Many efforts to design introductory "cultural competence" courses for medical students rely on an information delivery (competence) paradigm, which can exoticize patients while obscuring social context, medical culture, and power structures. Other approaches foster a general open-minded orientation, which can remain nebulous without clear grounding principles. Medical educators are increasingly recognizing the limitations of both approaches and calling for strategies that reenvision cultural competence training. Successfully realizing such alternative strategies requires the development of comprehensive models that specify and integrate theoretical frameworks, content, and teaching principles.In this article, the authors present one such model: Introduction to Medicine and Society (IMS), a required cultural competence course launched in 2013 for first-year medical students at the Perelman School of Medicine at the University of Pennsylvania. Building on critical pedagogy, IMS is centered on a novel specification of "critical consciousness" in clinical practice as an orientation to understanding and pragmatic action in three relational domains: internal, interpersonal, and structural. Instead of transmitting discrete "facts" about patient "types," IMS content provokes students to engage with complex questions bridging the three domains. Learning takes place in a small-group space specifically designed to spur transformation toward critical consciousness. After discussing the three key components of the course design and describing a representative session, the authors discuss the IMS model's implications, reception by students and faculty, and potential for expansion. Their early experience suggests the IMS model successfully engages students and prepares future physicians to critically examine experiences, manage interpersonal dynamics, and structurally contextualize patient encounters.
Introduction: Current approaches to teaching diagnostic reasoning minimally address the need for deliberate practice. We developed an educational conference for internal medicine residents to practice diagnostic reasoning and examine how biases affect their differential diagnoses through cognitive autopsies. Methods: We formatted the Virtual Interactive Case-Based Education (VICE) conference as a clinical problem-solving exercise, in which a facilitator presents a case to a single discussant selected from the audience. We delivered VICE on an internet-based conferencing platform with screen-sharing capability over approximately 30 minutes. To maximize learners' psychological safety, we employed an active facilitation model that normalized uncertainty and prioritized the diagnostic process over arriving at the correct diagnosis. Results: Resident attitudes toward VICE were assessed by utilizing a postconference survey and gathering descriptive data for 11 sessions. Ninety-seven percent of respondents (n = 35) felt that VICE was a novel and valuable addition to their curriculum. Qualitative data suggested that positive features of the conference included the opportunity to practice diagnostic reasoning, the single-discussant format, and the supportive learning environment. Discussants reported that holding the conference in person would have negatively impacted their experience. Discussion: Internal medicine residents universally valued the opportunity to engage in deliberate practice of case-based reasoning in a psychologically safe environment during the VICE conference. The virtual nature of the conference contributed significantly to discussants' positive experience. This resource includes all materials necessary to implement VICE, as well as an instructional video on facilitation.
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