Responding to the challenges of teaching cultural competency

Abstract

This study evaluates the effectiveness of a 2.5-hour introductory session on culture, health and illness delivered to Year 1 medical students. It examines the effectiveness of this session on students’ attitudes and compares it with that of prior efforts. The primary goal was to introduce the notion of culture and explore the interaction of cultures in a medical encounter. The session attempted to help students understand that both the patient and the doctor have a culture. A second objective was to provide a tool to help students to explore medically relevant aspects of a patient’s culture. The need to include cultural competency education throughout medical school is widely accepted. However, introducing this topic in the context of the basic science curriculum presents many challenges. Student apathy and resistance are primary challenges that are gaining wider acknowledgement. This session attempted to overcome such resistance through student leadership and a focus on the clinical encounter. During an interactive session in the Foundations of Doctoring course, upper-level students and a clinician jointly introduced the notion of culture to 156 Year 1 students (in groups of 50+). Each group then viewed a video of a medical situation involving culture and discussed their impressions of the doctor and family portrayed. The students were encouraged to reflect on the situation, the family’s culture, the medical culture and the interactions between the two cultures. Under the upper-level students’ leadership, group members then explored their own individual culture with a peer using structured dyads. Finally, the clinician and an upper-level student demonstrated the use of anthropologically oriented interviewing techniques in a role-play of a medical interview which the students then practised with their peers. Students completed the 15-item Health Beliefs Attitude Survey before and after participating in the session. A paired t-test was conducted for each attitudinal factor documented in the literature: whether the doctor should elicit a patient’s perspective, and whether knowing the patient’s perspective affects the quality of care the doctor provides. Students’ attitudes increased significantly (P = 0.001) on both factors resulting in large (d = 0.66) and moderate (d = 0.44) effect sizes for care and elicit, respectively. These results are remarkable when compared with those of prior studies with medical students in which attitudes declined or increased only on care. Asked to evaluate whether the session ‘advanced my understanding of the impact of culture on communication issues’, students rated the session significantly more highly than in the previous prior year (t = 3.4385, P ≤ 0.0007). We felt that the utilisation of upper-level students along with clinicians as instructors and the provision of opportunities to relate to culture personally and in a medical situation and to practise skills to address culture appeared to reduce resistance and improve students’ attitudes towards addressing cross-cultural communication in medicine.