In Reply: Dr Noble and colleagues point out important limitations of observational studies and self-report measures. We found an association between student body diversity and medical students' self-rated cultural competence but could not establish that this association was causal. It could have been confounded by the diversity of the patients to whom students were exposed if schools with the most diverse student bodies had students rotate through hospitals that served the most diverse patient populations and if exposure to diverse patient populations resulted in greater cultural competence. It is doubtful that nonelective instruction in cultural competence was a significant confounder. During the time the students in our study were in medical school, schools devoted an average of 15 hours during 4 years to instruction related to “cultural diversity.”1 Accounting for elective and volunteer diversity-related experiences during medical school did not affect our findings; it seems unlikely that accounting for the limited nonelective experience that students received would have altered our results.
Saha S, Wilkerson L. Cultural Competence and Student Body Composition Among US Medical Students—Reply. JAMA. 2009;301(6):596-597. doi:10.1001/jama.2009.77