An ethnographic investigation of medical students’ cultural competence development in clinical placements

Abstract

As a result of an increased understanding of culture’s impact on health and healthcare, cultural competence and diversity curricula have been incorporated into many medical programs. However, little is known about how students develop their cultural competence during their training. This ethnographic case study combined participant observation with interviews and focus group to understand students’ views and experiences in developing their cultural competence during clinical placements. The results show that students’ development of cultural competence is an individually varied process via four distinctive yet interrelated learning avenues. Immersion in a diverse healthcare environment contributes to students’ development of cultural awareness and knowledge. Observation of culturally appropriate or inappropriate practices allows students to enhance their practical skills and critical reflection. Interaction with other clinical professionals, patients, and their family members, enables students’ engagement within the busy clinical practice. Reflection helps students to actively think about culture’s impact on health and internalize the importance of cultural competence. Students’ learning via each avenue is interrelated and constantly interacting with their learning environment, which collectively contributes to their development. Integrating the results allowed the authors to generate a theoretical model that conceptualizes medical students’ cultural competence development in clinical placements, which unearths students’ cultural learning within the informal and hidden curriculum. This study provides a rare view of students’ development of cultural competence in clinical placements, which may inform the pedagogic development of cultural competence and diversity education in medicine and healthcare.

Integrating Shared Decision-Making into Undergraduate Oncology Education: A Pedagogical Framework

“…By interacting with patients from various backgrounds, students gain insights into how sociocultural factors influence treatment choices [ 52 , 53 ]. This exposure can be facilitated through case studies, clinical rotations in diverse settings, or structured interactions with patients of varied backgrounds [ 54 – 56 ]. Furthermore, sessions on cultural competence may be integrated into the curriculum.…”

Perceptions of and preparedness for cross-cultural care: a survey of final-year medical students in Ireland

“…[ 19 ], revealed eleven cross-cultural educational methods to cultivate cultural competence, whilst Liu et al . [ 20 ], demonstrated the ways in which the hidden curriculum can influence cross-cultural competence. From these studies, multiple methods of cultivating cross-cultural competence can be utilised, and there is no method has been proven superior to another [ 19 ].…”

Influences on improved confidence among allied health students in working with Australian Indigenous people during a rural placement: a pre-post survey study

“…The ndings of this study complement those of previously published qualitative research on the various aspects of placements that foster attitudes and skills that promote cultural safety among students of the health professions. From a broad international perspective, development of cultural competence during clinical placements is understood to be an individually varying process dependent on characteristics of both the placement and the student, through the four interrelated pathways of immersion in suitable healthcare environments, opportunities for interpersonal interaction while in these environments, observation by students of the cultural practices of others, and re ection by the student [20]. It has been recognised that in Australia, as in similar countries with a history of colonisation of Indigenous peoples such as New Zealand and Canada, universities have a responsibility to provide students of the health professions with teaching and learning that engenders culturally safe practice.…”

“…This can be achieved through curricula that incorporate 'Indigenous ways of knowing, being and doing into the curricula, understanding the local Indigenous histories and contexts, the adoption of online cultural education modules, and clinical placement partnerships with local Indigenous communities' [21] [p110]. Although the in uences on development of cultural competence among health professionals and students remain uncertain [20], there is evidence that various components of curriculum and student experience contribute, including single workshops [22] and single compulsory teaching units [23], as well as immersive service learning in an Indigenous community [24,25].…”