Components of Culture in Health for Medical Studentsʼ Education

Abstract

Medical educators across the United States are addressing the topics of culture, race, language, behavior, and social status through the development of cross-cultural coursework. Dramatic demographic changes and nationwide attention to eliminating racial and ethnic health disparities make educating medical students about the importance of the effects of culture on health a 21st-century imperative. Despite the urgent need for including this topic material, few medical schools have achieved longitudinal integration of issues of culture into four-year curricula. The author makes the practical contribution of describing key themes and components of culture in health care for incorporation into undergraduate medical education. These include teaching the rationale for learning about culture in health care, "culture basics" (such as definitions, concepts, the basis of "culture" in the social sciences, relationship of culture to health and health care, and health systems as cultural systems), data on and concepts of health status (including demographics, epidemiology, health disparities, and the historical context), tools and skills for productive cross-cultural clinical encounters (such as interviewing skills and the use of interpreters); characteristics and origins of attitudes and behaviors of providers; community participation (including the use of expert teachers, community-school partnerships, and the community as a learning environment); and the nature of institutional culture and policies.

Teaching Cultural Diversity: Current Status in U.K., U.S., and Canadian Medical Schools

“…medical schools generally include cultural competency education within required courses 32 . However, few medical schools have achieved longitudinal integration of issues of culture into 4-year curricula 33,34 instead concentrating in the first or second years of medical school, often in a didactic or case-based format 35 .…”

‘Fostering transformative learning, self-reflexivity and medical citizenship through guided tours of disadvantaged neighborhoods’

“…Rather than discuss these issues as abstract concepts or statistics as might happen in a classroom setting, the visceral sights, sounds and smells of the community tour, combined with the post-tour self-reflexive discussion and writing exercises, seemed to allow students to experience, feel, and contemplate social and structural inequality in an ‘experientially near’ learning experience[24]. Further, reflecting expert advice to focus on provider attitudes and stereotyping in medical education [10,11,25], combining guided tours, reflexive writing and group discussion effectively spurred students to critically interrogate personal biases, more fully evaluate how structures of inequality shape a community’s health, and contemplate pursuing careers of medical service.…”

Cultural Competence in Action: “Lifting the Hood” on Four Case Studies in Medical Education

“…1 (Betancourt 2003(Betancourt , 2006Bromley and Braslow 2008;Crenshaw et al 2011;Eiser and Ellis 2007;Fung et al 2008;Green et al 2008;Guarnaccia and Rodriguez 1996;Hayes-Bautista 2003;Hershberger et al 2008; Kirmayer 2011Kirmayer , 2012aKripalani et al 2006;Kumaş-Tan et al 2007;Lié et al 2006;Lim and Lu 2008;Lo and Stacey 2008;Núñez 2000;Park et al 2006;Park et al 2009;Shapiro et al 2006;Smith et al 2007; South-Paul and Like 2008; Sue 1998Sue , 2003Sumpter and Carthon 2011;Teal and Street 2009;Tervalon 2003;Tervalon and Murray-Garcia 1998;Wachtler and Troein 2003;Wear 2003;Whitcomb 2003).…”