b) Cultural humility.

18. A health disparity is defined as:

• a) Any difference in health between two people.
• a) A health difference that is closely linked with social, economic, and/or environmental disadvantage.
• c) A preference for one brand of medication over another.
• d) The natural variation in disease prevalence across the globe.

Answer: a) A health difference that is closely linked with social, economic, and/or environmental disadvantage.

19. A pharmacist can advocate for structural change to reduce health disparities by:

• a) Ignoring the issue.
• b) Supporting policies that improve access to care and address social determinants of health.
• c) Blaming patients for their health problems.
• d) Working only in affluent communities.

Answer: b) Supporting policies that improve access to care and address social determinants of health.

20. A core principle of cultural humility is to:

• a) Enter a patient encounter with the assumption that you are the expert on their life.
• b) Approach each patient as an individual and be willing to learn from them.
• c) Generalize from one patient’s experience to their entire culture.
• d) Use a standardized script for every patient interaction.

Answer: b) Approach each patient as an individual and be willing to learn from them.

21. When a pharmacist actively listens to a patient’s story without interruption, they are demonstrating:

• a) Inefficiency
• b) Respect and a core tenet of cultural humility.
• c) A lack of knowledge.
• d) That they have too much time.

Answer: b) Respect and a core tenet of cultural humility.

22. The syllabus for “Health Disparities in Stroke” likely covers why certain racial groups have worse outcomes. This is an example of identifying:

• a) A failure of personalized medicine.
• b) The need for structural and cultural humility in practice.
• c) A random statistical variation.
• d) A problem that pharmacists cannot help solve.

Answer: b) The need for structural and cultural humility in practice.

23. Which of the following is NOT a social determinant of health?

• a) Education access and quality
• b) A patient’s genetic sequence for CYP2D6
• c) Neighborhood and built environment
• d) Social and community context

Answer: b) A patient’s genetic sequence for CYP2D6

24. The student mistreatment report mentioned in the syllabus’s “Accessibility and Belonging Statement” is a tool for addressing failures in:

• a) Academic performance.
• b) Maintaining a respectful and inclusive learning environment.
• c) Course scheduling.
• d) Financial aid.

Answer: b) Maintaining a respectful and inclusive learning environment.

25. A pharmacist asks a patient, “What matters most to you when it comes to managing your diabetes?” This question helps align the care plan with the patient’s values, which is a key part of:

• a) A drug utilization review.
• b) Patient-centered care and cultural humility.
• c) A cost-benefit analysis.
• d) A legal deposition.

Answer: b) Patient-centered care and cultural humility.

26. Avoiding the use of medical jargon when speaking with patients is a strategy to address potential barriers related to:

• a) Health literacy
• b) Insurance coverage
• c) Transportation
• d) Food security

Answer: a) Health literacy

27. A patient declines a recommended vaccination due to beliefs rooted in their community’s historical experiences with medical research. A culturally humble pharmacist should:

• a) Dismiss their concerns as unscientific and refuse to serve them.
• b) Seek to understand their perspective, validate their concerns without judgment, and provide clear, respectful information.
• c) Administer the vaccine against their will.
• d) Tell them they are making a poor decision.

Answer: b) Seek to understand their perspective, validate their concerns without judgment, and provide clear, respectful information.

28. Structural humility requires us to recognize that health outcomes are shaped by institutions, policies, and societal values, not just:

• a) Individual choices and behaviors.
• b) The healthcare system.
• c) Government actions.
• d) The environment.

Answer: a) Individual choices and behaviors.

29. The “empathic attributes” mentioned in the Skills Lab 1 syllabus are foundational to:

• a) Building a therapeutic, trusting relationship with a patient.
• b) Calculating a correct dose.
• c) Performing sterile compounding.
• d) Managing pharmacy inventory.

Answer: a) Building a therapeutic, trusting relationship with a patient.

30. True or False: Practicing cultural humility means the pharmacist must adopt the patient’s beliefs as their own.

• a) True
• b) False

Answer: b) False

31. The concept of “power imbalance” is central to cultural humility. In the clinician-patient relationship, this refers to:

• a) The patient having more power than the clinician.
• b) The inherent authority and knowledge a clinician holds, which can intimidate or silence a patient.
• c) Both parties having equal power.
• d) A power outage in the clinic.

Answer: b) The inherent authority and knowledge a clinician holds, which can intimidate or silence a patient.

32. A pharmacist redesigns patient education materials to include pictograms and multiple languages. This is an action that demonstrates:

• a) A waste of resources.
• b) An understanding of cultural humility and a desire to address health literacy barriers.
• c) A violation of copyright law.
• d) That the pharmacist is a good artist.

Answer: b) An understanding of cultural humility and a desire to address health literacy barriers.

33. The inclusion of multiple modules on health disparities across different disease states (cancer, stroke, diabetes) in the curriculum suggests that:

• a) Health disparities are rare and isolated to one disease.
• b) These are systemic issues that affect many different patient populations and conditions.
• c) The faculty enjoys teaching the same topic repeatedly.
• d) Health disparities are not a serious problem.

Answer: b) These are systemic issues that affect many different patient populations and conditions.

34. A key outcome of practicing cultural and structural humility is:

• a) Increased patient trust.
• b) Improved communication.
• c) Better medication adherence.
• d) All of the above.

Answer: d) All of the above.

35. A pharmacist learns that a patient is fasting for a religious holiday. This may impact the dosing schedule of their diabetes medication. The culturally humble action is to:

• a) Tell the patient they must stop fasting.
• b) Ignore the information as it is not medically relevant.
• c) Work with the patient and their prescriber to create a safe medication plan that respects their religious practice.
• d) Document “non-compliant” in the patient’s chart.

Answer: c) Work with the patient and their prescriber to create a safe medication plan that respects their religious practice.

36. Structural barriers to care can include:

• a) A lack of insurance.
• b) A lack of reliable transportation.
• c) The absence of specialty clinics in a rural area.
• d) All of the above.

Answer: d) All of the above.

37. When a pharmacist assumes a patient will not be able to afford a medication based on their appearance, they are acting on:

• a) Clinical evidence
• b) A patient request
• c) Implicit bias
• d) A drug utilization review alert

Answer: c) Implicit bias

38. The lifelong learning component of cultural humility means that a pharmacist should:

• a) Complete all cultural training by the end of pharmacy school.
• b) Continuously seek out new knowledge and experiences to better understand their diverse patient populations.
• c) Assume that once they learn about one culture, they know everything.
• d) Only learn about cultures that are similar to their own.

Answer: b) Continuously seek out new knowledge and experiences to better understand their diverse patient populations.

39. How can a pharmacist practice structural humility within their pharmacy?

• a) By advocating for signage and materials in the languages common in their community.
• b) By being aware of local transportation challenges for patients.
• c) By understanding the different insurance plans and assistance programs available.
• d) All of the above.

Answer: d) All of the above.

40. A patient-centered approach, which is central to cultural humility, begins with the question:

• a) “What is wrong with you?”
• b) “What matters to you?”
• c) “Do you have insurance?”
• d) “Why are you here?”

Answer: b) “What matters to you?”

41. The ability to demonstrate “cultural sensitivity” as listed in the Skills Lab 3 objectives means:

• a) Being aware of and respecting cultural differences without assigning judgment.
• b) Knowing every detail of every culture.
• c) Feeling sorry for people from different backgrounds.
• d) Avoiding patients who are different from you.

Answer: a) Being aware of and respecting cultural differences without assigning judgment.

42. A pharmacist who consistently uses a loud tone of voice when speaking to older adult patients, assuming they are all hard of hearing, is engaging in:

• a) A best practice for communication.
• b) Stereotyping.
• c) A patient-centered approach.
• d) Empathy.

Answer: b) Stereotyping.

43. The ultimate goal of practicing cultural and structural humility is to:

• a) Make the pharmacist feel virtuous.
• b) Advance health equity and improve outcomes for all patients.
• c) Fulfill an accreditation requirement.
• d) Avoid malpractice lawsuits.

Answer: b) Advance health equity and improve outcomes for all patients.

44. Which of the following is a key part of the “self-critique” aspect of cultural humility?

• a) Regularly asking yourself how your own identity and biases might be influencing a patient interaction.
• b) Criticizing your patients’ choices.
• c) Criticizing your colleagues’ work.
• d) Believing you are always right.

Answer: a) Regularly asking yourself how your own identity and biases might be influencing a patient interaction.

45. A patient expresses distrust of the healthcare system. A culturally humble response is to:

• a) Tell them their feelings are not valid.
• b) Acknowledge that their experiences are real and ask, “How can I help build your trust in our work together?”
• c) Refuse to treat the patient.
• d) Immediately defend the healthcare system.

Answer: b) Acknowledge that their experiences are real and ask, “How can I help build your trust in our work together?”

46. Recognizing that a patient’s uncontrolled hypertension may be related to the chronic stress of living in an unsafe neighborhood is an example of applying:

• a) A pharmacokinetic model.
• b) A structural humility framework.
• c) The Beers Criteria.
• d) A drug interaction checker.

Answer: b) A structural humility framework.

47. The “R” in the “GATOR Way Patient Counseling Rubric” (Appendix D, PHA5164L) stands for “Repeat/Review,” and the “WAY” includes “understanding and empathetic responses.” This structure directly supports the practice of:

• a) Cultural humility
• b) Financial planning
• c) Inventory management
• d) Legal compliance

Answer: a) Cultural humility

48. Why is using a child as an interpreter for their parents a poor and potentially harmful practice?

• a) It can disrupt family dynamics and place an inappropriate burden on the child.
• b) The child may not understand complex medical terminology.
• c) The child may omit or alter information to protect their parent.
• d) All of the above.

Answer: d) All of the above.

49. The PPD curriculum’s emphasis on “reflection” is intended to build the core skill of self-critique, which is essential for:

• a) Passing exams.
• b) Cultural humility and lifelong learning.
• c) Writing prescriptions.
• d) Managing a budget.

Answer: b) Cultural humility and lifelong learning.

50. True or False: A pharmacist can be fully culturally and structurally humble after completing one course on the topic.

• a) True
• b) False

Answer: b) False