International Placements Increase the Cultural Sensitivity and Competency of Professional Health Students: A Quantitative and Qualitative Study

Abstract

Background and Purpose. Effective health care requires cultural and cultural competency, which are vital aspects of a health professional's background. The purpose of this study was to investigate if a difference occurs in cultural pre- and post-international clinical placement. Participants. Seventeen final-year health professions students were recruited from Curtin University of Technology for this study. Methods. Participants attended a 4-week placement in China or India. Social demographic information included previous intercultural experience, prior language study, and intercultural friendship. The Intercultural Development Inventory (IDI) measured cultural pre-and post-placement and was analysed using the paired sample t test. Experiences and reflections of participants were obtained using a guided learning journal; qualitative data were analysed using a phenomenological approach. Results. Overall IDI developmental scores (mean -4.31, 95% CI -9.55 to 0.93) and individual scale scores increased but did not reach statistical significance except for the Acceptance/Adaptation scale (mean -0.34, 95% CI -0.63 to -0.04). Five themes emerged from qualitative analysis suggesting development of cultural sensitivity: increased vigilance and adaptation to environment, uncertainty and anticipation, grappling with supremacy, recognizing and appreciating differences, and cultural immersion and development. Discussion and Conclusion. International placements increase the cultural and competency of health professions students. Future studies should explore variables that will further enhance these cultural attributes in health professionals. Key Words: International Education, Clinical Education, Cultural Competence. BACKGROUND AND PURPOSE Cross-cultural interactions are an inevitable and integral part of clinical practice in a globalised health care environment.1 Government policies including A First Class Service: Quality in the NHS2 in the United Kingdom and National Action Agenda3 in the United States have been implemented to ensure provision of high-quality service by the health care sector to all patients. The Australian Department of Health and Ageing also has in its vision better health for all Australians, with priorities including a move towards health equality in indigenous and non-indigenous populations.4 The resulting focus on the ability of health care professionals to care for a culturally diverse patient population1,5 is driving the assessment of professional competency to encompass not only discipline-specific skills, but also generic cultural competency. This challenges health care professionals, as the diverse groups possess unique notions of illness and health beliefs that influence the delivery and receptivity of care.6 Cultural biases also exist in interpreting communication cues such as body language, facial expression, and tone of voice.7 Therefore, a lack of cultural understanding can compromise the quality of health care services.8,9 To provide effective health care, cultural and cultural competency are vital aspects of a health professionals background.6,10,11 Despite widespread usage and acceptance of the phrases, these concepts are not definitive. Bhawuk and Brislin12 defined cultural as sensitivity to cultural differences and to the points of view of people in other cultures.(p414) This develops as one begins to appreciate, respect and value diversity13 and is essential to facilitate cross-cultural interactions.6,10 Burchum13 identifies cultural as an integral component of cultural competency, which is a broader concept encompassing 6 attributes: cultural awareness, knowledge, understanding, sensitivity, skill, and interaction. Cultural competency is a dynamic process built on the ongoing development of these component attributes.14,15 Previous studies have revealed that students are less competent in handling cross-cultural encounters in the absence of appropriate teaching. …