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Bottenfield KR, Kelley MA, Ferebee S, Best AN, Flynn D, Davies TA. Effectively teaching cultural competence in a pre-professional healthcare curriculum. BMC Med Educ 2024; 24:553. [PMID: 38773591 PMCID: PMC11106880 DOI: 10.1186/s12909-024-05507-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 05/02/2024] [Indexed: 05/24/2024]
Abstract
BACKGROUND There has been research documenting the rising numbers of racial and ethnic minority groups in the United States. With this rise, there is increasing concern over the health disparities that often affect these populations. Attention has turned to how clinicians can improve health outcomes and how the need exists to educate healthcare professionals on the practice of cultural competence. Here we present one successful approach for teaching cultural competence in the healthcare curriculum with the development of an educational session on cultural competence consisting of case-based, role-play exercises, class group discussions, online discussion boards, and a lecture PowerPoint presentation. METHODS Cultural competence sessions were delivered in a pre-dental master's program to 178 students between 2017 and 2020. From 2017 to 2019, the sessions were implemented as in-person, case-based, role-play exercises. In 2020, due to in-person limitations caused by the COVID-19 pandemic, students were asked to read the role-play cases and provide a reflection response using the online Blackboard Learn discussion board platform. Evaluation of each session was performed using post-session survey data. RESULTS Self-reported results from 2017 to 2020 revealed that the role-play exercises improved participant's understanding of components of cultural competence such as communication in patient encounters (95%), building rapport with patients (94%), improving patient interview skills (95%), and recognition of students own cultural biases when working with patients (93%). CONCLUSIONS Students were able to expand their cultural awareness and humility after completion of both iterations of the course session from 2017 to 2019 and 2020. This session can be an effective method for training healthcare professionals on cultural competence.
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Affiliation(s)
- Karen R Bottenfield
- Graduate Medical Sciences, Boston University Chobanian & Avedisian School of Medicine, 72 East Concord Street, L317, R-1017, Boston, MA, 02118, USA
| | - Maura A Kelley
- Department of Medical Sciences & Education, Boston University Chobanian & Avedisian School of Medicine, 72 East Concord Street, Boston, MA, 02118, USA
| | - Shelby Ferebee
- University of Maryland School of Dentistry, 650 W Baltimore Street, Baltimore, MD, 21201, USA
| | - Andrew N Best
- Graduate Medical Sciences, Boston University Chobanian & Avedisian School of Medicine, 72 East Concord Street, L317, R-1017, Boston, MA, 02118, USA
| | - David Flynn
- Department of Medical Sciences & Education, Boston University Chobanian & Avedisian School of Medicine, 72 East Concord Street, Boston, MA, 02118, USA
| | - Theresa A Davies
- Graduate Medical Sciences, Boston University Chobanian & Avedisian School of Medicine, 72 East Concord Street, L317, R-1017, Boston, MA, 02118, USA.
- Department of Medical Sciences & Education, Boston University Chobanian & Avedisian School of Medicine, 72 East Concord Street, Boston, MA, 02118, USA.
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Sharma H. Mapping the roots of specialist disparities. Lancet Reg Health Eur 2024; 36:100814. [PMID: 38111728 PMCID: PMC10727932 DOI: 10.1016/j.lanepe.2023.100814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 11/28/2023] [Indexed: 12/20/2023]
Affiliation(s)
- Hemant Sharma
- Transplantation Sciences/University of Liverpool, Prescot Street, Liverpool, L7 8XP, United Kingdom
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Klenner M, Mariño R, Pineda P, Espinoza G, Zaror C. Cultural Competence in the nursing, dentistry, and medicine professional curricula: a qualitative review. BMC Med Educ 2022; 22:686. [PMID: 36127655 PMCID: PMC9485016 DOI: 10.1186/s12909-022-03743-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 09/12/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Cultural competence development in the formative process of healthcare professionals is crucial for the provision of culturally appropriate health care. This educational issue is highly relevant in the growing multicultural composition of southern Chile. The objective of this study was to examine how the healthcare professions curricula at the Universidad de La Frontera, in La Araucanía Region, prepares future professionals to respond to patients' cultural needs. METHOD A sequential transformative mixed methods design composed of two phases was carried out. Phase 1 reviewed all printed material and documentation to explore content that developed cross-cultural skills and competencies in the curricula. In Phase 2 semi-structured interviews were conducted with academics with responsibilities for the development of the curriculum in each career, to detect how academics envisage the incorporation of cultural competence in the curricula. RESULTS Regarding curricular contents, findings indicated that the healthcare professions curricula at The Universidad de La Frontera have similar approaches to the inclusion of CCT in subjects' syllabuses, with inclusion of the different CCT, particularly in the Dental and Medical curricula. However, this coverage showed significant variations in the undergraduate healthcare curricula. The analysis revealed that themes around the Ethics and human values for professional practice; the Psychosocial and cultural determinants of health; the Relationship health-family-community, and to a lesser extent, the Clinician-patient relationship were well covered in the courses. On the other hand, Inequalities in health was the theme with the least contact time in all three courses. Academics called for a better organisation of the inclusion of CCT in the curricula. They also highlighted the challenges of maintaining the dominant paradigm underlying healthcare models, practices, and orientations within the academic staff and health discipline. CONCLUSION Curricula contents findings indicate that the healthcare professions curricula at Universidad de La Frontera have similar approaches to the inclusion of CCT in subjects' syllabuses. However, its depth of coverage allows for improvements. The systematization of CCT and teaching-learning methodologies in healthcare professions curricula is necessary to develop formative processes that allow future professionals to be aware of and respectful with patients' cultural characteristics and needs.
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Affiliation(s)
- Maura Klenner
- Deparment of Language, Literature and Communication, Faculty of Education, Humanities and Social Sciences, Universidad de La Frontera, Temuco, Chile
| | - Rodrigo Mariño
- Melbourne Dental School, University of Melbourne, Melbourne, Australia.
| | - Patricia Pineda
- Department of Pediatric Dentistry and Orthodontics, Faculty of Dentistry, Universidad de La Frontera, Temuco, Chile
| | - Gerardo Espinoza
- Department of Public Health, Faculty of Medicine, Universidad de La Frontera, Temuco, Chile
| | - Carlos Zaror
- Department of Pediatric Dentistry and Orthodontics, Faculty of Dentistry, Universidad de La Frontera, Temuco, Chile
- Center for Research in Epidemiology, Economics and Oral Public Health (CIEESPO), Faculty of Dentistry, Universidad de La Frontera, Temuco, Chile
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Abstract
BACKGROUND Systemic racism and inequity are embedded in higher education, especially in nursing. By disregarding health disparities and inequities, a hidden curriculum is endorsed, implicitly letting both instructors and students know that not addressing these subjects is acceptable. METHOD Needs assessments were performed to assess faculty and student attitudes about the needs for justice, equity, diversity, and inclusion (JEDI) concepts. Using the Plan-Do-Study-Act model, the School of Nursing leadership, faculty, and students created taskforces to implement anti-oppression curricula throughout prelicensure courses. RESULTS Anti-oppression curricula and workshops were piloted successfully in the first semester of prelicensure nursing. Student feedback was positive with constructive suggestions. JEDI curriculum mapping was completed across the prelicensure nursing curriculum. CONCLUSION JEDI concepts must be integrated across nursing curricula to identify gaps. Forming a collaboration between leadership, faculty, and students is an optimal way to proceed as they all are invested and accountable for change. [J Nurs Educ. 2022;61(8):447-454.].
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Dikomitis L, Wenning B, Ghobrial A, Adams KM. Embedding Behavioral and Social Sciences across the Medical Curriculum: (Auto) Ethnographic Insights from Medical Schools in the United Kingdom. Societies 2022; 12:101. [DOI: 10.3390/soc12040101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Key concepts and theories that are taught in order to develop cultural competency skills are often introduced to medical students throughout behavioral and social science (BSS) learning content. BSS represents a core component of medical education in the United Kingdom. In this paper, we examine, through (auto)ethnographic data and reflections, the experiences of BSS in medical education. The empirical data and insights have been collected in two ways: (1) through long-term ethnographic fieldwork among medical students and (2) via autoethnographic reflexive practice undertaken by the co-authors who studied, worked, examined, and collaborated with colleagues at different UK medical schools. Our findings indicate that despite BSS constituting a mandatory, essential component of the medical curriculum, medical students did not always perceive BSS as useful for their future practice as doctors, nor did they find it to be clinically relevant, in comparison to the biomedical learning content. We suggest that it is paramount for all stakeholders to commit to cultivating and developing cultural competency skills in medical education, through robustly embedding BSS learning content across the undergraduate medical curriculum. We conclude with recommendations for a wide range of educational practices that would ensure a full integration of BSS in the medical curriculum.
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Middel F, López López M, Fluke J, Grietens H. Racial/ethnic and gender disparities in child protection decision-making: What role do stereotypes play? Child Abuse Negl 2022; 127:105579. [PMID: 35299132 DOI: 10.1016/j.chiabu.2022.105579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 01/14/2022] [Accepted: 02/23/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND A wide range of studies have revealed racial/ethnic and gender disparities in child protection decision-making. OBJECTIVE This study investigated whether disparities are mediated by stereotypes that professionals may hold, by applying the Stereotype Content Model (SCM) which suggests that stereotypes are formed by perceptions of sociability, morality, and competence. PARTICIPANTS AND SETTING 258 professionals (133 current staff and 125 trainees) from Colorado participated in the study. METHODS The study applied a 2 × 3 randomized experimental vignette design. Participants read a case in which the gender of the parent responsible for maltreatment (mother or father) and race/ethnicity of the family (white, Black, or Latinx) varied. RESULTS A SEM model (CFI = .94, RMSEA = .05) with free parameters for trainees and current staff was estimated. No significant association between stereotypes and race/ethnicity and gender appeared. However, evidence for disparities emerged. In the trainee group, scores to decide for a supervision order were higher for white fathers, Black mothers, Latinx mothers, and Latinx fathers (β = 0.18 to 0.25) compared to white mothers. Current staff provided larger risk scores for Black mothers and both Latinx parents (β = 0.20 to 0.22) compared to the white mother, resulting in increased inclinations to decide for a supervision order (β = 0.26). Lastly, negative perceptions of morality increased supervision order scores (β = -0.55 to -0.36). CONCLUSIONS Evidence for disparities in decision-making appeared, but the study could not confirm that these disparities were mediated by stereotypes. Furthermore, perceptions of morality seemed to impact decision-making processes.
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Affiliation(s)
- Floor Middel
- Department of Pedagogical and Educational Sciences, University of Groningen, the Netherlands.
| | - Mónica López López
- Department of Pedagogical and Educational Sciences, University of Groningen, the Netherlands
| | - John Fluke
- Kempe Center, University of Colorado, Denver, CO, United States
| | - Hans Grietens
- Parenting and Special Education Research Unit, KU Leuven, Belgium
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Jenkins TM, Underman K, Vinson AH, Olsen LD, E. Hirshfield L. The Resurgence of Medical Education in Sociology: A Return to Our Roots and an Agenda for the Future. J Health Soc Behav 2021; 62:255-270. [PMID: 34528486 PMCID: PMC8446898 DOI: 10.1177/0022146521996275] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
From 1940 to 1980, studies of medical education were foundational to sociology, but attention shifted away from medical training in the late 1980s. Recently, there has been a marked return to this once pivotal topic, reflecting new questions and stakes. This article traces this resurgence by reviewing recent substantive research trends and setting the agenda for future research. We summarize four current research foci that reflect and critically map onto earlier projects in this subfield while driving theoretical development elsewhere in the larger discipline: (1) professional socialization, (2) knowledge regimes, (3) stratification within the profession, and (4) sociology of the field of medical education. We then offer six potential future directions where more research is needed: (1) inequalities in medical education, (2) socialization across the life course and new institutional forms of gatekeeping, (3) provider well-being, (4) globalization, (5) medical education as knowledge-based work, and (6) effects of the COVID-19 pandemic.
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Affiliation(s)
- Tania M. Jenkins
- The University of North Carolina
at Chapel Hill, Chapel Hill, NC, USA
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Abstract
In this review, we utilize a narrative approach to synthesize the multidisciplinary literature on diversity training. In examining hundreds of articles on the topic, we discovered that the literature is amorphous and complex and does not allow us to reach decisive conclusions regarding best practices in diversity training. We note that scholars of diversity training, when testing the efficacy of their approaches, too often use proxy measures for success that are far removed from the types of consequential outcomes that reflect the purported goals of such trainings. We suggest that the enthusiasm for, and monetary investment in, diversity training has outpaced the available evidence that such programs are effective in achieving their goals. We recommend that researchers and practitioners work together for future investigations to propel the science of diversity training forward. We conclude with a roadmap for how to create a more rigorous and relevant science of diversity training. Expected final online publication date for the Annual Review of Psychology, Volume 73 is January 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
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Affiliation(s)
- Patricia G Devine
- Department of Psychology, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA;
| | - Tory L Ash
- Department of Psychology, Syracuse University, Syracuse, New York 13244, USA;
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Wang C, Hou XY, Khawaja NG, Dunne MP, Shakespeare-Finch J. Improvement in the Cognitive Aspects of Cultural Competence after Short-Term Overseas Study Programs. Int J Environ Res Public Health 2021; 18:ijerph18137102. [PMID: 34281035 PMCID: PMC8297341 DOI: 10.3390/ijerph18137102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 06/28/2021] [Accepted: 06/29/2021] [Indexed: 11/16/2022]
Abstract
Universities are providing short-term overseas study programs for healthcare students to increase their cultural competence (i.e., capacity to work effectively in cross-cultural situations). However, there is limited empirical research evaluating the effects of these programs using well-controlled research designs. In the present research study, undergraduate healthcare students in an Australian university were selected as participants. Group 1 (n = 32) participated in a short-term overseas study program in Asia (i.e., China, Vietnam, Singapore, and Taiwan), whereas Group 2 (n = 46) stayed in Australia to continue their university education as usual. All participants completed a self-developed demographic questionnaire, Cultural Intelligence Scale, and Multicultural Personality Questionnaire. Cultural competence was surveyed pre- and post-short-term overseas programs. After controlling for prior overseas experiences and the open-mindedness trait, an ANCOVA indicated that Group 1 had a significantly higher scores than Group 2 in cultural knowledge (p < 0.05), but not in cultural awareness, attitude, or skills. It is suggested that short-term overseas study programs may increase healthcare students’ cultural knowledge, a component of competence, and that more needs to be accomplished to improve other areas of cultural competence.
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Affiliation(s)
- Chen Wang
- Center for Brain, Mind and Education, Shaoxing University, Shaoxing 312000, China
- School of Teacher Education, Shaoxing University, Shaoxing 312000, China
- Faculty of Health, School of Psychology and Counseling, Queensland University of Technology, Brisbane 4059, Australia; (N.G.K.); (J.S.-F.)
- Correspondence:
| | - Xiang-Yu Hou
- School of Health and Wellbeing, University of Southern Queensland, Brisbane 4059, Australia;
| | - Nigar G. Khawaja
- Faculty of Health, School of Psychology and Counseling, Queensland University of Technology, Brisbane 4059, Australia; (N.G.K.); (J.S.-F.)
| | - Michael P. Dunne
- Institute for Community Health Research, Hue University, Hue 47000, Vietnam;
- Australian Centre for Health Law Research, Faculty of Business and Law, Queensland University of Technology, Brisbane 4059, Australia
| | - Jane Shakespeare-Finch
- Faculty of Health, School of Psychology and Counseling, Queensland University of Technology, Brisbane 4059, Australia; (N.G.K.); (J.S.-F.)
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Vasquez Guzman CE, Sussman AL, Kano M, Getrich CM, Williams RL. A Comparative Case Study Analysis of Cultural Competence Training at 15 U.S. Medical Schools. Acad Med 2021; 96:894-899. [PMID: 33637658 DOI: 10.1097/acm.0000000000004015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
PURPOSE Twenty years have passed since the Liaison Committee on Medical Education (LCME) mandated cultural competence training at U.S. medical schools. There remain multiple challenges to implementation of this training, including curricular constraints, varying interpretations of cultural competence, and evidence supporting the efficacy of such training. This study explored how medical schools have worked to implement cultural competence training. METHOD Fifteen regionally diverse public and private U.S. medical schools participated in the study. In 2012-2014, the authors conducted 125 interviews with 52 administrators, 51 faculty or staff members, and 22 third- and fourth-year medical students, along with 29 focus groups with an additional 196 medical students. Interviews were recorded, transcribed, and imported into NVivo 10 software for qualitative data analysis. Queries captured topics related to students' preparedness to work with diverse patients, engagement with sociocultural issues, and general perception of preclinical and clinical curricula. RESULTS Three thematic areas emerged regarding cultural competence training: formal curriculum, conditions of teaching, and institutional commitment. At the formal curricular level, schools offered a range of courses collectively emphasizing communication skills, patient-centered care, and community-based projects. Conditions of teaching emphasized integration of cultural competence into the preclinical years and reflection on the delivery of content. At the institutional level, commitment to institutional diversity, development of programs, and degree of prioritization of cultural competence varied. CONCLUSIONS There is variation in how medical schools approach cultural competence. Among the 15 participating schools, longitudinal and experiential learning emerged as important, highlighting the needs beyond mere integration of cultural competence content into the formal curriculum. To determine efficacy of cultural competence programming, it is critical to conduct systematic assessment to identify and address gaps. While LCME standards have transformed aspects of medical education, further research is needed to clarify evidence-based, effective approaches to this training.
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Affiliation(s)
- Cirila Estela Vasquez Guzman
- C.E. Vasquez Guzman is a family medicine postdoctoral fellow, Oregon Health & Science University, Portland, Oregon
| | - Andrew L Sussman
- A.L. Sussman is associate professor, Comprehensive Cancer Center and Department of Family and Community Medicine, University of New Mexico, Albuquerque, New Mexico
| | - Miria Kano
- M. Kano is assistant professor, Department of Internal Medicine, University of New Mexico, Albuquerque, New Mexico
| | - Christina M Getrich
- C.M. Getrich is associate professor, Department of Anthropology, University of Maryland, College Park, Maryland
| | - Robert L Williams
- R.L. Williams is Distinguished Professor, Department of Family and Community Medicine, University of New Mexico, Albuquerque, New Mexico
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Greene SJ, Scott JA. Promoting cultural awareness, professionalism, and communication skills in medicine through anatomy: The Deaf culture session. Clin Anat 2021; 34:899-909. [PMID: 33984159 DOI: 10.1002/ca.23752] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 04/28/2021] [Accepted: 05/03/2021] [Indexed: 11/07/2022]
Abstract
The anatomy curriculum is a place where professionalism can be learned and practiced, including training in cultural competence and communication skills for working with diverse populations. One population that has received little attention in terms of medical education are d/Deaf and hard of hearing (d/DHH) patients, although there is much evidence to support health care disparities in this population. Several major contributing factors include differing views of deafness between medical professionals and those who are culturally Deaf, a lack of understanding of Deaf culture and American Sign Language (ASL) by medical professionals, a lack of educational resources in ASL, and poor experiences in health care. To address this need, a Deaf Culture Applied Anatomy session was incorporated into the first-year curriculum at Morehouse School of Medicine while medical students were studying anatomy of the ear and hearing. Panelists, who were culturally Deaf, hard of hearing, and hearing children of deaf adults, shared their experiences in healthcare, including challenges they faced with communication and care. Surveys were provided to students before and after the panel session. Surveys indicated a lack of knowledge prior to this session, while also demonstrating that this 90-min session improved students' understanding of effective communication with future patients and issues related to deafness. Qualitative feedback also suggested that the students found the session to be personally and professionally beneficial. Implementing the Deaf Culture session was an effective means for introducing students to Deaf culture and working with d/DHH patients.
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Affiliation(s)
- Sarah J Greene
- Department of Pathology and Anatomy, Morehouse School of Medicine, Atlanta, Georgia, USA
| | - Jessica A Scott
- College of Education and Human Development, Georgia State University, Atlanta, Georgia, USA
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Mariño R, Satur J, Tuncer E, Tran M, Milford E, Tran VMTH, Tran PQ, Tsai RPH. Cultural competence of Australian dental students. BMC Med Educ 2021; 21:155. [PMID: 33711993 PMCID: PMC7953755 DOI: 10.1186/s12909-021-02589-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 03/02/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Australia possesses a highly multicultural demographic, and thus dental practitioners are likely to regularly encounter culturally and linguistically diverse individuals. It is important for dental practitioners to be culturally competent, however, cultural competency education is highly variable in the curricula of dentistry and oral health courses in Australia, and research is largely limited to dentistry students. This study aims to investigate and compare perceived attitudes, beliefs and practices of cultural competence amongst first and final year Doctor of Dental Surgery (DDS) and Bachelor of Oral Health (BOH) students at the University of Melbourne Dental School. METHODS Following ethics approval, anonymous questionnaires were completed by 213 participants. The questionnaire was adapted from Schwarz's Healthcare Provider Cultural Competence Instrument and consisted of five scales. Data was analysed using SPSS V 24.0 software. RESULTS A total of 213 students participated in this study (response rate = 88%) The majority of participants were female (n = 114, 53.5%) and the mean age of 23.5 years (range 18-40). The majority of participants were Australian born (n = 110) with 74.6% (n = 159) first generation Australians. Participants who identified as Australian represented 35.7% (n = 76) with 66.1% (n = 141) identified as partly Australian. Multivariate analysis indicated that, after controlling for other independent variables in the model, those who had the highest cultural competence score were female, who self-identify as "Australian", who were in the final year. Furthermore, those who were in the final BOH year scored significatively higher than final year DDS students. CONCLUSION The findings of this study suggest that there is a significant difference in students self-reported cultural competence at different stages of their education. This may be attributed to differences in cultural competence education, scope of practice and the type of patient encounters and role modelling that students may experience. Future research should involve follow up to create longitudinal data, as well as research at other dental schools in Australia and overseas.
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Affiliation(s)
- Rodrigo Mariño
- Melbourne Dental School, University of Melbourne, Melbourne, Australia
| | - Julie Satur
- Melbourne Dental School, University of Melbourne, Melbourne, Australia
| | - Eren Tuncer
- Melbourne Dental School, University of Melbourne, Melbourne, Australia
| | - Megan Tran
- Melbourne Dental School, University of Melbourne, Melbourne, Australia
| | - Elizabeth Milford
- Melbourne Dental School, University of Melbourne, Melbourne, Australia
| | | | - Phuong Qui Tran
- Melbourne Dental School, University of Melbourne, Melbourne, Australia
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Middel F, López López M, Fluke J, Grietens H. The effects of migrant background and parent gender on child protection decision-making: An intersectional analysis. Child Abuse Negl 2020; 104:104479. [PMID: 32259710 DOI: 10.1016/j.chiabu.2020.104479] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 02/10/2020] [Accepted: 03/18/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Disparities in decision-making are a recognized concern within child protection systems and imply that marginalized groups are being treated unequally compared to majoritized groups. Previous studies reported that both ethnicity and the gender of the parent that maltreated the child seem associated with an increased likelihood that child protection agencies provide services after an investigation or that children are placed out of their homes. OBJECTIVE We investigated whether migration background and the gender of the parent who maltreated the child seem associated with the decision whether a case was opened for continuing services. In addition, we inspected whether the intersections between migration background and parent gender were correlated with disparities in decision-making. PARTICIPANTS AND SETTING Our multinational sample consisted of 1189 cases that were involved with child protection agencies in England, the Netherlands, and Germany. METHODS We systematically coded and analyzed child protection case files. We conducted logistic regression analysis to investigate for disparities in decision-making. RESULTS The intersectional analysis showed that maltreatment committed by mothers (OR = 2.25, p = .001) and migrant fathers (OR = 2.21, p = .030) was associated with an increased likelihood to provide ongoing services. However, country specific analyses showed that these effects were most pertinent in the English sample. CONCLUSIONS These findings suggest a need to address migration background and gender disparities in child protection practice. Future research could investigate whether other contextual factors (e.g. characteristics of the professional and agency) seem associated with disparities in decision-making.
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Affiliation(s)
| | | | - John Fluke
- University of Colorado Denver, CO, United States
| | - Hans Grietens
- University of Groningen, the Netherlands; KU Leuven, Belgium
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Manca A, Gormley GJ, Johnston JL, Hart ND. Honoring Medicine's Social Contract: A Scoping Review of Critical Consciousness in Medical Education. Acad Med 2020; 95:958-967. [PMID: 31688036 DOI: 10.1097/acm.0000000000003059] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
PURPOSE To explore how the construct of critical consciousness has been conceptualized within the medical education literature and identify the main elements of critical consciousness in medical education so as to inform educational strategies to foster socially conscious physicians. METHOD In March 2019, the authors conducted a literature search of 4 databases and Google Scholar, seeking articles discussing critical consciousness in medical education published any time after 1970. Three of the authors screened articles for eligibility. Two transcribed data using a data extraction form and identified preliminary emerging themes, which were then discussed by the whole research team to ensure agreement. RESULTS Of the initial 317 articles identified, 20 met study inclusion criteria. The publication of academic articles around critical consciousness in medical education has expanded substantially since 2017. Critical consciousness has been conceptualized in the medical education literature through 4 overlapping themes: (1) social awareness, (2) cultural awareness, (3) political awareness, and (4) awareness of educational dynamics. CONCLUSIONS Critical consciousness has been conceptualized in medical education as an intellectual construct to foster a reflexive awareness of professional power in health care, to unearth the values and biases legitimizing medicine as currently practiced, and to foster transformation and social accountability. Scholars highlighted its potential to improve sociocultural responsibility and to foster compassion in doctors. Adopting a critical pedagogy approach in medical education can help uphold its social accountability through an intrinsic orientation to action, but any enterprise working toward embedding critical pedagogy within curricula must acknowledge and challenge the current structure and culture of medical education itself.
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Affiliation(s)
- Annalisa Manca
- A. Manca is a PhD candidate in medical education, Centre for Medical Education, Queen's University Belfast, Belfast, Northern Ireland; ORCID: http://orcid.org/0000-0001-5494-4267. G.J. Gormley is clinical professor of education, Centre for Medical Education, Queen's University Belfast, Belfast, Northern Ireland; ORCID: https://orcid.org/0000-0002-1701-7920. J.L. Johnston is clinical senior lecturer in education, Centre for Medical Education, Queen's University Belfast, Belfast, Northern Ireland; ORCID: https://orcid.org/0000-0002-3999-8774. N.D. Hart is clinical senior lecturer in education, Centre for Medical Education, Queen's University Belfast, Belfast, Northern Ireland; ORCID: https://orcid.org/0000-0002-8168-1746
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Hammond JA, Williams A, Walker S, Norris M. Working hard to belong: a qualitative study exploring students from black, Asian and minority ethnic backgrounds experiences of pre-registration physiotherapy education. BMC Med Educ 2019; 19:372. [PMID: 31619242 PMCID: PMC6794793 DOI: 10.1186/s12909-019-1821-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 09/26/2019] [Indexed: 06/01/2023]
Abstract
BACKGROUND Previous research has demonstrated that attainment inequalities exist for students from Black Asian and Minority Ethnic (BAME) groups in pre-registration physiotherapy education. While previous research has explored students from BAME backgrounds experience of university, the context of physiotherapy is unique and is under researched. Therefore the purpose of this study was to explore BAME student experiences during their physiotherapy training. METHODS Using a phenomenological approach pre-registration BSc and MSc students from BAME backgrounds from two universities who had completed both academic and clinical modules were invited to participate. Focus groups followed a topic guide developed from the literature and were facilitated by physiotherapy educators from outside the host institution. They were digitally recorded, transcribed verbatim and analysed thematically. Analytical triangulation was adopted throughout the research process as a mechanism to enhance rigour. RESULTS Seventeen students participated from a range of self-identified BAME backgrounds that were also representative of age, gender and course. Themes derived from the data included: feeling an outsider in reflections of belonging, behaviours by others that marginalise BAME and personal strategies to integrate in physiotherapy despite the lack of power and influence. Collectively these themes demonstrate a range of challenges which students from BAME backgrounds face within both an academic and practice learning environment. CONCLUSIONS While this may not be surprising based on other disciplines, this study demonstrates that studying physiotherapy as a student from BAME background requires persistence to overcome a series of many implicit challenges. Understanding the experiences of students from BAME backgrounds presents unique opportunities to educate the profession and co-create opportunities for a more diverse profession with practitioners and educators as role models. There is a need for greater training for educators to listen to these students' voices and their stories, and understand where institutional structures and practices could be modified to enable BAME student inclusion in physiotherapy education and practice.
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Affiliation(s)
- John A. Hammond
- Faculty of Health, Social Care and Education, Kingston University and St George’s University of London, Cranmer Terrace, London, SW17 0RE UK
| | - Annabel Williams
- Department of Clinical Sciences, Brunel University London, London, UB8 3PH UK
| | - Saskia Walker
- Faculty of Health, Social Care and Education, Kingston University and St George’s University of London, Cranmer Terrace, London, SW17 0RE UK
| | - Meriel Norris
- Department of Clinical Sciences, Brunel University London, London, UB8 3PH UK
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16
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White J, Plompen T, Tao L, Micallef E, Haines T. What is needed in culturally competent healthcare systems? A qualitative exploration of culturally diverse patients and professional interpreters in an Australian healthcare setting. BMC Public Health 2019; 19:1096. [PMID: 31409317 PMCID: PMC6693250 DOI: 10.1186/s12889-019-7378-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 07/26/2019] [Indexed: 11/10/2022] Open
Abstract
Background Culturally competent health care service delivery can improve health outcomes, increasing the efficiency of clinical staff, and greater patient satisfaction. We aimed to explore the experience of patients with limited English proficiency and professional interpreters in an acute hospital setting. Methods In-depth interviews explored the experiences of four culturally and linguistically diverse communities with regards to their recent hospitalisation and access to interpreters. We also conducted focus group with professional interpreters working. Data were analysed using an inductive thematic approach with constant comparison. Results Individual interviews were conducted with 12 patients from Greek, Chinese, Dari and Vietnamese backgrounds. Focus groups were conducted with 11 professional interpreters. Key themes emerged highlighting challenges to the delivery of health care due distress and lack of advocacy in patients. Interpreters struggled due to a reliance on family to act as interpreters and hospital staff proficiency in working with them. Conclusions In an era of growing ethnic diversity this study confirms the complexity of providing a therapeutic relationships in contemporary health practice. This can be enhanced by training towards the effective use of professional interpreters in a hospital setting. Such efforts should be multidisciplinary and collective in order to ensure patients don’t fall through the gaps with regards to the provision of culturally competent care. Electronic supplementary material The online version of this article (10.1186/s12889-019-7378-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jennifer White
- School Primary and Allied Health Care, Monash University, Melbuorne, Victoria, Australia. .,School of Primary and Allied Health Care, Monash University, Moorooduc Hwy, Frankston, VIC, 3199, Australia.
| | - Trish Plompen
- Partnerships & Service Design, Monash Health, Melbourne, Victoria, Australia
| | - Leanne Tao
- Partnerships & Service Design, Monash Health, Melbourne, Victoria, Australia
| | - Emily Micallef
- Partnerships & Service Design, Monash Health, Melbourne, Victoria, Australia
| | - Terrence Haines
- School Primary and Allied Health Care, Monash University, Melbuorne, Victoria, Australia
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Hou TY, Bohlouli B, Amin M. Differences in Dental Students' Intercultural Competence Across a Four-Year Program. J Dent Educ 2019; 83:1272-1279. [PMID: 31332040 DOI: 10.21815/jde.019.134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 06/10/2019] [Indexed: 11/20/2022]
Abstract
Cultural competence is a combination of knowledge, awareness, and skills that dentists must acquire during their training in order to work with diverse populations. The aim of this study was to measure the perceived cultural competence of dental students in all four years at the University of Alberta in Canada. In 2018, a validated 17-item questionnaire-the Knowledge, Efficacy, and Practices Instrument for Oral Health Providers-was used to assess the students' perceived level of cultural competence on a scale from 1=lowest to 4=highest. Students were grouped into four cohorts (C1, C2, C3, C4) based on their level in the program. Newly admitted students (C1) were surveyed before they took any classes; first-year students were designated C2; second-year students were designated C3; and third- and fourth-year students were combined into C4. Of 160 students, 72% responded, and 102 eligible students (64%) were included in the analysis. The average age of participants was 24.6 years (SD=3.23), 56% were men, and 75% were born in Canada. White and East Asian were the most (48%) and second most (23%) prevalent race/ethnicity. The analysis showed a significant relationship between cohort groupings and determinant components for student classification. The overall mean scores by cohort were C1 2.50 (SD=0.81), C2 2.60 (SD=0.79), C3 2.81 (SD=0.69), and C4 3.04 (SD=0.80). The mean scores of C4 were significantly higher than the mean scores of the other cohorts (p=0.001). This study found that clinical-level students at the University of Alberta had significantly higher perceived cultural competence than those in the preclinical years, though the results also pointed to the need for increased training in this area.
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Affiliation(s)
- Tasha Yuntao Hou
- Tasha Yuntao Hou is a DDS student, School of Dentistry, University of Alberta; Babak Bohlouli, MD, PhD, is Research Associate, Department of Emergency Medicine, University of Alberta; and Maryam Amin, DMD, MSc, PhD, is Professor, Division of Pediatric Dentistry, School of Dentistry, University of Alberta
| | - Babak Bohlouli
- Tasha Yuntao Hou is a DDS student, School of Dentistry, University of Alberta; Babak Bohlouli, MD, PhD, is Research Associate, Department of Emergency Medicine, University of Alberta; and Maryam Amin, DMD, MSc, PhD, is Professor, Division of Pediatric Dentistry, School of Dentistry, University of Alberta
| | - Maryam Amin
- Tasha Yuntao Hou is a DDS student, School of Dentistry, University of Alberta; Babak Bohlouli, MD, PhD, is Research Associate, Department of Emergency Medicine, University of Alberta; and Maryam Amin, DMD, MSc, PhD, is Professor, Division of Pediatric Dentistry, School of Dentistry, University of Alberta.
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18
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Korkmaz-Aslan G, Kartal A, Turan T, Taşdemir-Yiğitoğlu G, Kayan S. [Intercultural Sensitivity of University Students Studying At Health-Related Departments and Some Associated Factors]. Florence Nightingale Hemsire Derg 2019; 27:188-200. [PMID: 34267973 PMCID: PMC8127606 DOI: 10.26650/fnjn420577] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 03/22/2019] [Indexed: 11/20/2022] Open
Abstract
Aim This study was carried out to determine cultural sensitivity levels and affecting factors among the students who were studying at health-related departments. Method The study had a cross-sectional design. The universe of the study consisted of 1127 students who were studying at 1st and 4th years in nursing department of institute of health sciences, school of physical therapy and rehabilitation and medical faculty of a state university. 523 students who agreed to participate in the study and who were attending school on the day of data collection constituted the sample of the study. The data of the study were collected using a socio-demographic data form and Intercultural Sensitivity Scale. Descriptive statistics were used in data analysis. In addition, t test was used in paired groups, and one-way variance analysis (ANOVA) was used in more than two groups. Results The mean score of the students from Intercultural Sensitivity Scale was found to be 3.88±0.64. It was determined that cultural sensitivity was higher among the students who had interaction with people from different cultures, whose opinions about their jobs changed positively during their education, who wanted to attend student exchange programs and who spoke a foreign language (p<0.05). Conclusion In this study, the cultural sensitivity level of the students was found to be at a good level. In addition, gender, interaction with people from different cultures, participation in student exchange programs and knowledge of a foreign language were found to have a bearing on cultural sensitivity. Based on these results, the promotion of collaborations which would create opportunities allowing students to interact with individuals from different cultures might be offered. This would support them in the improvement of their language qualifications and would enable participation of more students in student exchange programs abroad.
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Affiliation(s)
- Gülbahar Korkmaz-Aslan
- Pamukkale Üniversitesi Sağlık Bilimleri Fakültesi, Halk Sağlığı Hemşireliği Anabilim Dalı, Denizli, Türkiye
| | - Asiye Kartal
- Pamukkale Üniversitesi Sağlık Bilimleri Fakültesi, Halk Sağlığı Hemşireliği Anabilim Dalı, Denizli, Türkiye
| | - Türkan Turan
- Pamukkale Üniversitesi Sağlık Bilimleri Fakültesi, Çocuk Sağlığı ve Hastalıkları Hemşireliği Anabilim Dalı, Denizli, Türkiye
| | - Gülay Taşdemir-Yiğitoğlu
- Pamukkale Üniversitesi Sağlık Bilimleri Fakültesi, Ruh Sağlığı Hemşireliği Anabilim Dalı, Denizli, Türkiye
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MacMillan GA, Falardeau M, Girard C, Dufour-Beauséjour S, Lacombe-Bergeron J, Menzies AK, Henri DA. Highlighting the potential of peer-led workshops in training early-career researchers for conducting research with Indigenous communities. Facets (Ott) 2019. [DOI: 10.1139/facets-2018-0046] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
For decades, Indigenous voices have called for more collaborative and inclusive research practices. Interest in community-collaborative research is consequently growing among university-based researchers in Canada. However, many researchers receive little formal training on how to collaboratively conduct research with Indigenous communities. This is particularly problematic for early-career researchers (ECRs) whose fieldwork often involves interacting with communities. To address this lack of training, two peer-led workshops for Canadian ECRs were organized in 2016 and 2017 with the following objectives: ( i) to cultivate awareness about Indigenous cultures, histories, and languages; ( ii) to promote sharing of Indigenous and non-Indigenous ways of knowing; and ( iii) to foster approaches and explore tools for conducting community-collaborative research. Here we present these peer-led Intercultural Indigenous Workshops and discuss workshop outcomes according to five themes: scope and interdisciplinarity, Indigenous representation, workshop environment, skillful moderation, and workshop outcomes. Although workshops cannot replace the invaluable experience gained through working directly with Indigenous communities, we show that peer-led workshops can be an effective way for ECRs to develop key skills for conducting meaningful collaborative research. Peer-led workshops are therefore an important but insufficient step toward more inclusive research paradigms in Canada.
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Affiliation(s)
- Gwyneth A. MacMillan
- Department of Biological Sciences, Centre d’études nordiques, Université de Montréal, Montréal, QC H2V 2S9, Canada
| | - Marianne Falardeau
- Department of Natural Resource Sciences, McGill University, Macdonald Campus, Ste. Anne de Bellevue, QC H9X 3V9, Canada
| | - Catherine Girard
- Centre d’études nordiques, Université Laval, Québec, QC G1V 0A6, Canada
| | - Sophie Dufour-Beauséjour
- Centre d’études nordiques, Centre Eau Terre Environnement, Institut national de la recherche scientifique, Québec, QC G1K 9A9, Canada
| | - Justine Lacombe-Bergeron
- Mine of Knowledge, Department of Biological Sciences, Université de Montréal, Montréal, QC H2V 2S9, Canada
| | - Allyson K. Menzies
- Department of Natural Resource Sciences, McGill University, Macdonald Campus, Ste. Anne de Bellevue, QC H9X 3V9, Canada
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Malatzky C, Glenister K. Talking about overweight and obesity in rural Australian general practice. Health Soc Care Community 2019; 27:599-608. [PMID: 30311287 DOI: 10.1111/hsc.12672] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 07/25/2018] [Accepted: 09/10/2018] [Indexed: 06/08/2023]
Abstract
As many patients' sole point of contact with the health care system, primary health care physicians (general practitioners [GPs] in Australia) are often positioned as key players in responding to rates of overweight and obesity in dominant public discourse. However, research from Western industrialised countries suggests that GPs may not be prepared for, or confident in, having conversations about overweight and obesity with patients. Little attention has been given to this topic in Australia, particularly in the context of rural health. The aim of this study was to understand how GPs in two rural settings in Victoria, Australia talk about overweight and obesity with patients. Working from a multidisciplinary perspective, a qualitative study design was adopted, and semi-structured interviews were conducted with seven GPs and seven GP patients living in two rural communities between January and April, 2016. Data was coded manually and thematic analysis was used to explore the data. The findings of this study support the argument that, in contrast to dominant messages within public health discourses, GPs may not be best placed to act as the primary actors in responding to overweight and obesity as they are constructed in epidemiological terms. In fact, the perspectives of GP study participants suggest that to do so would compromise important dimensions of general medical practice that make it simultaneously a human practice. Instead, more balanced, holistic approaches to discussing and responding to overweight and obesity with patients could be taken up in local, interdisciplinary collaborations between different health professionals and patients, which utilise broader social supports. Focussing on long-term, incremental programs that consider the whole person within their particular socio-cultural environment would be a productive means of working with the complexities of overweight and obesity. However, structural level changes are required to ensure such initiatives are sustainable in rural practice.
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Affiliation(s)
- Christina Malatzky
- Culture and Rural Health, Department of Rural Health, Melbourne Medical School, The University of Melbourne, Shepparton, VIC, Australia
| | - Kristen Glenister
- Rural Chronic Ill Health, Department of Rural Health, Melbourne Medical School, The University of Melbourne, Wangaratta, VIC, Australia
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Abstract
To adequately address gendered issues of sexual harassment, wage gaps, and leadership inequities, medical institutions must interrogate medical education. Feminist theories can help to understand how power operates within our classrooms and at the bedside. This scoping review maps the four main ways in which feminist theory has been applied to medical education and medical education research-namely, critical appraisal of what is taught in medical curricula; exploration of the experiences of women in medical training; informing pedagogical approaches to how medicine is taught; and finally, medical education research, determining both areas of inquiry and methodologies. Feminist theory has the potential to move clinicians and educators from theory to action, building bridges of solidarity between the medical profession and the community it is called to serve.
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Affiliation(s)
- Malika Sharma
- Casey House, Toronto, ON, Canada; Department of Medicine, Women's College Hospital, University of Toronto, ON, Canada; Maple Leaf Medical Clinic, Toronto, ON, Canada.
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22
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Yeung S, Bombay A, Walker C, Denis J, Martin D, Sylvestre P, Castleden H. Predictors of medical student interest in Indigenous health learning and clinical practice: a Canadian case study. BMC Med Educ 2018; 18:307. [PMID: 30547790 PMCID: PMC6295008 DOI: 10.1186/s12909-018-1401-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 11/22/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND Including content on Indigenous health in medical school curricula has become a widely-acknowledged prerequisite to reducing the health disparities experienced by Indigenous peoples in Canada. However, little is known about what levels of awareness and interest medical students have about Indigenous peoples when they enter medical school. Additionally, it is unclear whether current Indigenous health curricula ultimately improve students' beliefs and behaviours. METHODS A total of 129 students completed a 43-item questionnaire that was sent to three cohorts of first-year medical students (in 2013, 2014, 2015) at one undergraduate medical school in Canada. This survey included items to evaluate students' sociopolitical attitudes towards Indigenous people, knowledge of colonization and its links to Indigenous health inequities, knowledge of Indigenous health inequities, and self-rated educational preparedness to work with Indigenous patients. The survey also assessed students' perceived importance of learning about Indigenous peoples in medical school, and their interest in working in an Indigenous community, which were examined as outcomes. Using principal component analysis, survey items were grouped into five independent factors and outcomes were modelled using staged multivariate regression analyses. RESULTS Generally, students reported strong interest in Indigenous health but did not believe themselves adequately educated or prepared to work in an Indigenous community. When controlling for age and gender, the strongest predictors of perceived importance of learning about Indigenous health were positive sociopolitical attitudes about Indigenous peoples and knowledge about colonization and its links to Indigenous health inequities. Significant predictors for interest in working in an Indigenous community were positive sociopolitical attitudes about Indigenous peoples. Knowledge about Indigenous health inequities was negatively associated with interest in working in an Indigenous community. CONCLUSIONS Students' positive sociopolitical attitudes about Indigenous peoples is the strongest predictor of both perceived importance of learning about Indigenous health and interest in working in Indigenous communities. In addition to teaching students about the links between colonization, health inequities and other knowledge-based concepts, medical educators must consider the importance of attitude change in designing Indigenous health curricula and include opportunities for experiential learning to shape students' future behaviours and ultimately improve physician relationships with Indigenous patients.
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Affiliation(s)
- Sharon Yeung
- Department of Public Health Sciences, Queen’s University, Kingston, Ontario Canada
- School of Medicine, Queen’s University, Kingston, Ontario Canada
| | - Amy Bombay
- Department of Psychiatry and School of Nursing, Dalhousie University, Halifax, Nova Scotia Canada
| | - Chad Walker
- Department of Geography and Planning, Queen’s University, Kingston, Ontario Canada
| | - Jeff Denis
- Department of Sociology, McMaster University, Hamilton, Ontario Canada
| | - Debbie Martin
- School of Health and Human Performance, Dalhousie University, Halifax, Nova Scotia Canada
| | - Paul Sylvestre
- Department of Geography and Planning, Queen’s University, Kingston, Ontario Canada
| | - Heather Castleden
- Department of Public Health Sciences, Queen’s University, Kingston, Ontario Canada
- Department of Geography and Planning, Queen’s University, Kingston, Ontario Canada
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Affiliation(s)
- Peter Gallagher
- Wellington School of Medicine & Health Sciences, University of Otago, Wellington, New Zealand
| | - Eileen Mckinlay
- Wellington School of Medicine & Health Sciences, University of Otago, Wellington, New Zealand
| | - Sue Pullon
- Wellington School of Medicine & Health Sciences, University of Otago, Wellington, New Zealand
| | - Patrick McHugh
- Wellington School of Medicine & Health Sciences, University of Otago, Wellington, New Zealand
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Affiliation(s)
- Mary Kate Worden
- Department of Medical Education, University of Virginia School of Medicine, Charlottesville, VA, USA.
| | - Nassima Ait-Daoud Tiouririne
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine, Charlottesville, VA, USA
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Dominicé Dao M, Inglin S, Vilpert S, Hudelson P. The relevance of clinical ethnography: reflections on 10 years of a cultural consultation service. BMC Health Serv Res 2018; 18:19. [PMID: 29325569 PMCID: PMC5765648 DOI: 10.1186/s12913-017-2823-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 12/28/2017] [Indexed: 11/30/2022] Open
Abstract
Background Training health professionals in culturally sensitive medical interviewing has been widely promoted as a strategy for improving intercultural communication and for helping clinicians to consider patients’ social and cultural contexts and improve patient outcomes. Clinical ethnography encourages clinicians to explore the patient’s explanatory model of illness, recourse to traditional and alternative healing practices, healthcare expectations and social context, and to use this information to negotiate a mutually acceptable treatment plan. However, while clinical ethnographic interviewing skills can be successfully taught and learned, the “real-world” context of medical practice may impose barriers to such patient-centered interviewing. Creating opportunities for role modeling and critical reflection may help overcome some of these barriers, and contribute to improved intercultural communication in healthcare. We report and reflect on a retrospective analysis of 10 years experience with a “cultural consultation service” (CCS) whose aim is to provide direct support to clinicians who encounter intercultural difficulties and to model the usefulness of clinical ethnographic interviewing for patient care. Methods We analyzed 236 cultural consultation requests in order to identify key patient, provider and consultation characteristics, as well as the cross cultural communication challenges that motivate health care professionals to request a cultural consultation. In addition, we interviewed 51 clinicians about their experience and satisfaction with the CCS. Results Requests for cultural consultations tended to involve patient care situations with complex social, cultural and medical issues. All patients had a migration background, two-thirds spoke French less than fluently. In over half the cases, patients had a high degree of social vulnerability, compromising illness management. Effective communication was hindered by language barriers and undetected or underestimated patient/provider differences in health-related knowledge and beliefs. Clinicians were highly satisfied with the CCS, and appreciated both the opportunity to observe how clinical ethnographic interviewing is done and the increased knowledge they gained of their patients’ context and perspective. Conclusions A cultural consultation service such as ours can contribute to institutional cultural competence by drawing attention to the challenges of caring for diverse patient populations, identifying the training needs of clinicians and gaps in resource provision, and providing hands-on experience with clinical ethnographic interviewing.
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Affiliation(s)
- Melissa Dominicé Dao
- Department of Community Medicine, Primary Care and Emergency Medicine, Geneva University Hospitals, 4 rue Gabrielle-Perret-Gentil, 1211, Geneva, Switzerland. .,Institute of Primary Care Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland.
| | | | - Sarah Vilpert
- Institute of social and preventive medicine, University of Lausanne, Lausanne, Switzerland
| | - Patricia Hudelson
- Department of Community Medicine, Primary Care and Emergency Medicine, Geneva University Hospitals, 4 rue Gabrielle-Perret-Gentil, 1211, Geneva, Switzerland.,Institute of Primary Care Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
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Bandiera G, Kuper A, Mylopoulos M, Whitehead C, Ruetalo M, Kulasegaram K, Woods NN. Back from basics: integration of science and practice in medical education. Med Educ 2018; 52:78-85. [PMID: 28994457 DOI: 10.1111/medu.13386] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 04/10/2017] [Accepted: 05/31/2017] [Indexed: 06/07/2023]
Abstract
CONTEXT In 1988, the Edinburgh Declaration challenged medical teachers, curriculum designers and leaders to make an organised effort to change medical education for the better. Among a series of recommendations was a call to integrate training in science and clinical practice across a breadth of clinical contexts. The aim was to create physicians who could serve the needs of all people and provide care in a multitude of contexts. In the years since, in the numerous efforts towards integration, new models of curricula have been proposed and implemented with varying levels of success. SCOPE OF REVIEW In this paper, we examine the evolution of curricular integration since the Edinburgh Declaration, and discuss theoretical advances and practical solutions. In doing so, we draw on recent consensus reports on the state of medical education, emblematic initiatives reported in the literature, and developments in education theory pertinent to the role of integrated curricula. CONCLUSIONS Interest in integration persists despite 30 years of efforts to respond to the Edinburgh Declaration. We argue, however, that a critical shift has taken place with respect to the conception of integration, whereby empirical models support a view of integration as pertaining to both cognitive activity and curricular structure. In addition, we describe a broader definition of 'basic science' relevant to clinical practice that encompasses social and behavioural sciences, as well as knowledge derived from biomedical science.
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Affiliation(s)
- Glen Bandiera
- PostMD Education, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Ayelet Kuper
- Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
- The Wilson Centre, University of Toronto, Toronto, Ontario, Canada
| | - Maria Mylopoulos
- The Wilson Centre, University of Toronto, Toronto, Ontario, Canada
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Cynthia Whitehead
- The Wilson Centre, University of Toronto, Toronto, Ontario, Canada
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Family and Community Medicine, Women's College Hospital, Toronto, Ontario, Canada
| | - Mariela Ruetalo
- PostMD Education, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Kulamakan Kulasegaram
- The Wilson Centre, University of Toronto, Toronto, Ontario, Canada
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Nicole N Woods
- The Wilson Centre, University of Toronto, Toronto, Ontario, Canada
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Abstract
This article describes the expansion of a transcultural secondary consultation model run by a state-wide transcultural unit. The model aims to enhance cultural responsiveness in partnership with mental health services. We discuss a series of 12 consultations that occurred between 2011 and 2012. We outline the processes of setting up the structure of secondary consultation, the actual consultation-facilitation format, and methods of evaluation. Evaluations were done in two phases: the first immediately after the consult and the second after a period of 3-6 months. The discussion highlights the usefulness of a transcultural model of consultation and, based on the evaluations, identifies the benefits the model brings to understanding and intervening with clients, culture, and systems. The results emphasise the need for multidisciplinary collaboration and a facilitated space for clinical teams to explore culturally responsive therapeutic practices.
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Affiliation(s)
| | - Natalie Fraser
- The Melbourne Clinic.,St Vincent's Mental Health, Australia
| | - Anna Jenkins
- Metro North Mental Health Service, Australia.,University of Queensland Brisbane
| | - Can Tuncer
- St Vincent's Hospital, Australia.,University of Melbourne Victoria.,Istanbul Medeniyet University
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Macdonald H, Nicholls DA. Teaching physiotherapy students to “be content with a body that refuses to hold still”. Physiother Theory Pract 2017; 33:303-315. [DOI: 10.1080/09593985.2017.1302027] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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White AA, Logghe HJ, Goodenough DA, Barnes LL, Hallward A, Allen IM, Green DW, Krupat E, Llerena-quinn R. Self-Awareness and Cultural Identity as an Effort to Reduce Bias in Medicine. J Racial Ethn Health Disparities 2018; 5:34-49. [DOI: 10.1007/s40615-017-0340-6] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 01/09/2017] [Accepted: 01/11/2017] [Indexed: 10/19/2022]
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Robertson WJ. The Irrelevance Narrative: Queer (In)Visibility in Medical Education and Practice. Med Anthropol Q 2017; 31:159-176. [PMID: 26990123 DOI: 10.1111/maq.12289] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Revised: 03/05/2016] [Accepted: 03/09/2016] [Indexed: 11/27/2022]
Abstract
How might heteronormativity be reproduced and become internalized through biomedical practices? Based on in-depth, person-centered interviews, this article explores the ways heteronormativity works into medical education through the hidden curriculum. As experienced by my informants, case studies often reinforce unconscious heteronormative orientations and heterosexist/homophobic stereotypes about queer patients among straight and queer medical students alike. I introduce the concept of the irrelevance narrative to make sense of how queer medical students take up a heteronormative medical gaze. Despite recognizing that being queer affects how they interact with patients, my informants describe being queer as irrelevant to their delivery of care. I conclude with a discussion of how these preliminary findings can inform research on knowledge production in biomedical education and practice with an eye toward the tensions between personal and professional identity among biomedical practitioners.
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Dao DK, Goss AL, Hoekzema AS, Kelly LA, Logan AA, Mehta SD, Sandesara UN, Munyikwa MR, DeLisser HM. Integrating Theory, Content, and Method to Foster Critical Consciousness in Medical Students: A Comprehensive Model for Cultural Competence Training. Acad Med 2017; 92:335-344. [PMID: 27680318 DOI: 10.1097/acm.0000000000001390] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Many efforts to design introductory "cultural competence" courses for medical students rely on an information delivery (competence) paradigm, which can exoticize patients while obscuring social context, medical culture, and power structures. Other approaches foster a general open-minded orientation, which can remain nebulous without clear grounding principles. Medical educators are increasingly recognizing the limitations of both approaches and calling for strategies that reenvision cultural competence training. Successfully realizing such alternative strategies requires the development of comprehensive models that specify and integrate theoretical frameworks, content, and teaching principles.In this article, the authors present one such model: Introduction to Medicine and Society (IMS), a required cultural competence course launched in 2013 for first-year medical students at the Perelman School of Medicine at the University of Pennsylvania. Building on critical pedagogy, IMS is centered on a novel specification of "critical consciousness" in clinical practice as an orientation to understanding and pragmatic action in three relational domains: internal, interpersonal, and structural. Instead of transmitting discrete "facts" about patient "types," IMS content provokes students to engage with complex questions bridging the three domains. Learning takes place in a small-group space specifically designed to spur transformation toward critical consciousness. After discussing the three key components of the course design and describing a representative session, the authors discuss the IMS model's implications, reception by students and faculty, and potential for expansion. Their early experience suggests the IMS model successfully engages students and prepares future physicians to critically examine experiences, manage interpersonal dynamics, and structurally contextualize patient encounters.
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Affiliation(s)
- Diane K Dao
- D.K. Dao is a fourth-year MD/MPH student, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. A.L. Goss is a fourth-year medical student, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. A.S. Hoekzema is a fourth-year medical student, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. L.A. Kelly is a fourth-year MD/MPH student, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. A.A. Logan is a fourth-year medical student, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. S.D. Mehta is a fourth-year MD/MBE student, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. U.N. Sandesara is a seventh-year MD/PhD student, Perelman School of Medicine and Department of Anthropology, University of Pennsylvania, Philadelphia, Pennsylvania. M.R. Munyikwa is a fifth-year MD/PhD student, Perelman School of Medicine and Department of Anthropology, University of Pennsylvania, Philadelphia, Pennsylvania. H.M. DeLisser is associate professor of medicine and associate dean for diversity and inclusion, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Sopoaga F, Zaharic T, Kokaua J, Covello S. Training a medical workforce to meet the needs of diverse minority communities. BMC Med Educ 2017; 17:19. [PMID: 28109292 PMCID: PMC5251211 DOI: 10.1186/s12909-017-0858-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 01/09/2017] [Indexed: 05/25/2023]
Abstract
BACKGROUND The growing demand for a competent health workforce to meet the needs of increasingly diverse societies has been widely acknowledged. One medical school in New Zealand explored the integration of the commonly used patient-centred model approach, with an intersectional framework in the development of a cultural competency training programme. In the Pacific Immersion Programme, medical students in their fourth year of training are given the opportunity to learn about different factors that influence the health and health care of a minority community through immersion in that community. The programme objectives include enabling students to learn through experience living within the local community context, and supporting them to re-evaluate their own personal beliefs, assumptions and/or prior prejudices. This study evaluates the usefulness of this programme in the training of medical students to work in diverse communities. METHODS Two analytical approaches were used for evaluation. Deductive and inductive analyses were conducted on 235 reflective essays completed by three cohorts of students from 2011 to 2013 to ascertain the value of the programme for student learning. In addition, one cohort was invited to complete a pre and post-programme questionnaire. RESULTS Overall, the students found the programme to be a valued learning environment. They found living within a Pacific family environment to be an eye opening experience. It increased students comfort level in cross cultural engagement and emphasised the importance of patient's perspectives in health care provision. Students' self-reported knowledge about Pacific cultural values, protocols, traditional beliefs and the main health challenges increased significantly after the programme. They appreciated learning directly from community members, and through observations about how culture, beliefs and the socio-economic environment influence peoples' health and wellbeing. CONCLUSIONS Medical schools are required to train a competent health workforce to meet the needs of diverse communities. The Pacific Immersion Programme provides a unique learning environment which can improve the training of doctors to work in diverse communities. The key to its success is enabling students to be engaged learners from "the inside" rather than an "outsider looking in". The Programme enables experiential learning in a sensitive and meaningful way and can be useful for training in other institutions.
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Affiliation(s)
- Faafetai Sopoaga
- Department Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, P.O. Box 913, , Post Code 9054 Dunedin, New Zealand
| | - Tony Zaharic
- Department of Biochemistry, University of Otago, P.O. Box 56, , Post Code 9054, Dunedin, New Zealand
| | - Jesse Kokaua
- Pacific Islands Research & Student Support Unit, Division of Health Sciences, University of Otago, P.O. Box 56, , Post Code 9054 Dunedin, New Zealand
| | - Sahra Covello
- Pacific Islands Research & Student Support Unit, Division of Health Sciences, University of Otago, P.O. Box 56, , Post Code 9054 Dunedin, New Zealand
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Sherrill WW, Mayo RM, Truong KD, Pribonic AP, Schalkoff CA. Assessing medical student cultural competence: what really matters. Int J Med Educ 2016; 7:248-54. [PMID: 27474895 PMCID: PMC4983182 DOI: 10.5116/ijme.578b.687c] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 07/17/2016] [Indexed: 05/21/2023]
Abstract
OBJECTIVES The study aimed to explore medical students' attitudes and beliefs toward Latino patients, specifically: to assess students' levels of knowledge, cultural competence, and comfort with Latinos; to determine students' exposure to and previous experience with Latinos; and to evaluate whether factors such as study abroad, living abroad, previous clinical experience with Latinos, and language proficiency predict Latino knowledge, cultural competence, and comfort with Latinos. METHODS This study utilized a cross-sectional survey design. Participants were third and fourth year medical students at three medical schools in the Southeastern United States. Three composite measures: Latino knowledge, Cultural competence, and Comfort with Latino patients, were predicted in a multivariate regression model including individual sociodemographic characteristics and past clinical or social experience with Latinos. RESULTS A total of 170 medical students completed the survey (43% response rate). Spanish language proficiency was a statistically significant predictor (t(131)=2.72, p<0.05) of Latino knowledge. Social interaction with Latinos in the past year (t(126)=3.09, p<0.01), ever having lived in a Spanish-speaking country (t(126)=2.86, p<0.01), and Spanish language proficiency (t(126)=3.28, p<0.01) independently predicted cultural competence. Previous clinical experience with Latinos was not significantly associated with the three composite dependent variables, and comfort with Latino patients was not significantly predicted by any of the six Latino-related explanatory variables. CONCLUSIONS Factors prior to medical school matriculation and during medical education may contribute to increased cultural competence and comfort with multicultural patients. Cultural patient-partner programs may be an effective way to increase cultural competence within the confines of medical school curricula.
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Affiliation(s)
| | - Rachel M. Mayo
- Department of Public Health Sciences, Clemson University, Clemson, SC, USA
| | - Khoa D. Truong
- Department of Public Health Sciences, Clemson University, Clemson, SC, USA
| | - Anne P. Pribonic
- Department of Public Health Sciences, Clemson University, Clemson, SC, USA
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Fredericks E, Harbin A, Baker K. Being (in)visible in the clinic: A qualitative study of queer, lesbian, and bisexual women's health care experiences in Eastern Canada. Health Care Women Int 2016; 38:394-408. [PMID: 27428268 DOI: 10.1080/07399332.2016.1213264] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
In this article, we examine the ways in which 18 queer, lesbian, and bisexual (QLB) women in Eastern Canada negotiated their visibility in interactions with primary care providers. QLB women patients used a number of strategies to determine risk and to be visible or invisible to their health care providers. We describe participants' disclosure decisions and strategies, and we argue that being visible and invisible requires work on the part of QLB patients in the context of institutionalized heteronormativity. Conceptualizing (in)visibility as work is required in efforts to account for and improve health care interactions across differences.
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Affiliation(s)
- Erin Fredericks
- a Department of Sociology , St. Thomas University , Fredericton , New Brunswick , Canada
| | - Ami Harbin
- b Departments of Philosophy and Women & Gender Studies , Oakland University , Rochester , Michigan , USA
| | - Kelly Baker
- c Department of Global Studies , Wilfrid Laurier University , Waterloo , Ontario , Canada
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Desrosiers JE, Macpherson SA, Coughlan EP, Dawson NM. Sex, Bugs, and Rock 'n' Roll: A Service-Learning Innovation to Enhance Medical Student Knowledge and Comfort With Sexual Health. MedEdPORTAL 2016; 12:10421. [PMID: 31008201 PMCID: PMC6464422 DOI: 10.15766/mep_2374-8265.10421] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
INTRODUCTION Sexual health is an intrinsic element of overall health; however, opportunities to enhance medical student comfort and knowledge about sexual health vary substantially and receive limited curricular time. Sex, Bugs, and Rock 'n' Roll is a novel service-learning initiative designed to enhance undergraduate medical student knowledge and comfort with sexual health. A total of 80 fifth-year undergraduate medical students researched, designed, and delivered a short sexual health promotion initiative for a population that experiences inequity. METHODS This initiative employed active learning tasks including performing a literature review, participating in team learning, facilitating small-group sessions, and providing peer feedback. Ongoing formative feedback from the program leaders, tutors, and members of the target audience contributed to student development. A summative assessment rubric was used by program leaders to evaluate student performance at the end of the module. Anonymized pre- and posttest knowledge questions and module evaluations were used to evaluate the module. RESULTS All 80 (100%) students completed randomized pre- and posttest knowledge questions and module evaluations. Student knowledge scores about sexuality and sexual health improved by 17% between pre- and posttest. All students reported increased comfort with and understanding of the clinical relevance of sexual health in the module evaluations. DISCUSSION Sex, Bugs, and Rock 'n' Roll is a promising initiative for improving medical student knowledge and comfort with sexual health. This module also offers a novel way for students to experience sexual health, public health, and social accountability in an active and engaging fashion.
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Affiliation(s)
- Jennifer E. Desrosiers
- Lecturer, Department of Population Health, University of Otago, Dunedin, New Zealand
- Corresponding author:
| | - Sean A. Macpherson
- Senior Lecturer, Department of Pathology, University of Otago, Dunedin, New Zealand
- Consultant Hematologist, Department of Pathology, University of Otago, Dunedin, New Zealand
| | - Edward P. Coughlan
- Clinical Director for Sexual Health, Canterbury District Health Board, Christchurch, New Zealand
| | - Ngaere M. Dawson
- Team Facilitator, Business Development Unit, Canterbury District Health Board, Christchurch, New Zealand
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Angoff NR, Duncan L, Roxas N, Hansen H. Power Day: Addressing the Use and Abuse of Power in Medical Training. J Bioeth Inq 2016; 13:203-13. [PMID: 26979827 PMCID: PMC5539994 DOI: 10.1007/s11673-016-9714-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 02/13/2016] [Indexed: 05/20/2023]
Abstract
PROBLEM Medical student mistreatment, as well as patient and staff mistreatment by all levels of medical trainees and faculty, is still prevalent in U.S. clinical training. Largely missing in interventions to reduce mistreatment is acknowledgement of the abuse of power produced by the hierarchical structure in which medicine is practiced. APPROACH Beginning in 2001, Yale School of Medicine has held annual "Power Day" workshops for third year medical students and advanced practice nursing students, to define and analyse power dynamics within the medical hierarchy and hidden curriculum using literature, guest speakers, and small groups. During rotations, medical students write narratives about the use of power witnessed in the wards. In response to student and small group leader feedback, workshop organizers have developed additional activities related to examining and changing the use of power in clinical teams. OUTCOME Emerging narrative themes included the potential impact of small acts and students feeling "mute" and "complicit" in morally distressing situations. Small groups provided safe spaces for advice, support, and professional identity formation. By 2005, students recognized residents that used power positively with Power Day awards and alumni served as keynote speakers on the use of power in medicine. By 2010, departments including OB/GYN, surgery, psychiatry, and paediatrics, had added weekly team Power Hour discussions. NEXT STEPS The authors highlight barriers, benefits, and lessons learned. Barriers include the notion of clinical irrelevance and resistance to the word "power" due to perceived accusation of abuse. Benefits include promoting open dialogue about power, fostering inter-professional collaboration, rewarding positive role modelling by residents and faculty, and creating a network of trainee empowerment and leadership. Furthermore, faculty have started to ask that issues of power be addressed in a more transparent way at their level of the hierarchy as well.
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Affiliation(s)
- Nancy R Angoff
- Office of Student Affairs and Department of Internal Medicine, Yale University School of Medicine, 367 Cedar Street, New Haven, CT, 06510, USA.
| | - Laura Duncan
- University of California, San Francisco (UCSF) School of Medicine, San Francisco, California, USA
| | - Nichole Roxas
- University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Helena Hansen
- Departments of Psychiatry and Anthropology, New York University, New York, New York, USA
- Nathan Kline Institute for Psychiatry Research, Orangeburg, New York, USA
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Zaidi Z, Verstegen D, Naqvi R, Morahan P, Dornan T. Gender, religion, and sociopolitical issues in cross-cultural online education. Adv Health Sci Educ Theory Pract 2016; 21:287-301. [PMID: 26303113 DOI: 10.1007/s10459-015-9631-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 07/27/2015] [Indexed: 06/04/2023]
Abstract
Cross-cultural education is thought to develop critical consciousness of how unequal distributions of power and privilege affect people's health. Learners in different sociopolitical settings can join together in developing critical consciousness-awareness of power and privilege dynamics in society-by means of communication technology. The aim of this research was to define strengths and limitations of existing cross-cultural discussions in generating critical consciousness. The setting was the FAIMER international fellowship program for mid-career interdisciplinary health faculty, whose goal is to foster global advancement of health professions education. Fellows take part in participant-led, online, written, task-focused discussions on topics like professionalism, community health, and leadership. We reflexively identified text that brought sociopolitical topics into the online environment during the years 2011 and 2012 and used a discourse analysis toolset to make our content analysis relevant to critical consciousness. While references to participants' cultures and backgrounds were infrequent, narratives of political-, gender-, religion-, and other culture-related topics did emerge. When participants gave accounts of their experiences and exchanged cross-cultural stories, they were more likely to develop ad hoc networks to support one another in facing those issues than explore issues relating to the development of critical consciousness. We suggest that cross-cultural discussions need to be facilitated actively to transform learners' frames of reference, create critical consciousness, and develop cultural competence. Further research is needed into how to provide a safe environment for such learning and provide faculty development for the skills needed to facilitate these exchanges.
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Affiliation(s)
- Zareen Zaidi
- Division of General Internal Medicine, Department of Medicine, University of Florida, PO Box 100277, Gainesville, FL, 32610-0277, USA.
| | - Daniëlle Verstegen
- Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | | | - Page Morahan
- FAIMER Institute, Drexel University College of Medicine, Philadelphia, PA, USA
| | - Tim Dornan
- Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
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Leigh-Hunt N, Stroud L, Murdoch Eaton D, Rudolf M. A qualitative study of enablers and barriers influencing the incorporation of social accountability values into organisational culture: a perspective from two medical schools. Isr J Health Policy Res 2015; 4:48. [PMID: 26664668 PMCID: PMC4675024 DOI: 10.1186/s13584-015-0044-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 08/29/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Definitions of social accountability describe the obligation of medical schools to direct education, research and service activities towards addressing the priority health concerns of the population they serve. While such statements give some direction as to how the goal might be reached, it does not identify what factors might facilitate or hinder its achievement. This study set out to identify and explore enablers and barriers influencing the incorporation of social accountability values into medical schools. METHODS Semi structured interviews of fourteen senior staff in Bar Ilan and Leeds medical schools were undertaken following a literature review. Participants were recruited by purposive sampling in order to identify factors perceived to play a part in the workings of each institution. RESULTS Academic prestige was seen as a key barrier that was dependent on research priorities and student selection. The role of champions was considered to be vital to tackle staff perceptions and facilitate progress. Including practical community experience for students was felt to be a relevant way in which the curriculum could be designed through engagement with local partners. CONCLUSIONS Successful adoption of social accountability values requires addressing concerns around potential negative impacts on academic prestige and standards. Identifying and supporting credible social accountability champions to disseminate the values throughout research and education departments in medical and other faculties is also necessary, including mapping onto existing work streams and research agendas. Demonstrating the contribution the institution can make to local health improvement and regional development by a consideration of its economic footprint may also be valuable.
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Affiliation(s)
- Nicholas Leigh-Hunt
- />Division of Primary Care and Public Health, Leeds Institute of Health Sciences, Faculty of Medicine and Health, Leeds University, Charles Thackrah Building, 101 Clarendon Road, Leeds, LS2 9LJ UK
| | - Laura Stroud
- />Division of Primary Care and Public Health, Leeds Institute of Health Sciences, Faculty of Medicine and Health, Leeds University, Charles Thackrah Building, 101 Clarendon Road, Leeds, LS2 9LJ UK
| | - Deborah Murdoch Eaton
- />The Medical School, University of Sheffield, Beech Hill Road, Sheffield, S10 2RX UK
| | - Mary Rudolf
- />Faculty of Medicine in the Galilee, Bar Ilan University, Ramat Gan, 5290002 Israel
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Kottorp A, Johansson K, Aase P, Rosenberg L. Housing for ageing LGBTQ people in Sweden: a descriptive study of needs, preferences, and concerns. Scand J Occup Ther 2015; 23:337-46. [DOI: 10.3109/11038128.2015.1115547] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
INTRODUCTION The General Medical Council (GMC) expects that medical students graduate with an awareness of how the diversity of the patient population may affect health outcomes and behaviours. However, little guidance has been provided on how to incorporate diversity teaching into medical school curricula. Research highlights the existence of two different models within medical education: cultural competency and cultural humility. The Southampton medical curriculum includes both models in its diversity teaching, but little was known about which model was dominant or about the students' experience. METHODS Fifteen semi-structured, in-depth interviews were carried out with medical students at the University of Southampton. Data were analysed thematically using elements of grounded theory and constant comparison. RESULTS Students identified early examples of diversity teaching consistent with a cultural humility approach. In later years, the limited diversity teaching recognised by students generally adopted a cultural competency approach. Students tended to perceive diversity as something that creates problems for healthcare professionals due to patients' perceived differences. They also reported witnessing a number of questionable practices related to diversity issues that they felt unable to challenge. The dissonance created by differences in the largely lecture based and the clinical environments left students confused and doubting the value of cultural humility in a clinical context. CONCLUSIONS Staff training on diversity issues is required to encourage institutional buy-in and establish consistent educational and clinical environments. By tackling cultural diversity within the context of patient-centred care, cultural humility, the approach students valued most, would become the default model. Reflective practice and the development of a critical consciousness are crucial in the improvement of cultural diversity training and thus should be facilitated and encouraged. Educators can adopt a bidirectional mode of teaching and work with students to decolonise medical curricula and improve medical practice.
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Barros NFD. O ensino das ciências sociais em saúde: entre o aplicado e o teórico. Ciênc saúde coletiva 2014; 19:1053-63. [DOI: 10.1590/1413-81232014194.15202013] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2013] [Accepted: 08/22/2013] [Indexed: 11/21/2022] Open
Abstract
Os modelos de ensino de ciências sociais e da clínica são insuficientes para as necessidades prático-reflexivas quando aplicados à saúde. O objetivo deste artigo é refletir sobre os desafios e as perspectivas do ensino de ciências sociais para profissionais da saúde. Na década de 1950 iniciou-se o importante movimento de aproximação das ciências sociais com o campo da saúde, no entanto prevalecem relações de fraca credencial, devido: baixo status profissional dos cientistas sociais na área da saúde; localização pouco clara dos profissionais de ciências sociais no campo da saúde; pequena importância atribuída pelos estudantes às ciências sociais; reduzido número de profissionais e a colonização das ciências sociais pela cultura biomédica no campo da saúde. Dessa maneira, aos profissionais das ciências sociais aplicadas à saúde ainda é colocada a necessidade de construir uma identidade, mesmo após seis décadas de presença neste campo, pois sua condição ambivalente os tem fixado como presença parcial, incompleta e virtual, exigindo estratégia complexa de sobrevivência na fronteira entre as ciências sociais e a saúde.
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Zanetti ML, Dinh A, Hunter L, Godkin MA, Ferguson W. A longitudinal study of multicultural curriculum in medical education. Int J Med Educ 2014; 5:37-44. [PMID: 25341210 PMCID: PMC4207173 DOI: 10.5116/ijme.52ec.d075] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Accepted: 02/01/2014] [Indexed: 05/27/2023]
Abstract
OBJECTIVE To evaluate impact a multicultural interclerkship had on students' perception of knowledge, interview skills, and empathy towards serving culturally diverse populations and role student demographics played in learning. METHODS Data extracted from students' self-reported course evaluations and pre/post questionnaires during multiculturalism interclerkship across 11 academic years. Inquired students' opinion about four areas: effectiveness, small group leaders, usefulness, and overall experience. Subscale and item ratings were compared using trend tests including multivariate analyses. RESULTS During studied years, 883 students completed course evaluation with high overall mean rating of 3.08 (SD=0.45) and subscale mean scores ranging from 3.03 to 3.30. Trends in three of four subscales demonstrated clear uptrend (p<0.0001). Positive correlations between ratings of leaders and "usefulness" were observed (p<0.0001). Pre/post matched dataset (n=967) indicated majority of items (19/23) had statistically significant higher post interclerkship ratings compared to pre scores with nine of 19 having statistically significant magnitudes of change. Questionnaire had high overall reliability (Cronbach alpha=0.8), and item-to-group correlations ranged from 0.40 to 0.68 (p<0.0001). CONCLUSIONS By increasing students' exposure and interaction with diverse patients, their knowledge, attitude, and skills were increased and expanded in positive manner. These findings might inform those who are interested in enhancing this important competence. This is especially true given increasing scrutiny this global topic is receiving within and across healthcare professions around the world.
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Affiliation(s)
- Mary L. Zanetti
- Office of Institutional Research, Evaluation and Assessment, University of Massachusetts Medical School, USA
| | - An Dinh
- Office of Institutional Research, Evaluation and Assessment, University of Massachusetts Medical School, USA
| | - Laura Hunter
- Office of Institutional Research, Evaluation and Assessment, University of Massachusetts Medical School, USA
| | - Michael A. Godkin
- Department of Family Medicine and Community Health, University of Massachusetts Medical School, USA
| | - Warren Ferguson
- Department of Family Medicine and Community Health, University of Massachusetts Medical School, USA
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Abstract
Cultural competence has become a ubiquitous and unquestioned aspect of professional formation in medicine. It has been linked to efforts to eliminate race-based health disparities and to train more compassionate and sensitive providers. In this article, I question whether the field of cultural competence lives up to its promise. I argue that it does not because it fails to grapple with the ways that race and racism work in U.S. society today. Unless we change our theoretical apparatus for dealing with diversity to one that more critically engages with the complexities of race, I suggest that unequal treatment and entrenched health disparities will remain. If the field of cultural competence incorporates the lessons of critical race scholarship, however, it would not only need to transform its theoretical foundation, it would also need to change its name.
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Affiliation(s)
- Rebecca J Hester
- Institute for the Medical Humanities, University of Texas Medical Branch, Suite 2.104, Primary Care Pavilion, 301 University Boulevard, Galveston, TX 77555-1311, USA.
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Miller PA, Sinding C, McGillicuddy P, Gould J, Fitzpatrick-Lewis D, Learn L, Wiernikowski J, Fitch MI. Disparities in cancer care: perspectives from the front line. Palliat Support Care 2014; 12:175-81. [PMID: 23659734 DOI: 10.1017/S147895151200106X] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The purpose of this qualitative study was to investigate how frontline healthcare professionals witness and understand disparity in cancer care. METHOD Six healthcare providers from a range of care settings, none with < 15 years of frontline experience, engaged with researchers in an iterative process of identifying and reflecting on equity and disparity in cancer care. This knowledge exchange began with formal interviews. Thematic analysis of the interviews form the basis of this article. RESULTS Participants drew attention to health systems issues, the meaning and experience of discontinuities in care for patients at personal and community levels, and the significance of social supports. Other concerns raised by participants were typical of the literature on healthcare disparities. SIGNIFICANCE OF RESULTS Providers at the front lines of care offer a rich source of insight into the operation of disparities, pointing to mechanisms rarely identified in traditional quantitative studies. They are also well positioned to advocate for more equitable care at the local level.
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Johnson C, Killinger LZ, Christensen MG, Hyland JK, Mrozek JP, Zuker RF, Kizhakkeveettil A, Perle SM, Oyelowo T. Multiple views to address diversity issues: an initial dialog to advance the chiropractic profession. J Chiropr Humanit 2012; 19:1-11. [PMID: 23966884 PMCID: PMC3748330 DOI: 10.1016/j.echu.2012.10.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The purpose of this article is to provide expert viewpoints on the topic of diversity in the chiropractic profession, including cultural competency, diversity in the profession, educational and clinical practice strategies for addressing diversity, and workforce issues. Over the next decades, changing demographics in North America will alter how the chiropractic profession functions on many levels. As the population increases in diversity, we will need to prepare our workforce to meet the needs of future patients and society.
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Affiliation(s)
- Claire Johnson
- Editor, Journal of Chiropractic Humanities
- Professor, National University of Health Sciences, Lombard, IL
| | | | - Mark G. Christensen
- Assistant Executive Vice President, National Board of Chiropractic Examiners, Greeley, CO
| | - John K. Hyland
- Senior Chiropractic Specialist, National Board of Chiropractic Examiners, Greeley, CO
| | - John P. Mrozek
- Dean of Academic Affairs, Texas Chiropractic College, Pasadena, TX
| | - R. Fred Zuker
- Vice President of Enrollment Management, Texas Chiropractic College, Pasadena, TX
| | | | - Stephen M. Perle
- Professor, University of Bridgeport College of Chiropractic, Bridgeport, CT
| | - Tolu Oyelowo
- Chair, Department of Health Promotion and Wellness, Northwestern Health Sciences University, Bloomington, MN
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Mak DB, Miflin B. Living and working with the people of 'the bush': a foundation for rural and remote clinical placements in undergraduate medical education. Med Teach 2012; 34:e603-10. [PMID: 22489973 DOI: 10.3109/0142159x.2012.670326] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
BACKGROUND The Australian Government's policies and programmes to redress the medical workforce shortage in rural and remote areas focus on recruitment of rural students and provision of rural clinical placements. The University of Notre Dame's Rural and Remote Health Placement Programme (RRHPP) uses an additional approach to address this issue. AIM This article describes the RRHPP undertaken by all medical students in the first 2-years of their course and examines the educational worth of this approach. METHOD Data were obtained from curricular documents, publications about the RRHPP and evaluation questionnaires administered to students and supervisors. RESULTS The RRHPP provides students with opportunities to develop a patient- and community-centred perspective on the health issues of rural and remote populations by having them live and work with people in these areas prior to clinical placements. It is based on sound educational principles and underpinned by participation of rural/remote communities as experts and equal teaching partners. The RRHPP is valued and perceived by a majority of students and placement hosts as a useful strategy to develop medical students' understanding of the rural/remote community context and its impact on health. CONCLUSION This community participatory approach benefits medical students and rural/remote communities.
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Affiliation(s)
- Donna B Mak
- School of Medicine, University of Notre Dame, Fremantle, Western Australia, Australia.
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Vivekananda-Schmidt P. Reflection on developing an undergraduate course: the value of an action research approach. Educ Prim Care 2011; 22:152-8. [PMID: 21640004 DOI: 10.1080/14739879.2011.11493990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Busy practitioners may not always act on their critical reflection though critical reflection is key to improving practice. This paper presents action research (AR) as a tool that could help to translate reflection into action which can aid improvement of practice. AIM To critically discuss the development of a medical education course to illustrate the use of AR in enabling reflection on action and improvement to practice in complex educational environments. METHODOLOGY Developmental evaluation cycles were employed in designing and integrating a cultural diversity course for student doctors. RESULTS Iterative cycles of evaluation on the cultural diversity course resulted in: (1) increased student centred activities in the course; (2) recognition and attempts to improve student reflective ability around cultural competency issues; (3) opportunity to monitor own teaching practice and; (4) improvement in practice. However, the model described here fell short of a true AR approach because of limited involvement of stakeholders in all stages of the process. CONCLUSION Future research should investigate AR as a tool for educational change management, postgraduate learning and portfolio documentation.
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MacLeod A. Caring, competence and professional identities in medical education. Adv Health Sci Educ Theory Pract 2011; 16:375-94. [PMID: 21188513 DOI: 10.1007/s10459-010-9269-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2010] [Accepted: 12/13/2010] [Indexed: 05/22/2023]
Abstract
This paper considers the multiple discourses that influence medical education with a focus on the discourses of competence and caring. Discourses of competence are largely constituted through, and related to, biomedical and clinical issues whereas discourses of caring generally focus on social concerns. These discourses are not necessarily equal partners in the enterprise of medical education. Discourses of competence tend to be privileged while those discourses of caring are often marginalised. Medical students learn to be physicians, and develop professional identities, in the context of these competing discourses. This paper documents a qualitative study designed to explore how professional identities are developed in the context of competing discourses. The study included a Foucauldian discourse analysis of medical education curriculum documents (67 problem-based learning cases in total), 26 h of observation of a small group learning experience (a problem-based learning tutorial), and in-depth, open-ended interviews with five medical students and nine medical educators at a Canadian medical school. The paper describes how professional identities are developed in relation to discourses of competence, noting that students displayed what they considered to be desirable professional identities of confidence, capability and suitability. Also explored are the professional identities demonstrated in relation to discourses of caring, including those of benevolence and humbleness. Despite current conceptualisations, medical education is ripe with potential. The data indicate Foucauldian "spaces of freedom"-sites at which the complexity of the practice of medicine and the interwoven natures of the discourses of competence and caring might be taken into account as a means of challenging taken for granted cultural norms and broadening the medical gaze.
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Affiliation(s)
- Anna MacLeod
- Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
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Butler PD, Swift M, Kothari S, Nazeeri-Simmons I, Friel CM, Longaker MT, Britt LD. Integrating cultural competency and humility training into clinical clerkships: surgery as a model. J Surg Educ 2011; 68:222-230. [PMID: 21481809 DOI: 10.1016/j.jsurg.2011.01.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2010] [Revised: 01/10/2011] [Accepted: 01/20/2011] [Indexed: 05/30/2023]
Abstract
BACKGROUND Cultural competency is gaining recognition as an essential strategy by which to address health care disparities. A closer examination of medical school curriculums was undertaken to determine how the need for cultural competency and humility (CCH) training in medical education is being addressed. METHODS A MEDLINE review of published literature regarding CCH training in medical education was performed. Additionally, key informant interviews with influential faculty members from prominent medical institutions were completed. RESULTS Many academic medical institutions recognize the need for CCH and have successfully integrated it into the first 2 years of their curriculums. However, there seems to be a uniform deficit in CCH training in the third and fourth years of their education. CONCLUSIONS Recognizing the need for CCH training during the third and fourth years of medical education, we explored the issues inherent to the integration of CCH training in clinical education. Using surgery as a model, we established a set of recommendations to assist clerkship directors and curriculum committees in their efforts to ensure CCH training in the last 2 years of medical education.
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Affiliation(s)
- Paris D Butler
- Department of Surgery, University of Virginia School of Medicine, Charlottesville, Virginia 22908-0300, USA.
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Abstract
BACKGROUND Cross-cultural undergraduate medical education in North America lacks conceptual clarity. Consequently, school curricula are unsystematic, nonuniform, and fragmented. This article provides a literature review about available conceptual models of cross-cultural medical education. The clarification of these models may inform the development of effective educational programs to enable students to provide better quality care to patients from diverse sociocultural backgrounds. SUMMARY The approaches to cross-cultural health education can be organized under the rubric of two specific conceptual models: cultural competence and critical culturalism. The variation in the conception of culture adopted in these two models results in differences in all curricular components: learning outcomes, content, educational strategies, teaching methods, student assessment, and program evaluation. CONCLUSIONS Medical schools could benefit from more theoretical guidance on the learning outcomes, content, and educational strategies provided to them by governing and licensing bodies. More student assessments and program evaluations are needed in order to appraise the effectiveness of cross-cultural undergraduate medical education.
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Affiliation(s)
- Sylvia Reitmanova
- Division of Community Health and Humanities, Memorial University of Newfoundland, St. John's, NL, Canada.
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