Enhancing cultural competence in medical education

Cultural Competence Interventions in European Healthcare: A Scoping Review

Europe is undergoing rapid social change and is distinguished by its cultural superdiversity. Healthcare is facing an increasing need for professionals to adapt to this environment. Thus, the promotion of cultural competence in healthcare has become a priority. However, the training being developed and their suitability for the European context are not well known. The aim of this qualitative study has been to map the scientific literature in order to comprehend the current state of research on this topic. For this purpose, we conducted a systematic scoping review of the empirical publications focused on cultural competence interventions for healthcare professionals in European countries. The search was conducted in eight thematic (PsycINFO, MedLine, and PubPsych) and multidisciplinary databases (Academic Search Ultimate, E-Journals, Scopus, ProQuest, and Web of Science) to identify relevant publications up to 2023. Results were presented qualitatively. Out of the initial 6506 records screened, a total of 63 publications were included. Although the interventions were implemented in 23 different European countries, cultural competence interventions have not been widely adopted in Europe. Significant heterogeneity was observed in the conception and operacionalización of cultural competence models and in the implementation of the interventions. The interventions have mostly aimed at improving healthcare for minority population groups and have focused on the racial and ethnic dimensions of the individual. Future research is needed to contribute to the conceptual development of cultural competence to design programs tailored to European superdiversity. This scoping review has been registered in OSF and is available for consultation.

Spotlight on El-Zahrawi, Father of Modern Surgery: Reflections on His Impact on Contemporary Medicine and the Need for Greater Medical Education on Pivotal Figures in Medicine

Issue: For students in the preclinical years of medical school, it is easy to overlook the narrative component of medicine and become occupied with learning the vast sea of information about the human body. There are limited, if any, options to learn about historical figures in medicine and how they can inform our future in clinical medicine. Evidence: There is an apparent lack of education offered on pivotal figures in medicine across many institutions. The few instances that medical history has been incorporated into the curriculum are further discussed. Implications: In order to incorporate cultural competency in our delivery of care, it is important to consider the diversity of the population we will be serving and how we can prepare to help patients feel heard in their unique issues. In this paper, we propose learning about the true history of certain medical practices, rather than the "colonial" version often utilized in textbooks and lectures, as a means of diversifying students' perspectives of the origins of these practices as well as giving credit where it is due. The time period during which many of these medical practices were cultivated is referred to as the Islamic Golden Age, but scholars who made contributions belonged to many different faiths and cultural backgrounds. El-Zahrawi was a Muslim physician whose principal work, Kitab-at-Tasrif, contains topics on medicine, surgery, midwifery, pharmacology, therapeutics, diet, psychotherapy, and medical chemistry. He pioneered numerous techniques in surgery and invented surgical devices that are still used to this day.

Tackling discrimination in medicine head on: The impact of bystander intervention training

PURPOSE

A mixed-methods study to evaluate Bystander Intervention Training (BiT), a simulation-based small-group training programme designed to teach skills to tackle discrimination.

MATERIALS AND METHODS

Norwich Medical School delivered the intervention online between January 2020 and June 2023 to medical students, physician associate trainees, and qualified doctors. A sample of 569 participants was used in the main analysis. Participants completed pre- and post-training and follow-up evaluations.

RESULTS

Paired post-training scores were significantly different (all p < 0.001) from the pre-training scores for all 12 questions, in favour of the post-training scores. Of the 159 participants who completed follow-up questionnaires, 27 (17.9%) reported having the opportunity to be an active bystander; of those, 23 (85%) intervened. Scores in the follow-up questionnaire were significantly higher than those in the pre-training survey and significantly lower than those in the post-training questionnaire (p < 0.001). Participants had an increased sense of responsibility to be an active bystander and were empowered to challenge discrimination. Participants from marginalised groups expressed positive views about the training.

CONCLUSIONS

Interventions that allow open discussion and carefully supported personal disclosure in safe spaces, where difficult and uncomfortable discussions can occur, with an opportunity to change behaviour, must be developed to tackle discrimination.

Indigenizing and co-producing the ACGME anesthesiology milestone in Taiwan: a Delphi study and subgroup analysis

BACKGROUND

To implement the ACGME Anesthesiology Milestone Project in a non-North American context, a process of indigenization is essential. In this study, we aim to explore the differences in perspective toward the anesthesiology competencies among residents and junior and senior visiting staff members and co-produce a preliminary framework for the following nation-wide survey in Taiwan.

METHODS

The expert committee translation and Delphi technique were adopted to co-construct an indigenized draft of milestones. Descriptive analysis, chi-square testing, Pearson correlation testing, and repeated-measures analysis of variance in the general linear model were employed to calculate the F values and mean differences (MDs).

RESULTS

The translation committee included three experts and the consensus panel recruited 37 participants from four hospitals in Taiwan: 9 residents, 13 junior visiting staff members (JVSs), and 15 senior visiting staff members (SVSs). The consensus on the content of the 285 milestones was achieved after 271 minor and 6 major modifications in 3 rounds of the Delphi survey. Moreover, JVSs were more concerned regarding patient care than were both residents (MD = - 0.095, P < 0.001) and SVSs (MD = 0.075, P < 0.001). Residents were more concerned regarding practice-based learning improvement than were JVSs (MD = 0.081; P < 0.01); they also acknowledged professionalism more than JVSs (MD = 0.072; P < 0.05) and SVSs (MD = 0.12; P < 0.01). Finally, SVSs graded interpersonal and communication skills lower than both residents (MD = 0.068; P < 0.05) and JVSs (MD = 0.065; P < 0.05) did.

CONCLUSIONS

Most ACGME anesthesiology milestones are applicable and feasible in Taiwan. Incorporating residents' perspectives may bring insight and facilitate shared understanding to a new educational implementation. This study helped Taiwan generate a well-informed and indigenized draft of a competency-based framework for the following nation-wide Delphi survey.

Educating correct ECG interpretation is a way to promote the satisfaction and competency the diagnostic service providers

Background

Given electrocardiogram (ECG) interpretation as one of the diagnostical challenges for medical students and health professionals, this research was carried out to present an experience of web-based teaching method and novel approaches used for training of ECG interpretation.

Methods

This online program was conducted in three days. The main content of the class was taught during one hour, and after that, the teacher spent enough time for responding the asked questions. The components of a normal ECG and different changes that can occur in these waves were taught through clinical case-based scenarios using the web platform and Adobe Connect software. The participants' satisfaction was assessed with a 12-item questionnaire, and the short-term retention of ECG interpretation skill was examined by comparing the posttest scores with pretest.

Results

A total of 224 individuals completed the course. Total satisfaction score was 53.05±6.98 (out of the maximum score of 60). Based on the results of the paired t test, the interpretation skill scores of the participants increased significantly from 2.5 ± 1.57 to 6.96 ± 1.89. (p<0.001, CI = -4.8 to- 4.11).

Conclusion

This web-based nationwide training program provided a supplementary resource for ECG learning among medical students and health-care providers.

Beliefs and Intentions of Anesthesia Physicians Toward Providing Culturally Competent Care to Transgender Patients

Purpose

Anesthesiologists have limited relationships with their patients before delivering care and have little time for patient interactions. Yet, they should possess the knowledge and skills to treat all patients in an equitable, culturally competent manner, including transgender patients. The study's purpose was to determine behavioral factors influencing culturally competent care by anesthesia physicians with transgender patients.

Methods

A two-phase design was utilized in 2020 to examine the attitudes, subjective norms, and perceived behavioral control of anesthesia physicians, both in training and practicing independently. Phase 1 allowed exploration of themes related to facilitators and barriers of the provision of culturally competent care to transgender patients. Phase 2 involved the creation and deployment of a 51-question survey informed by phase 1 to 100 anesthesia physicians at a single academic medical center in the southeastern United States.

Results

Thematic analysis was performed on results from the phase 1 elicitation survey, which informed the creation of the survey for phase 2. One hundred phase 2 surveys were distributed, with a 70% response rate. Analyses were conducted to determine the largest influence of intent to interact with transgender patients in a culturally competent manner, as well as to establish the reliability of the tool.

Conclusion

Attitude followed by subjective norms were positive influencers of intent, while lack of knowledge was a negative influencer. Strengthening attitudes and subjective norms, while implementing programs to increase knowledge, competence, and humility, would be goals for future studies and actions toward improving healthcare of transgender individuals.

Academic pharmacist competencies in ordinary and emergency situations: content validation and pilot description in Lebanese academia

BACKGROUND

In the absence of a similar study in the Lebanese context, this study aimed to validate the content of the specialized competencies frameworks of academic pharmacists (educators, researchers, and clinical preceptors) and pilot their use for practice assessment in the context of multiple severe crises.

METHODS

A web-based cross-sectional study was conducted between March and September 2022 among academic pharmacists enrolled by snowball sampling using a questionnaire created on Google Forms.

RESULTS

The suggested frameworks had appropriate content to assess the competencies of academic pharmacists. Educators and clinical preceptors were confident in all their competencies except for emergency preparedness. Researchers had varying levels of confidence, ranging from moderate to high confidence for many competencies, but gaps were reported in fundamental research, conducting clinical trials, and pharmacy practice research (mean < 80). Educators and researchers relied primarily on experience and postgraduate studies, while clinical preceptors emphasized undergraduate studies to acquire their respective competencies. Continuing education sessions/programs were the least cited as a competency-acquiring venue across all roles.

CONCLUSION

This study could develop and validate the content of frameworks for specialized competencies of academic pharmacists, including educators, researchers, and clinical preceptors, in a challenging setting. The frameworks were also piloted for practice assessment, which could contribute to supporting effective performance and sustained development of practitioners and help link the skills and competencies pharmacists learn during their studies with those required for a career in academia.

Diversity competence training for health professionals in Europe: a modified delphi study investigating relevant content for short or online courses

BACKGROUND

Diversity is a reality in our societies, requiring health professionals to adapt to the unique needs of all patients, including migrants and ethnic minorities. In order to enable health professionals to meet related challenges and reduce health disparities, long and demanding training courses have been developed. But due to busy schedules of professionals and often scarce resources, a need for shorter training courses exists. This study aims to investigate which topics and methods should be prioritised in designing basic diversity training courses that provide health professionals the opportunity to foster this competence.

METHODS

The study provided an expert panel of 31 academic and clinical migrant health experts with the content and methods of an existing diversity training course. The panel was asked to prioritise training topics and teaching methods in a two-stage process, using an adapted Delphi method. In the first stage, experts rated 96 predefined items, commented on those items, provided answers to eight open-ended questions and suggested additional content for a short course. In the second stage, they commented on the ratings from Round 1, and rated new suggested content. Consensus for training topics was set to 80% and for teaching methods 70%.

RESULTS

The entire panel deemed 'health effects of migration (pre-, during- and post-migration risk factors)' to be important or very important to include in a short/online, basic diversity training (100% consensus). Other high-scoring items and therefore topics to be included in trainings were 'social determinants of health' (97%) and 'discrimination within the healthcare sector' (also 97%). A general trend was to focus on reflective practice since almost all items regarding reflection reached consensus. 'Reflection on own stereotypes and prejudices' (97%) was the highest-rated reflection item. 'Opportunities and best practices in working with interpreters' was the highest-scoring skills item, both on consensus (96%) and mean value (5.77).

CONCLUSIONS

Experts' prioritizations of teaching content and methods for diversity training can help the design of short (online) trainings for health professionals and reduce unnecessary course content, thereby fostering professional development and enabling diversity competence trainings to be implemented also when time and/or financial resources are limited.

Education on medically unexplained symptoms: a systematic review with a focus on cultural diversity and migrants

BACKGROUND

Health care providers often struggle with the management of patients with medically unexplained symptoms (MUS), especially in case of a different ethnicity and/or cultural background. These challenges are insufficiently addressed in their training.

OBJECTIVES

A systematic review on education in the field of MUS in a diverse context to improve MUS healthcare provider-patient interaction focused on intercultural communication.

METHODS

Screening of PubMed, Web of Science, Cinahl and Cochrane Library on the keywords 'Medical unexplained (physical) symptoms (MUS)', 'Somatoform disorder', 'Functional syndrome', 'Diversity', 'Migrants', 'Ethnicity', 'Care models', 'Medical education', 'Communication skills', 'Health literacy'.

RESULTS

MUS patients, especially with a different ethnic background, often feel not understood or neglected. Health care providers experience feelings of helplessness, which may provoke medical shopping and resource consumption. Attitudes and perceptions from undergraduate trainees to senior physicians tend to be negative, impacting on the quality of the patient/health care provider relationship and subsequently on health outcomes, patient satisfaction and therapeutic adherence. Current undergraduate, graduate and postgraduate education and training does not prepare health care providers for diagnosing and managing MUS patients in a diverse context. A continuum of training is necessary to achieve a long term and lasting change in attitudes towards these patients and trainers play a key role in this process. Hence, education should pay attention to MUS, requiring a specific competency profile and training, taken into account the variety in patients' cultural backgrounds.

CONCLUSIONS

This systematic review identified significant gaps and shortcomings in education on MUS in a diverse context. These need to be addressed to improve outcomes.

Validation of the Clinicians' Cultural Sensitivity Survey for Use in Pedatric Primary Care Settings

Incorporating cultural sensitivity into healthcare settings is important to deliver high-quality and equitable care, particularly for marginalized communities who are non-White, non-English speaking, or immigrants. The Clinicians' Cultural Sensitivity Survey (CCSS) was developed as a patient-reported survey assessing clinicians' recognition of cultural factors affecting care quality for older Latino patients; however, this instrument has not been adapted for use in pediatric primary care. Our objective was to examine the validity and reliability of a modified CCSS that was adapted for use with parents of pediatric patients. A convenience sampling approach was used to identify eligible parents during well-child visits at an urban pediatric primary care clinic. Parents were administered the CCSS via electronic tablet in a private location. We first conducted exploratory factor analyses (EFAs) to explore the dimensionality of survey responses in the adapted CCSS, and then conducted a series of confirmatory factor analyses (CFAs) using maximum likelihood estimation based on the results of the EFAs. Exploratory and confirmatory factor analyses (N = 212 parent surveys) supported a three-factor structure assessing racial discrimination ([Formula: see text]=0.96), culturally-affirming practices ([Formula: see text]=0.86), and causal attribution of health problems ([Formula: see text]=0.85). In CFAs, the three-factor model also outperformed other potential factor structures in terms of fit statistics including scaled root mean square error approximation (0.098), Tucker-Lewis Index (0.936), Comparative Fit Index (0.950), and demonstrated adequate fit according to the standardized root mean square residual (0.061). Our findings support the internal consistency, reliability, and construct validity of the adapted CCSS for use in a pediatric population.

Cultural Competence Is Everyone's Business: Embedding Cultural Competence in Curriculum Frameworks to Advance Veterinary Education

Cultural competence in professional and research practice is important to effectively deliver animal and One Health services and programs. Veterinarians work with culturally and linguistically diverse teams, clients, and communities. Cultural perspectives on the significance and perceptions of animals and differences in consultation and engagement protocols and strategies can influence client-practitioner and researcher-community relationships, impacting animal health, welfare, and/or research outcomes. Curricula have been proposed to build cultural capacity in graduates, but these have not been reported in veterinary programs, and early attempts to integrate cultural competency into the University of Sydney veterinary curriculum lacked a formal structure and were ad hoc with respect to implementation. To address this, the authors introduced a broad curriculum framework into the University of Sydney veterinary program, which defines cultural competence, perceptions of animals, effective communication, and community engagement in a range of contexts. Cultural competency learning outcomes were described for units of study. These were contextually relevant and aligned to course learning outcomes and University of Sydney graduate qualities. Constructive alignment was achieved by linking learning outcomes to teaching and learning activities and assessment. The continuum of cultural competency underpinned mapping of cultural competency across the curriculum with staged, vertical integration of key principles. Additionally, action to engage staff, students, and stakeholders in a cultural competence agenda assisted in sustaining curriculum change. The result was integration of cultural competency across the curriculum aligning with recommendations from accrediting bodies and with best practice models in medicine, nursing, and allied health programs.

Why are so many indigenous Pando people dying? Using observations from Chhattisgarh, India, to conduct structural assessment and identify solutions

Health challenges of communities are often assessed using biomedical or individual risk-based frameworks which are often inadequate for understanding their full extent. We use observations from the global South to demonstrate the usefulness of structural assessment to evaluate a public health problem and spur action. Following newspaper reports of excessive deaths in the marginalised indigenous or Adivasi community of the Pando people in Northern Chhattisgarh in central India, we were asked by the state government's public health authorities to identify root causes of these deaths. In this rapidly evolving situation, we used a combination of public health, social medicine, and structural vulnerability frameworks to conduct biomedical investigation, social inquiry, and structural assessment. After biomedical investigations, we identified scrub typhus, a neglected tropical disease, as the most likely cause for some of the deaths which was unrecognised by the treating physicians. In the social inquiry, the community members identified the lack of Adivasi status certificates, education, and jobs as the three major social factors leading to these deaths. During the structural assessment of these deaths, we inductively identified the following ten structures- political, administrative, legal, economic, social, cultural, material, technical, biological, and environmental. We recommended improving the diagnosis and treatment of scrub typhus, making the hospitals more friendly for Adivasi people, and tracking the health status of the Adivasi communities as some of the measures. We suggest that a combination of biomedical, social,and structural assessments can be used to comprehensively evaluate a complex public health problem to spur action..

How school life with international students develops the intercultural competence of domestic dental students

INTRODUCTION

Reflecting multicultural society, the diversity of the healthcare professional students' ethnicities and cultures is promoted around the world. However, most of the healthcare professional education in Japan had been targeted mainly at students who follow the Japanese language and culture. The aim of this study is to clarify what Japanese dental students have culturally experienced and how they developed intercultural competence during their school life with international dental students in Japan.

MATERIALS AND METHODS

We conducted semi-structured interviews with 18 of the sixth-grade students in standard Japanese undergraduate dental programmes who shared required classes in Japan with non-Japanese-speaking international dental students in preclinical programmes. Based on the qualitative analysis of the interviews, we administered a questionnaire survey to 82 dental trainees (the seventh grade) in clinical training programmes who just graduated from various Japanese dental schools. Then, the answers of the questionnaire were statically analysed.

RESULTS

The interview identified a total of 37 constituent elements regarding "students' attitudes and experiences in school days" and "perceptions and motivations." Analysis of the questionnaire showed that the group experiencing a learning environment with international students had various communication with and respect for their various classmates and had the ambition to develop themselves. Especially, the participants who had international experiences both in and out of classrooms showed more active attitude on intercultural communication.

CONCLUSIONS

Overall, for Japanese dental students, daily contact with international students gave direct and indirect cross-cultural experiences and recognitions. In particular, the Japanese students were stimulated active perceptions. The findings of this study can be used for future discussion about the cross-cultural education and collaboration of healthcare professionals not only within Japan but also around the world.

Promoting cultural competency and osteopathic medicine awareness among premedical students through a summer premedical rural enrichment program

CONTEXT

Premedical preparatory programs at osteopathic medical schools that recruit students from medically underserved areas (MUAs) may promote interest in practicing osteopathic medicine in underserved or rural areas. In these programs, emphasis on cultural competency may increase diversity among medical school applicants and decrease healthcare disparities in the future.

OBJECTIVES

The goal of this study is to determine whether a summer premedical rural enrichment program (PREP) held at an osteopathic medical school located in a MUA will foster greater prioritization of cultural competency in medicine, enhance interest in practicing in rural or underserved areas, and increase familiarity with osteopathic medicine.

METHODS

An eight-week summer PREP was hosted at the California Health Sciences University College of Osteopathic Medicine (CHSU-COM) in Clovis, California. Seventy-eight diverse participants were recruited from the Central Valley, an underserved region of California. Attendees were required to finish the formal application process and were recommended to have completed medical school prerequisite courses. The curriculum included Medical College Admission Test (MCAT) preparation through team-based learning sessions, introduction to the osteopathic medical school curriculum, osteopathic philosophy, and osteopathic manipulative medicine, as well as integrated anatomy and physiology sessions, medical school application workshops, mock interviews, simulation workshops, and sociology and cultural competency sessions. Data were collected via a voluntary and anonymous survey administered before and after the program with questions about familiarity with osteopathy, interest in practicing in underserved areas, medical school preparedness, and a post-course survey about cultural competency. The surveys had students rate statements on a Likert scale.

RESULTS

Seventy-four of the 78 premedical students (95%) completed the pre-and postsurvey. There was a significant increase in agreement to statements evaluating medical school preparedness, osteopathic familiarity, and desire to practice medicine locally in the postprogram survey, compared to the preprogram survey. In the cultural competency postsurvey, 75.0% of the responses to questions that evaluated the positive effect of the course were "Agree" or "Strongly Agree." Of the reported postcourse outcomes, the average MCAT score was 504 ± 6.2 (38 students reported, 50.7%). Of the 27 participants who reported matriculation, 16 (59.2%) were admitted to osteopathic medical schools, 9 (33.3%) to allopathic medical schools, and 2 to other health programs.

CONCLUSIONS

After completing the PREP program, premedical participants reported that they have better understanding of cultural competency and improvement in preparation for medical school, including familiarity with osteopathic medicine, and interest in serving MUAs. These findings indicate that similar programs may have a positive impact on MUAs. These programs may help create diverse and culturally competent osteopathic physicians.

A discourse analysis of General Medical Council (GMC) guidelines for the inclusion of cultural diversity issues in medical education and practice

BACKGROUND

Several studies have highlighted the insufficient inclusion of cultural diversity in medical schools' curricula and the extent of health inequalities highlighted by the COVID-19 pandemic. This study aimed to critically review a range of GMC publications to identify the inclusion of cultural diversity topics in their guidelines, as according to recent studies, doctors are inadequately prepared to serve a diverse population.

METHODS

Twenty-four relevant GMC publications were analysed. An inductive thematic analysis was conducted to review the content of the guidelines; and discourse analysis was used to critically understand the linguistics used whilst also considering the cultural and social context.

RESULTS

The GMC publications primarily focused on discouraging discrimination and promoting equality. Themes around diversity in medical practice were less commonly covered. There was considerable internal inconsistency across the guidelines. Guidelines aimed at medical schools and medical students were more likely to consider cultural diversity issues compared to those intended for doctors.

CONCLUSIONS

Cultural diversity teaching can only be as effective as the policy that drives it. Despite the inclusion of cultural diversity issues in GMC guidelines, this study suggests considerable ambiguity in how these issues are represented and understood. The guidelines require careful revision and should be written to reduce the likelihood of variable interpretation, thereby promoting better cultural diversity inclusion in medical schools' curricula, and consequently better patient care.

COVID-19 vaccine: A 2021 analysis of perceptions on vaccine safety and promise in a U.S. sample

BACKGROUND

Despite reliable evidence-based research supporting the COVID-19 vaccines, population-wide confidence and trust remain limited. We sought to expand prior knowledge about COVID-19 vaccine perceptions, while determining which population groups are at greatest risk for not getting a vaccine.

METHODS

Study participants in the U.S. (79% female, median age group 46-60 years) were recruited through an online Qualtrics survey distributed as a Facebook advertisement from 3/19/21-4/30/21. We assumed that every participant is at risk of COVID-19 infection and should be able to get the vaccine with proper access. Bivariate and multivariable models were performed. Collinearity between variables was assessed.

RESULTS

A total of 2,626 responses were generated and 2,259 were included in data analysis. According to our multivariate model analysis, vaccines were perceived as safe by those who had or planned to obtain full vaccination (adjusted odds ratio (aOR) (95% confidence interval) = 40.0 (19.0, 84.2); p< 0.0001) and those who indicated trust in science (aOR = 10.5 (5.1, 21.8); p< 0.0001); vaccines were perceived as not safe by those who self-identified as Republicans vs. self-identified Democrats (aOR = 0.2 (0.1, 0.5); p = 0.0020) and those with high school or lower education (aOR = 0.2 (0.1, 0.4); p = 0.0007). Similarly, according to our multivariate model analysis, the following groups were most likely to reject vaccination based on belief in vaccinations: those with lower income (aOR = 0.8 (0.6, 0.9); p = 0.0106), those who do not know anyone who had been vaccinated (aOR = 0.1 (0.1, 0.4); p< 0.0001), those who are unwilling to get vaccinated even if family and friends had done so (aOR = 0.1 (<0.1, 0.2); p< 0.0001), those who did not trust science (aOR < 0.1 (<0.1, 0.1); p< 0.0001), those who believe that vaccination was unnecessary if others had already been vaccinated (aOR = 2.8 (1.5, 5.1); p = 0.0007), and those who indicate refusal to vaccinate to help others (aOR = 0.1 (0.1, 0.2); p< 0.0001). An alpha of p<0.05 was used for all tests.

CONCLUSION

Level of education and partisanship, but not race/ethnicity, were the most likely factors associated with vaccine hesitancy or likelihood to vaccinate. Also, low vaccination rates among underrepresented minorities may be due to distrust for healthcare industries. Population sub-groups less likely to be vaccinated and/or receptive to vaccines should be targeted for vaccine education and incentives.

Organisational and staff-related effects on cultural competence in the hospital setting: a cross-sectional online survey of nursing and medical staff

Background

Cultural competence is considered a core qualification for dealing with socio-cultural diversity and balancing disparities in health care.

Objectives

To explore features supporting and inhibiting cultural competence in the hospital at both organisational and staff levels.

Design

Cross-sectional online survey in the form of a full census from May to November 2018.

Setting

Two organisations that run a total of 22 hospitals in Germany.

Participants

Eight hundred nursing and medical professionals [nurses: n = 557; doctors: n = 243].

Methods

Using the Short Form Cultural Intelligence SCALE (SFCQ), cultural competence was measured and its relation to potential influencing factors at staff level and organisational level examined, using bivariate (t-Test, one-way ANOVA, Pearson and Spearman correlations) and multivariate (multiple linear regression) approaches. Model 1 examined features at organisational level, Model 2 at individual level and Model 3 included organisational and individual features.

Results

The mean cultural competence measured was 3.49 [min.: 1.3; max.: 5.0]. In the bivariate and isolated multivariate models [Models 1 and 2], factors on both organisational and individual levels were significantly related to the hospital staff’s cultural competence. The multivariate overview [Model 3], however, revealed that individual features at staff level were the statistically relevant predictors. Positive influencing features included staff’s assessment of the importance of cultural competence in their professional context [B: 0.368, 95% confidence interval 0.307; 0.429], participation in competence training [B: 0.193; 95% confidence interval 0.112; 0.276] and having a migration background [B: 0.175; 95% confidence interval 0.074; 0.278], while negative features included length of medical service [B: -0.004; 95% confidence interval -0.007; -0.001].

Conclusions

The development and practice of cultural competence appear to be determined less by organisational features and more on the level of individual actors. In addition to staff development, adequate organisational structures and an economic incentive system are required to promote sociocultural diversity in hospitals.

Medical educators' experiences on medically unexplained symptoms and intercultural communication-an expert focus group study

BACKGROUND

Medically unexplained symptoms (MUS) are highly prevalent and remain challenging in healthcare and medical education, along with the increase in the importance of intercultural issues regarding MUS. However, less is known about the challenges of professionally addressing patients with MUS in the interprofessional and intercultural contexts. Thus, the present study aims to provide the first exploration of the experiences of medical specialists regarding treating MUS in intercultural contexts and inputs for training development on the intercultural aspects of MUS.

METHODS

Three focus groups (total n = 13) consisting of medical specialists from a Hungarian university who were teaching at the medical faculty in intercultural settings and also worked for the university health services were interviewed. The topics covered the participants' personal experiences on addressing MUS and the challenges of intercultural communication and the intercultural educational context. Thematic analysis was used to yield a qualitative account of the interviews as guided by the research questions.

RESULTS

Representing the different aspects of medical specialists, the study identified three main themes in the experiences of medical specialists, namely, 1) the need to adapt to the personal world of patients and search for common frames to understand MUS, 2) the need to discover methods for adapting to cultural differences and 3) the need to enhance the interprofessional coordination of knowledge and practices.

CONCLUSIONS

The results are in line with the distinct conclusions of previous studies. Moreover, an integrated educational program on the intercultural aspects of MUS may address the main themes separately and, subsequently, support their integration. Therefore, the study discusses the manner in which an integrated educational program on the intercultural aspects of MUS may address the needs recognized in these aspects.

From the World to Western: A Community-Engaged Teaching Strategy to Enhance Students' Learning of Cultural Issues Relevant to Healthcare

Using the transformational learning theory and action research method, this study captured the experiences of students from health-related disciplines in the cultural immersion program From the World to Western. A total of nine students participated in the pilot program with four host families from Culturally and Linguistically Diverse (CALD) backgrounds, and four cultural facilitators who connected the host families and students. The findings of this research showed that it was beneficial for students in health-related disciplines to engage in the cultural immersion program to further prepare them for culturally competent care in their future roles as healthcare professionals. In addition, the students indicated the need for the cultural immersion program to be part of the curriculum for future students to develop cultural skills, awareness and encounters with diverse populations.

Social and ethnic group differences in healthcare use by children aged 0-14 years: a population-based cohort study in England from 2007 to 2017

OBJECTIVE

To describe social and ethnic group differences in children's use of healthcare services in England, from 2007 to 2017.

DESIGN

Population-based retrospective cohort study.

SETTING/PATIENTS

We performed individual-level linkage of electronic health records from general practices and hospitals in England by creating an open cohort linking data from the Clinical Practice Research Datalink and Hospital Episode Statistics. 1 484 455 children aged 0-14 years were assigned to five composite ethnic groups and five ordered groups based on postcode mapped to index of multiple deprivation.

MAIN OUTCOME MEASURES

Age-standardised annual general practitioner (GP) consultation, outpatient attendance, emergency department (ED) visit and emergency and elective hospital admission rates per 1000 child-years.

RESULTS

In 2016/2017, children from the most deprived group had fewer GP consultations (1765 vs 1854 per 1000 child-years) and outpatient attendances than children in the least deprived group (705 vs 741 per 1000 child-years). At the end of the study period, children from the most deprived group had more ED visits (447 vs 314 per 1000 child-years) and emergency admissions (100 vs 76 per 1000 child-years) than children from the least deprived group.In 2016/2017, children from black and Asian ethnic groups had more GP consultations than children from white ethnic groups (1961 and 2397 vs 1824 per 1000 child-years, respectively). However, outpatient attendances were lower in children from black ethnic groups than in children from white ethnic groups (732 vs 809 per 1000 child-years). By 2016/2017, there were no differences in outpatient, ED and in-patient activity between children from white and Asian ethnic groups.

CONCLUSIONS

Between 2007 and 2017, children living in more deprived areas of England made greater use of emergency services and received less scheduled care than children from affluent neighbourhoods. Children from Asian and black ethnic groups continued to consult GPs more frequently than children from white ethnic groups, though black children had significantly lower outpatient attendance rates than white children across the study period. Our findings suggest substantial levels of unmet need among children living in socioeconomically disadvantaged areas. Further work is needed to determine if healthcare utilisation among children from Asian and black ethnic groups is proportionate to need.

Epidemiology and organisation of care in medically unexplained symptoms: A systematic review with a focus on cultural diversity and migrants

BACKGROUND

Since the pathophysiology of medically unexplained symptoms (MUS) remains unclear, healthcare providers often struggle with these patients, especially with a different ethnic and/or cultural background. These challenges are insufficiently addressed in their training and in the organisation of care.

AIM

To improve healthcare provider-patient interaction focused on MUS patients in general and in ethnic minorities and refugees in particular through a systematic review of syndromal definitions and epidemiology and organisation of care of MUS patients.

METHODS

Screening of PubMed, Web of Science, Cinahl and Cochrane Library on the keywords 'Medical unexplained (physical) symptoms (MUPS)', 'Somatoform disorder', 'Functional syndrome', 'Diversity', 'Migrants', 'Ethnicity', 'Care models', 'Medical education', 'Communication skills', 'Health literacy'.

RESULTS

Different case definitions result in markedly different epidemiological estimates for MUS patients. Nevertheless, they are prevalent in a wide range of healthcare settings. Literature offers evidence of the effectiveness of structural frameworks in approaching MUS patients. Organisation of MUS care needs to transcend different levels of care: specialist tertiary and secondary care and primary care involving different qualifications of caregivers need to be aligned.

CONCLUSION

The systematic review identified significant gaps and shortcomings in organisation of care. These need to be addressed in order to improve outcomes.

Systematic development of a training program for healthcare professionals to improve communication about breast cancer genetic counseling with low health literate patients

There is a disproportionate underuse of genetic testing in breast cancer patients from lower education or migrant background. Within these groups, communication about referral to genetic counseling appears challenging due to limited health literacy and cultural barriers. Our aim was to develop and evaluate a training program for healthcare professionals (breast surgeons and specialized nurses), to increase effective communication. We systematically developed a blended training program based on patients’ and healthcare professionals’ needs and preferences. Prior to the training, we assessed awareness, knowledge and self-efficacy of healthcare professionals. Acceptability and usefulness of the training program were assessed directly after the training. Healthcare professionals (n = 65) from 17 hospitals showed moderate to high awareness and knowledge about the prevalence and impact of limited health literacy. They were aware of cultural factors that influence communication. However, they did not feel confident in recognizing limited health literacy and their self-efficacy to communicate effectively with these patients was low. The training program was rated as acceptable and useful. Healthcare professionals lack confidence to effectively communicate with patients with limited health literacy or migrant background. The training program offers opportunities to improve communication about referral to breast cancer genetic counseling.

Assessment of Cultural Competence in Pharmacy Students Prior to Advanced Pharmacy Practice Experiences

Objective. To assess various aspects of cultural competence in second year Doctor of Pharmacy students' and investigate the relationship between cultural competence and students' demographics, work experience, and prior education.Methods. A 63-item survey modified from the Clinical Cultural Competency Questionnaire (CCCQ) and comprising four domains (knowledge, skills, encounters or situations, and attitudes towards cultural competency) was administered to second year pharmacy students before they started their advanced pharmacy practice experiences (APPEs). Additional questions regarding their ability to identify and recognize elements of cultural competence were asked. The effects of demographics, work experience, and education on cultural competence also were assessed.Results. Ninety-seven students (86.6%) participated in the study. The majority of participants were Asian, female, and in their late 20s. Most students agreed or strongly agreed that they could identify and recognize elements of cultural competence. However, participants indicated they were only a little or somewhat comfortable when asked questions about knowledge, skills, and comfort. Students indicated they had "quite a bit" of competence regarding attitudes towards other cultures. Previous cultural diversity training in undergraduate studies and pharmacy school were associated with higher scores on the modified CCCQ.Conclusion. The findings emphasize the importance of schools providing training in the didactic and experiential portion of the pharmacy curriculum to increase pharmacy students' knowledge, skills, comfort, and attitudes towards other cultures.

The effectiveness of cultural competence education in enhancing knowledge acquisition, performance, attitudes, and student satisfaction among undergraduate health science students: a scoping review

PURPOSE

Cultural competence in healthcare assists in the delivery of culturally sensitive and high-quality services. This scoping review aims to provide an overview of the available evidence and to examine the effectiveness of classroom-based intervention strategies used to enhance the cultural competence of undergraduate health science students.

METHODS

A comprehensive and systematic literature search was undertaken in databases, including Cochrane Library, Medline, and Emcare. Articles were eligible if they employed an experimental study design to assess classroom-based cultural competency education for university students across the health science disciplines. Two reviewers independently screened and extracted relevant data pertaining to study and participant characteristics using a charting table. The outcomes included knowledge, attitudes, skills, and perceived benefits.

RESULTS

Ten studies were analysed. Diverse approaches to cultural education exist in terms of the mode, frequency, and duration of interventions. For the knowledge outcome, students who experienced cultural education interventions yielded higher post-test scores than their baseline cultural knowledge, but without a significant difference from the scores of students who did not receive interventions. Data relating to the skills domain demonstrated positive effects for students after experiencing interventions. Overall, students were satisfied with their experiences and demonstrated improvements in confidence and attitudes towards culturally competent practice.

CONCLUSION

Across health science disciplines, cultural competency interventions were shown to be effective in enhancing knowledge acquisition, performance of skills, attitudes, and student satisfaction. Future research is necessary to address the significant absence of control arms in the current literature, and to assess long-term effects and patient-related outcomes.

Integrating Cultural Awareness into Medical Gross Anatomy Instruction

Medical students need to understand how culture and patient management relate in order to provide optimal care to a diverse society. Multiple studies call for more cultural training in medical education. Some studies show that well-intentioned cultural competency curriculum can reinforce stereotypes, yet it is essential for educators to discuss varying identities with our students in their training in order to avoid the implication that white is the default patient identity. Our study evaluates a pilot, novel approach for integrating cultural content into the biomedical sciences, specifically gross anatomy. Clinical vignette practice questions were developed as tools to help students expand their anatomical knowledge and cultural and socioeconomic awareness, taking special consideration to avoid stereotypical presentations. We evaluated class of 2021 students' self-reported cultural awareness and ability to utilize culturally relevant information through completion of a survey in fall 2017 (pre) and winter 2017 (post). The students were surveyed on their ability to recognize and/or integrate culturally relevant information. Twenty-one students (n = 21) participated. There was significant improvement in the overall cultural awareness score between the pre- and post-surveys (pre mean = 3.54, while post mean = 3.81; p = 0.016). The most dramatic domains that students became aware of included incorporating culturally relevant information into a treatment plan and communicating with sensitivity and respect when caring for patients. Culturally informed curriculum does not need to be limited to the humanities courses in medical education. Direct integration into biomedical sciences is a novel approach to help students gain exposure to biomedical and cultural content simultaneously.

Culturally Competent in Medical Education - European Medical Teachers' Self-Reported Preparedness and Training Needs to Teach Cultural Competence Topics and to Teach a Diverse Class

This article was migrated. The article was marked as recommended. Background Health inequalities related to culture and ethnicity may be reduced by training future health care providers.Medical teachers therefore also need to be culturally competent. The aim of this study was to assess medical teachers' preparedness and their training needs to teach cultural competence topics and to teach a diverse class. Methods A link to an online survey was sent to medical teachers of eleven European institutions. Results were analysed through descriptive analysis and answers to open-ended questions were analysed using qualitative analysis. Results 968 respondents were included. The majority of respondents felt it was important that cultural competence topics should be incorporated into the medical curriculum. Assessment of skills in cultural competence was found important as well. Over 60% of all respondents reported to be somewhat or very prepared to teach cultural competence topics like migrant health and disparities. Most respondents felt somewhat or very prepared to teach a diverse class. A high interest in training was expressed on teaching cultural competence topics, specifically on communication-related topics. Conclusion This study emphasizes the importance of incorporating cultural issues into the medical curriculum and to train medical teachers according to their needs.

Defining a framework for medical teachers' competencies to teach ethnic and cultural diversity: Results of a European Delphi study

BACKGROUND

Medical students need to be trained in delivering diversity-responsive health care but unknown is what competencies teachers need. The aim of this study was to devise a framework of competencies for diversity teaching.

METHODS

An open-ended questionnaire about essential diversity teaching competencies was sent to a panel. This resulted in a list of 74 teaching competencies, which was sent in a second round to the panel for rating. The final framework of competencies was approved by the panel.

RESULTS

Thirty-four experts participated. The final framework consisted of 10 competencies that were seen as essential for all medical teachers: (1) ability to critically reflect on own values and beliefs; (2) ability to communicate about individuals in a nondiscriminatory, nonstereotyping way; (3) empathy for patients regardless of ethnicity, race or nationality; (4) awareness of intersectionality; (5) awareness of own ethnic and cultural background; (6) knowledge of ethnic and social determinants of physical and mental health of migrants; (7) ability to reflect with students on the social or cultural context of the patient relevant to the medical encounter; (8) awareness that teachers are role models in the way they talk about patients from different ethnic, cultural and social backgrounds; (9) empathy for students of diverse ethnic, cultural and social background; (10) ability to engage, motivate and let all students participate.

CONCLUSIONS

This framework of teaching competencies can be used in faculty development programs to adequately train all medical teachers.

Acquire, apply, and activate knowledge: A pyramid model for teaching and integrating cultural competence in medical curricula

The importance of cultural competence in health care has been more acknowledged since modern societies are becoming increasingly multi-cultural. Research evidence shows that cultural competence is associated with improved skills and patient satisfaction, and it also seems to have a positive impact on adherence to therapy. Based on this evidence, the acknowledged importance of cultural competence and its poor integration into medical curricula, we present a pyramid model for building cultural competence into medical curricula whereby medical students can enhance their skills through acquiring, applying and activating knowledge.

Preaching to the choir? Sociodemographic differences in medical students' evaluation of an undergraduate diversity training module

This article was migrated. The article was marked as recommended. Introduction: Patients with diverse cultural backgrounds experience barriers in access to care, and do not always receive the care they need. To prepare future doctors to provide high quality care for all patients, adequate diversity education is essential. At VUmc School of Medical Sciences, we therefore developed a bachelor second year module on Care ethics and Diversity using an arts-based approach. The aim of this study was to evaluate the module from the students' perspective, and to gain insight in the relationship between evaluation outcomes and student sociodemographic characteristics. Methods: Design: cross-sectional evaluation study. Module content: after watching three short film fragments, students engaged in a structured dialogue about diversity in relation to care and care giving. Data collection: in 2015 and 2016, a questionnaire containing 12 evaluation items based on module learning outcomes were administered to second year medical students (N=287) immediately after receiving the module. Overall satisfaction with the module was measured using a 1-10 scale (with 1 indicating a very poor, and 10 indicating an excellent evaluation score); learning objective-related items were measured using a 5-point Likert scale. Results were analyzed using multiple linear regression, Pearson's correlation and Chi-square tests. Results: The average overall satisfaction score was 7.3. We found a strong positive correlation between the overall satisfaction score and the score of the item that measured students' level of interest (r=.70). Multiple linear regression showed a significant positive effect of identifying as non-native Dutch on multiple evaluation outcomes. Students with non-native Dutch backgrounds reported higher satisfaction with the module, perceived the module as more interesting and more personally relevant, and had higher scores on four of the six learning objective items. Discussion: Our findings indicate that students with non-native Dutch backgrounds were more satisfied with the module and reported more learning than their native Dutch peers. This might be explained by the fact that diversity education acknowledges Dutch students' lived experiences and builds on preexisting embodied diversity knowledge. Conversely, (white) native Dutch students might not always perceive diversity knowledge as legitimate or consider diversity as something that does not concern them. Conclusion: Non-native Dutch students reported more overall satisfaction with diversity education and more diversity learning than majority students. To secure and advance high quality health care for all patients, medical schools should invest in researching and developing diversity content that engages all students.

Cultural Competence and Global Health: Perspectives for Medical Education - Position paper of the GMA Committee on Cultural Competence and Global Health

Introduction: Routine medical care in Germany, Austria and Switzerland is being increasingly impacted by the cultural and linguistic diversity of an ever more complex world. Both at home and as part of international student exchanges, medical students are confronted with different ways of thinking and acting in relation to health and disease. Despite an increasing number of courses on cultural competence and global health at German-speaking medical schools, systematic approaches are lacking on how to integrate this topic into medical curricula. Methodological approach: This paper is based on a structured consensus-building process by a multidisciplinary committee composed of faculty and students. In a first step, a qualitative online survey was carried out in order to establish an inventory of definitions and concepts. After the second step, in which a literature search was conducted and definitions of global health and transcultural and intercultural competence were clarified, recommendations were formulated regarding content, teaching and institutional infrastructure. Based on small-group work and large-group discussions, different perspectives and critical issues were compiled using multiple feedback loops that served to ensure quality. Results: An inventory on the national and international level showed that great heterogeneity exists in regard to definitions, teaching strategies, teaching formats and faculty qualification. Definitions and central aspects considered essential to medical education were thus established for the use of the terms "cultural competence" and "global health". Recommendations are given for implementation, ranging from practical realization to qualification of teaching staff and education research. Outlook: High-quality healthcare as a goal calls for the systematic internationalization of undergraduate medical education. In addition to offering specific courses on cultural competence and global health, synergies would be created through the integration of cultural competence and global health content into the curricula of already existing subject areas. The NKLM (the national competence-based catalogue of learning objectives for undergraduate medical education) would serve as a basis for this.