Monday, June 13, 2016

The Introduction of a Cultural Competence Curriculum in the First Year of Medical School

Mia Mallory
Cincinnati Children’s Hospital Medical Center
Background: The design of a cultural competency curriculum can be challenging in a dense medical school curriculum. Medical schools have been challenged by the LCME to integrate cross-cultural education into the training of all current and future health professionals. Future physicians will care for an increasingly diverse patient population and the health gap is widening among minority populations.  There is support that cultural competence education improves health outcomes, racial disparities and patient outcomes. Students are important stakeholders in the development of a cultural competence curriculum

Objective: Gather ideas from focus groups of medical students enrolled at the University of Cincinnati College of Medicine. Information from the focus groups will be used to inform a medical school curriculum. Focus group stakeholders will also give feedback on an online course and lecture provided by a cultural competence expert. Students will be better equipped to take care of growing diverse patient population.

Methodology: Students were asked to participate in an online cultural competence course provided by Quality Interactions®, a validated instrument which included a pretest and posttest, in February 2015. Students were required to attend a lecture by a cultural competence expert after the completion of the online course.  Focus groups were held within 6 weeks of the initial activity and again at 6 months with a snowball sample of students in the subsequent focus groups. Open coding of the qualitative recorded data was performed by looking for recurrent themes. Quality Interactions® staff provided results of pretest and posttests, open-ended question responses, and answers to specific questions.

Results: 90% of first year medical students completed the 60-minute online course; Average Pretest Score 56/100; Average Posttest Score 91/100. 85% of students said that they will change one or more of aspects of future medical practice as a result of participation in activity; 77% of students said that the information made them better able to summarize importance of cultural competence in delivery of health care; 76% of students said that the information helped define social and cultural issues that are most relevant in the care of diverse patient populations; 64% of students said that the information will help them communicate effectively across cultures. Students participating in the focus groups noted that cultural competence is an important and necessary component of their education. They noted that it is difficult to incorporate it into a curriculum and had several suggestions of additional exposures to cultural competence in their curriculum which included diverse clinical case presentations, enhanced diverse patient encounters in the Clinical Skills course, facilitated workshops and culturally competent faculty debrief sessions.

Conclusions: The case for cultural competence is evident. Students believe that cultural competency is an important component of their education. Our students desire hands-on application in the form of clinical cases incorporated into their clinical skills curriculum. The implementation of cultural competence curriculum is challenging in a dense medical school curriculum. The next steps will be to repeat the online curriculum and lecture for all incoming first year medical students and to incorporate quarterly culturally focused cases into the Physician and Society course. We will also work toward recruiting culturally diverse standardized patients for the Clinical Skills course, and outline cultural competence activities, learning objectives and assessments in all courses in the curriculum