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BackgroundSouth Africa (SA) has a growing multilingual and multicultural population of approximately 55 million people, and faces service delivery challenges due to a shortage in skilled health professionals. Many health care facilities still depict distinct racial and ethnic characteristics that date back to the apartheid era, and there are reports of racial intolerance or preferential treatment at some facilities. There is limited literature in South Africa on cultural competence or on how to train health professionals to provide culturally competent care. This paper describes a study conducted to gain a better understanding of final year medical students’ perceptions regarding concepts related to cultural and linguistic competence in the SA healthcare setting.MethodsAn exploratory, cross-sectional, analytical study used a questionnaire to collect data from final year students at the medical school.ResultsThe demographic profile indicated considerable diversity in the respondents for languages spoken, ethnicity and religion. Responses indicated a level of cultural awareness and, according to the Cross Framework, a position of cultural pre-competence. This position was supported by the majority expressing high levels of agreement with the items deemed to indicate responsiveness: a desire for cultural competence to be promoted in the medical curriculum and for professional development to improve delivery of services and support to linguistically and culturally diverse groups. No significant association was found when analysing the latter item against demographic grouping variables. However, although not significant, a diminishing trend emerged in the rankings of monolingualism, bilingualism and multilingualism, suggesting that the ability to speak more than one language could possibly be a facilitating factor in acquiring cultural competence.ConclusionsIn response, it is recommended that specific learning objectives be included in the medical curriculum. Understanding of concepts related to both individual and institutional cultural competence would improve insights into their relevance in responding to the challenges related to culture in SA healthcare. Further research in teaching cultural competence is recommended. In order to respond to local needs, this should include research at a community level to analyse patients’ perspectives and satisfaction with the cultural competence of healthcare providers and organisations serving the SA public.

BackgroundGood communication is integral to social accountability, and training is included in medical curricula internationally. In KwaZulu-Natal, training is conducted in English, in spite of most public sector patients being mother tongue isiZulu speakers. Communication challenges with patients are common, but good communication and African language teaching are not emphasised in teaching.AimThis study explored communication training and how it related to social accountability at a single institution in KwaZulu-Natal.SettingThis exploratory, qualitative case study design at the medical school explored participants’ perceptions about communication and social accountability and reviewed relevant educational documentation for evidence.MethodsPurposive sampling was used to select medical students, educators and stakeholders from the educational and service platforms. Focus group discussions and semi-structured interviews were conducted. The data were thematically analysed with reference to Boelen’s social obligation scale for medical schools.ResultsGood communication was valued, but often poorly role-modelled. Participants agreed that communication and isiZulu teaching were insufficiently supported to respond adequately to the needs of local communities. Social accountability was not well understood by students, while medical school educators and other stakeholders indicated that, despite aspirations, this goal had not yet been achieved.ConclusionsLearning isiZulu language and culture in an integrated manner in both pre-clinical and clinical phases would improve communication with patients, contribute to socially responsive health care, and better address health care needs. Incorporating a social accountability framework in curriculum review would highlight the importance of measuring health outcomes and community impacts, and so enhance the educational mission of the medical school.

Background. The role of communicator has been included as a key competency for health science students in South Africa. Owing to the population's diverse language and cultural backgrounds, communication between patients and healthcare professionals is challenging. In this study, the Attention, Generation, Emotion and Spacing (AGES) neurocognitive model of learning was used as a framework to create videos for language teaching for the vocational needs of students. Objectives. To explore students' views on the use of videos of simulated clinical scenarios for isiZulu communication and language teaching and the development of cultural awareness. Methods. Videos were developed using first-and second-language isiZulu speakers with scripts (verified by the university's Language Board) based on authentic clinical settings. Videos were shown to a target group of students, who were then interviewed in focus group discussions. Audio recordings from the discussions were transcribed and analysed thematically in three categories, i.e. communication, language skills, and cultural awareness, using deductive coding based on the objectives of the research. Results. Students affirmed numerous benefits of the videos and commented on their use and further development. Benefits described related well to the AGES model of learning and fulfilled the learning requirements of communication teaching, language acquisition and cultural awareness. Conclusion. The videos represent an innovative teaching method for the resource-constrained environment in which we work and are relevant to the 21st century learner. Further evaluation and development of the tool using different scenarios and African languages is recommended.

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