Training a medical workforce to meet the needs of diverse minority communities

Abstract

BackgroundThe 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.MethodsTwo 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.ResultsOverall, 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.ConclusionsMedical 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.Electronic supplementary materialThe online version of this article (doi:10.1186/s12909-017-0858-7) contains supplementary material, which is available to authorized users.

Exploring a communication curriculum through a focus on social accountability: A case study at a South African medical school

“… 36 Placement in the rural context, where exposures to isiZulu-speaking patients, traditional medicine and cultural practices are common, would build on the isiZulu communication skills covered in the pre-clinical phase. Immersion in the community 55 would also improve students’ understanding of how patients access health care in KZN, moving between traditional and Western models. It would provide students with the opportunity to experience and critically reflect on patients’ needs to access health care in a language that can convey the necessary cultural nuances.…”

Black Ice: Five ways to get a grip on grouped self-assessments of competence for program evaluation

“…[4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] Six studies measured competency or ability, 10,13,[22][23][24][25] two studies measured readiness, 9,16 and five studies e92 lacked sufficient detail to determine what they used. [26][27][28][29][30] Measuring one's willingness to perform a task or one's confidence helps promote reflection of performance 3 but is not the most effective method of evaluating learning or performance. Additionally, pre-test GS-a coupled with post-test GSa are inadequate measurements of program results.…”

“…According to our analysis, five studies had not used any pre-intervention assessments at all. 5,10,18,22,28 Eighteen studies administered pre-post self-assessments, 4,[6][7][8][9][12][13][14][15][16][17]19,21,23,25,27,29,30 whereas only three studies employed post-intervention retrospective pre-test selfassessments. 11,24,26 One study had employed both pre-intervention pre-test and post-intervention retrospective pre-test self-assessments.…”

“…Of the 27 selected studies, 22 studies used the observable, clearly written, specific learning objectives from the program or intervention in their self-assessments. [4][5][6][7][8][9][10][12][13][14][15][16][17][18][21][22][23][24][25]28,29 Yet, five studies either lacked sufficient details to determine what they used or used topic areas and broad domains instead of learning objectives. 11,20,26,27,30 When selfassessments refer to ambiguous learning objectives, respondents may not be able to accurately interpret what they are expected to assess.…”

Burn-out and mental health of minority medical students in Hungarian medical education.

“…University training has a vital role in the support of minority students, in the improvement of attitudes and competencies related to minorities, in the recognition and mitigation of implicit biases or everyday microaggressions (85,(103)(104)(105)(106)(107)(108)(109) to prepare medical students for the care of a population being diverse in many respects.…”