How do medical specialists value their own intercultural communication behaviour? A reflective practice study

Physicians' Self-Perceived Competence on Breaking Bad News to Parents of Children with Neurodisabilities

Delivering difficult news to parents of children with neurodisabilities, often involving new diagnoses, prognosis changes, or declines in function or health, presents a complex task. Our aim was to assess physicians' self-perceived competence in breaking bad news (BBN) within this context. An online survey was administered to neuropediatricians and developmental and rehabilitation pediatricians in Switzerland. Among 247 invited physicians, 62 (25.1%) responded (age of 51 ± 11 years; M/F ratio of 2:3). They rated their BBN competence at 7.5 ± 1.6 out of 10. Factors significantly associated with self-perceived competence in uni- and multivariate analyses included years of professional experience (≤10 years: 6.2 ± 1.8; >10 years: 8.2 ± 0.8), and region of pregraduate training (Switzerland: 7.3 ± 1.6; European Union: 8.3 ± 0.9). The respondents highlighted the positive roles of professional and personal experience, quality relationships with families, and empathy in BBN. In summary, physicians generally expressed a sense of competence in delivering difficult news to parents of children with neurodisabilities. They underscored the significance of life experiences and certain individual qualities in their effectiveness. These findings provide valuable insights into enhancing professional training and support in this crucial yet underexplored aspect of medical practice.

Cultural competency education in the medical curriculum to overcome health care disparities

Background

Our increasingly diverse population demands the adoption of transcultural approaches to health care delivery. Training courses in medical education have been developed across the country for cultural competency, but have not been standardized or incorporated consistently. This study sought to formulate an educational intervention in medical training using the concepts of cultural competency and humility to improve understanding of cultural disparities in health care.

Methods

This study used three domains of Tools for Assessing Cultural Competence Training (TACCT) by the Association of American Medical Colleges. Participants included 106 fourth-year medical students and 19 internal medicine residents at Louisiana State University in Shreveport in 2022. The training session included a lecture introducing cultural and structural competency for 30 minutes followed by three workshops based on the TACCT domains of key aspects of cultural competence, understanding the impact of stereotyping on medical decision-making, and cross-cultural clinical skills. The participants were given a pre- and postsession questionnaire.

Results

After the session, 68% of students rated their understanding of cultural competency as excellent. For methods of teaching-lecture versus workshop versus both-66% rated the combination as excellent.

Conclusion

The rudimentary understanding of cultural competency and cultural humility improved after the session.

Yemeni refugees' health literacy and experience with the Dutch healthcare system: a qualitative study

BACKGROUND

The Netherlands is receiving increasing numbers of Yemeni refugees due to the ongoing war in Yemen. Since there is a lack of knowledge about access to healthcare by refugees, this study investigates the experiences of Yemeni refugees with the Dutch healthcare system from a health literacy perspective.

METHODS

Qualitative semi-structured in-depth interviews were conducted among 13 Yemeni refugees in the Netherlands, to gauge their level of health literacy and investigate their experiences with the Dutch healthcare system. Participants were invited using convenience and snowball sampling. Interviews were done in Arabic and then transcribed and translated ad verbatim to English. Deductive thematic analysis was conducted on the transcribed interviews based on the Health Literacy framework.

RESULTS

The participants knew how to use primary and emergency care, and were aware of health problems related to smoking, physical inactivity, and an unhealthy diet. However, some participants lacked an understanding of health insurance schemes, vaccination, and food labels. They also experienced language barriers during the first months after arrival. Furthermore, participants preferred to postpone seeking mental healthcare. They also showed mistrust towards general practitioners and perceived them as uncaring and hard to convince of their health complaints.

CONCLUSION

Yemeni refugees in our study are well-acquainted with many aspects of Dutch healthcare, disease prevention, and health promotion. However, trust in healthcare providers, vaccination literacy and mental health awareness must improve, as also confirmed by other studies. Therefore, it is suggested to ensure appropriate cultural mediation services available for refugees as well as training for healthcare providers focused on understanding cultural diversity, developing cultural competence and intercultural communication. This is crucial to prevent health inequalities, improve trust in the healthcare system and tackle unmet health needs regarding mental healthcare, access to primary care, and vaccination.

Cultural competence of dutch physician assistants: an observational cohort study

BACKGROUND

Current cultural competence training needs were assessed as baseline measurement in Dutch physician assistant (PA) students and PA alumni that were not specifically trained in cultural competence. In particular, differences in cultural competency between PA students and PA alumni were assessed.

METHODS

In this cross-sectional, observational cohort study knowledge, attitude, and skills and self-perceived overall cultural competence were assessed in Dutch PA students and alumni. Demographics, education and learning needs were collected. Total cultural competence domain scores as well as percentage of maximum scores were calculated.

RESULTS

A total of 40 PA students and 96 alumni (female:75%; Dutch origin:97%) consented to participate. Cultural competence behavior was moderate in both groups. In contrast, general knowledge and exploration of patients' social context were insufficient, i.e., 53% and 34%, respectively. Self-perceived cultural competence was significantly higher in PA alumni (6.5 ± 1.3, mean ± SD) than in students (6.0 ± 1.3; P < 0.05). Low heterogeneity among PA students and educator exists. Seventy percent of the respondents considers cultural competence important and the majority expressed a need for cultural competence training.

CONCLUSIONS

Dutch PA students and alumni have moderate overall cultural competence, but insufficient knowledge and exploring social context. Based on these outcomes the curriculum of the master of science program for physician assistant will be adapted.Emphasis should be made to increase the diversity of PA students to stimulate cross-cultural learning and developing a diverse PA workforce.

Chapitre 4. The recognition and value of traditional care practices in french overseas territories: a singular and contemporary example from French Polynesia

In French Polynesia (the Pacific), the knowledge and practices of traditional therapies, inherited from cultural specificities sometimes thousands of years old, were mostly, during the process of cultural integration that took place during the colonial period, neglected, side-lined, or disqualified by the public powers concerned. A state of tension is palpable in the hospital care service, where, on a daily basis, the medical staff experience socio-cultural resistance and incomprehension for which their education and training have not prepared them. By means of a diachronic approach, the article presents both the ways and the places of the traditional medicine at the heart of the Polynesian world, which are underpinned by a system of cosmogonic and symbolic representations, while also presenting the points of tension which derive from local, social, and sanitary specificities that are currently neither recognized nor taken on board by the powers that be. In this context, the article discusses a singular experiment in medical plurality, carried out by the pulmonology service at the hospital of Papeete. This first ethnological exploration of healthcare in a multicultural overseas territory is part of a healthcare dynamic already being put into practice by a body of carers within the pulmonology service of the Centre Hospitalier en Polynésie Française (CHPF), who are looking for new ways of thinking and caring in touch with local constraint and specificities. Drawing on these various research perspectives, it is important to try and sketch out, by means of an anthropological reflection on care, some paths for understanding a divisive situation which puts in danger the very practice of care.

Global surgery for medical students - is it meaningful? A mixed-method study

Introduction

There has been an increase in global health courses at medical universities in high-income countries. Their effect on students, however, is poorly understood. In 2016 an elective global surgery course was introduced for medical students at Karolinska Institutet in Sweden. The course includes a theoretical module in Sweden and a two-week clinical rotation in Uganda. The present study aimed to assess the format and determine its effect on students’ knowledge of global surgery and approach towards patients of non-Swedish origin.

Method

A mixed-methods design was used. Semi-structured case-based interviews were conducted individually with 18 students and analysed using qualitative content analysis. Examination scores and the course evaluation were analysed with Kruskal Wallis one-way analysis of variance, Pearson’s Chi-square and a Wilcoxon signed-rank test as appropriate.

Results

The course was appreciated and students reported gained insights and interest in global surgery. Students’ ability to reason about global surgery issues was improved after the course. Students considered complicating aspects in the meeting with patients of non-Swedish origin. Students with abroad clinical experience felt less compelled to act on preconceptions.

Discussion

The global surgery course at Karolinska Institutet is appreciated and students gained valuable knowledge. The case-based interviews acted as a catalyst for reflection and showed that students felt insecure as they lacked knowledge about globally common surgical conditions and struggled with generalized preconceptions of patients of non-Swedish origin. To further support students to integrate theoretical knowledge and professional development, we suggest the introduction of problem-based learning.

Conclusion

The ability of the course to inspire students’ commitment to global surgery is promising as this engagement is the key to reaching the goal of equitable health globally. Offering such courses is a step towards inspiring and recruiting the future clinicians and researchers needed for expanding the field of global surgery.

Barriers and facilitators of patient centered care for immigrant and refugee women: a scoping review

BACKGROUND

Migrants experience disparities in healthcare quality, in particular women migrants. Despite international calls to improve healthcare quality for migrants, little research has addressed this problem. Patient-centred care (PCC) is a proven approach for improving patient experiences and outcomes. This study reviewed published research on PCC for migrants.

METHODS

We conducted a scoping review by searching MEDLINE, CINAHL, SCOPUS, EMBASE and the Cochrane Library for English-language qualitative or quantitative studies published from 2010 to June 2019 for studies that assessed PCC for adult immigrants or refugees. We tabulated study characteristics and findings, and mapped findings to a 6-domain PCC framework.

RESULTS

We identified 581 unique studies, excluded 538 titles/abstracts, and included 16 of 43 full-text articles reviewed. Most (87.5%) studies were qualitative involving a median of 22 participants (range 10-60). Eight (50.0%) studies involved clinicians only, 6 (37.5%) patients only, and 2 (12.5%) both patients and clinicians. Studies pertained to migrants from 19 countries of origin. No studies evaluated strategies or interventions aimed at either migrants or clinicians to improve PCC. Eleven (68.8%) studies reported barriers of PCC at the patient (i.e. language), clinician (i.e. lack of training) and organization/system level (i.e. lack of interpreters). Ten (62.5%) studies reported facilitators, largely at the clinician level (i.e. establish rapport, take extra time to communicate). Five (31.3%) studies focused on women, thus we identified few barriers (i.e. clinicians dismissed their concerns) and facilitators (i.e. women clinicians) specific to PCC for migrant women. Mapping of facilitators to the PCC framework revealed that most pertained to 2 domains: fostering a healing relationship and exchanging information. Few facilitators mapped to the remaining 4 domains: address emotions/concerns, manage uncertainty, make decisions, and enable self-management.

CONCLUSIONS

While few studies were included, they revealed numerous barriers of PCC at the patient, clinician and organization/system level for immigrants and refugees from a wide range of countries of origin. The few facilitators identified pertained largely to 2 PCC domains, thereby identifying gaps in knowledge of how to achieve PCC in 4 domains, and an overall paucity of knowledge on how to achieve PCC for migrant women.

Circling the undefined-A grounded theory study of intercultural consultations in Swedish primary care

Well-functioning physician-patient communication is central to primary care consultations. An increasing demand on primary care in many countries to manage a culturally diverse population has highlighted the need for improved communication skills in intercultural consultations. In previous studies, intercultural consultations in primary care have often been described as complex for various reasons, but studies exploring physician-patient interactions contributing to the understanding of why they are complex are lacking. Therefore, the aim of this study was to explore intercultural physician-patient communication in primary care consultations, generating a conceptual model of the interpersonal interactions as described by both the patients and the physicians. Using grounded theory methodology, 15 residents in family medicine and 30 foreign-born patients, the latter with Arabic and Somali as native languages, were interviewed. The analysis generated a conceptual model named circling the undefined, where a silent agreement on issues fundamental to the core of the consultation was inadequately presumed and the communicative behaviors used did not contribute to clarity. This could be a possible contributory cause of the perceived complexity of intercultural consultations. Identifying what takes place on an interpersonal level in intercultural consultations might be a first step towards building a common ground for increased mutual understanding, thereby bringing us one step closer to sharing, rather than circling the undefined.