Original Article

CME Article: Student Clinical Experiences in Cross-Cultural Education

Authors: Christopher J. King, MD, David Gamble, MD, Gretchen Guiton, PhD, Paritosh Kaul, MD

Abstract

Objectives: Education in cultural competence is critical to training medical students to care for patients from all backgrounds, but it is unclear what experience students have in the clinical learning environment. We describe the medical student experience in directly observed cross-cultural encounters within two clinical clerkships, and we identify areas of need for further resident and faculty training in providing high-quality feedback following these encounters.

Methods: We collected direct observation feedback forms from third-year medical students in the Internal Medicine and Pediatrics clerkships. The observed cross-cultural skill was categorized, and the quality of feedback given to students was quantified using a standardized model.

Results: Students were observed using an interpreter more frequently than any other skill. Positive feedback received the highest quality scores, averaging 3.34 out of 4 coded elements. Corrective feedback quality only averaged 2.3 out of 4 coded elements, and quality correlated with the frequency of cross-cultural skill observation.

Conclusions: Significant variability exists in the quality of feedback provided to students following the direct observation of cross-cultural clinical skills. Faculty and resident training to improve feedback should focus on corrective feedback in less commonly observed cross-cultural skills.

This content is limited to qualifying members.

Existing members, please login first

If you have an existing account please login now to access this article or view purchase options.

Purchase only this article ($25)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

1. Smedley BD, Stith AY, Nelson AR, eds. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Washington, DC: The National Academies Press; 2003.
 
2. Awosogba T, Betancourt JR, Conyers FG, et al. Prioritizing health disparities in medical education to improve care. Ann N Y Acad Sci. 2013;1287:17–30.
 
3. Accreditation Council for Graduate Medical Education. Common program requirements. https://www.acgme.org/What-We-Do/Accreditation/Common-Program-Requirements. Accessed February 1, 2023.
 
4. Boardman J. Critical synthesis package: tool for assessing cultural competence training (TACCT). https://www.mededportal.org/doi/10.15766/mep_2374-8265.10298. Published December 28, 2015. Accessed February 1, 2023.
 
5. Association of American Medical Colleges. Behavioral and social science foundations for future physicians. https://www.aamc.org/system/files/d/1/271020-behavioralandsocialsciencefoundationsforfuturephysicians.pdf. Published November 2011. Accessed February 1, 2023.
 
6. Primary Care Collaborative. Cultural competence education for students in medicine and public health: report of an expert panel. https://www.pcpcc.org/resource/cultural-competence-education-students-medicine-and-public-health. Published July 2012. Accessed March 31, 2020.
 
7. Chang A, Chou CL, Teherani A, et al. Clinical skills-related learning goals of senior medical students after performance feedback. Med Educ 2011;45: 878–885.
 
8. Li ST, Paterniti DA, Co JPT, et al. Successful self-directed lifelong learning in medicine: a conceptual model derived from qualitative analysis of a national survey of pediatric residents. Acad Med 2010;85:1229–1236.
 
9. Davis DA, Mazmanian PE, Fordis M, et al. Accuracy of physician self-assessment compared with observed measures of competence: a systematic review. JAMA 2006;296:1094–1102.
 
10. Lockspeiser TM, Kaul P. Using individualized learning plans to facilitate learner-centered teaching. J Pediatr Adolesc Gynecol 2016;29:214–217.
 
11. Bekdache GN, Berndl A. Women with physical disability in pregnancy resident education: a national survey as a needs assessment for curriculum improvement in obstetrics and gynaecology in Canada. BMJ Open 2019;9: e024505.
 
12. Smeltzer SC, Mitra M, Long-Bellil L, et al. Obstetric clinicians’ experiences and educational preparation for caring for pregnant women with physical disabilities: a qualitative study. Disabil Health J 2018;11:8–13.
 
13. Bu P, Veloski JJ, Ankam NS. Effects of a brief curricular intervention on medical students’ attitudes toward people with disabilities in healthcare settings. Am J Phys Med Rehabil 2016;95:939–945.
 
14. Lynch J, Last J, Dodd P, et al. ‘Understanding Disability’: evaluating a contact-based approach to enhancing attitudes and disability literacy of medical students. Disabil Health J 2019;12:65–71.
 
15. John JT, Block L, Stein A, et al. Caring for patients with physical disabilities: assessment of an innovative spinal cord injury session that addresses an educational gap. Am J Phys Med Rehabil 2019;98:1031–1035.
 
16. Satchidanand N, Gunukula SK, Lam WY, et al. Attitudes of healthcare students and professionals toward patients with physical disability: a systematic review. Am J Phys Med Rehabil 2012;91:533–545.
 
17. Miller SR. A curriculum focused on informed empathy improves attitudes toward persons with disabilities. Perspect Med Educ 2013;2:114–125.