Using a scale of I to 5, with 1 = never and 5 always, please answer the following questions:
Question
EXHIBIT 1.1
8. 10
Cultural Diversity and Sensitivity Self-Evaluation Form
Response Value
2.
3.
4.
5.
6.
7.
I am comfortable with my culture and can compromise on situations without sacrificing my integrity.
I think about what I say and how it may affect people with different beliefs and practices.
I am aware that others may stereotype me, and I am willing to proactively get involved and share my
beliefs and practices.
I evaluate what the real reasons are when I encounter a conflict with persons of a different culture.
I am aware of sensitive issues when I am around women and persons of different beliefs and races.
I ask for clarification when I do not understand what others mean.
I am aware of my assumptions about others who are culturally or racially different from me and I am
okay with it.
8,
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
okay with it.
I object when others tell ethnic jokes.
I listen without interrupting when someone is speaking.
I am comfortable forming friendships with people of different cultures.
I find ways to learn more about different cultures and to communicate effectively.
I realize that flexibility and empathy allow me to evaluate persons of different cultures without imposing
any judgments, which allows me to collaborate effectively.
I recognize that there are other ways to do things than mine.
I accept people for who they are regardless of color, educational achievement, financial status, or gender.
I do not mind apologizing if I have wronged or offended someone.
I respect that others may have a different interpretation of personal space than I do.
I treat people differently than suggested by the biases and prejudices of members of my culture.
I do not look down on people who do not speak English fluently or may have an accent.
I understand that there are other ways to communicate than I do.
I use simple and common phrases when around someone of diverse culture who may not speak
my language proficiently.
Add up all of the numbers to get a total score.
Total score
otal score:
Outstanding: 95-100
Good: 85-94
Average: 75-84
Needs improvement: 74 or less
(This tool is intended for personal use only. It is designed to be performed as a personal self-assessment. No reliability test that
measures stability, equivalence, and homogeneity has been performed.)
Source: American Academy of Family Physicians, American Academy of Pediatrics, American College of Sports Medicine, American Medical Society for
Sports Medicine (2010). Copyright 0 2010 American Academy of Pediatrics. Reproduced with permission.
Question
EXHIBIT 1.1
8. 10
Cultural Diversity and Sensitivity Self-Evaluation Form
Response Value
2.
3.
4.
5.
6.
7.
I am comfortable with my culture and can compromise on situations without sacrificing my integrity.
I think about what I say and how it may affect people with different beliefs and practices.
I am aware that others may stereotype me, and I am willing to proactively get involved and share my
beliefs and practices.
I evaluate what the real reasons are when I encounter a conflict with persons of a different culture.
I am aware of sensitive issues when I am around women and persons of different beliefs and races.
I ask for clarification when I do not understand what others mean.
I am aware of my assumptions about others who are culturally or racially different from me and I am
okay with it.
8,
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
okay with it.
I object when others tell ethnic jokes.
I listen without interrupting when someone is speaking.
I am comfortable forming friendships with people of different cultures.
I find ways to learn more about different cultures and to communicate effectively.
I realize that flexibility and empathy allow me to evaluate persons of different cultures without imposing
any judgments, which allows me to collaborate effectively.
I recognize that there are other ways to do things than mine.
I accept people for who they are regardless of color, educational achievement, financial status, or gender.
I do not mind apologizing if I have wronged or offended someone.
I respect that others may have a different interpretation of personal space than I do.
I treat people differently than suggested by the biases and prejudices of members of my culture.
I do not look down on people who do not speak English fluently or may have an accent.
I understand that there are other ways to communicate than I do.
I use simple and common phrases when around someone of diverse culture who may not speak
my language proficiently.
Add up all of the numbers to get a total score.
Total score
otal score:
Outstanding: 95-100
Good: 85-94
Average: 75-84
Needs improvement: 74 or less
(This tool is intended for personal use only. It is designed to be performed as a personal self-assessment. No reliability test that
measures stability, equivalence, and homogeneity has been performed.)
Source: American Academy of Family Physicians, American Academy of Pediatrics, American College of Sports Medicine, American Medical Society for
Sports Medicine (2010). Copyright 0 2010 American Academy of Pediatrics. Reproduced with permission.
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