Examining clinical training through a bicultural lens: Experiences of genetic counseling students who identify with a racial or ethnic minority group

Abstract

Biculturals are individuals who have had significant exposure to more than one culture and who possess more than one cultural frame of reference. In the United States, this term has been used to describe both immigrants and members of racial or ethnic minority groups who live within the majority white culture. Biculturals develop a distinct repertoire of social and cognitive skills and have been shown to engage in a process of cultural frame switching in response to salient cultural cues. Through a conceptual lens offered by current research on biculturalism, this article examines transcripts of focus groups we collected for a study on the clinical training experiences of genetic counseling students who identify with a racial or ethnic minority group. We conducted a constructivist grounded theory study, collecting data via 13 videoconference focus groups with 32 recent graduates of genetic counseling training programs who identify with a racial or ethnic minority group. We focus here on two of the thematic categories identified in that study related to participants’ experiences interacting with patients during supervised clinical rotations. We find three ways in which being bicultural influenced these genetic counselors’ patient interactions. First, participants described interactions with both culturally concordant and culturally discordant patients that highlighted the salience of their racial, ethnic, or cultural identity in these encounters. Second, they reported sensitivity to social nuances between and within cultures, reflecting the findings of prior research about heightened cultural awareness in biculturals. Third, they described switching cultural frames in response to their patients’ identities which, at times, created conflict between their professional and culturally concordant frameworks. The results of this study suggest that the influence of a student's racial, ethnic, or cultural identity on interactions with patients should be discussed within the supervisory relationship, and that being bicultural confers advantages in learning to provide culturally responsive care.

Perspectives on Spanish language concordant cancer genetic counseling sessions from the Spanish‐speaking population

“…Additionally, several participants mentioned that the GC acted like a friend or someone that they had known for a long time which enhanced their level of comfort in speaking openly and honestly with her. This contrasts with the current literature on interpreter-mediated genetic counseling sessions which have confirmed the unfavorable effects that an interpreter can have on rapport and relationship-building within genetic counseling sessions (Ault et al, 2019;Browner et al, 2003;Carmichael et al, 2021;Joseph & Guerra, 2015;Kamara et al, 2018). Interpersonal relationship, which was assessed in this study, directly impacts communication between a GC and patient.…”

“…All study participants received healthcare via medical interpreters in the past and most stated they preferred Spanish‐speaking providers due to the absence of a language barrier, a finding consistent with previous literature which supports that provider language concordance is preferred among Spanish‐speaking patients (Carmichael et al, 2021; de Leon et al, 2022; Gonzalez et al, 2010). Two participants in our study did highlight the significance of having no language barriers in the session, with one of these participants also emphasizing that cultural concordance plays a role in successful communication.…”

“…Interestingly, our findings differ from previous studies which have shown that Spanish-speaking patients do not ask many questions in interpreter-mediated genetic counseling sessions (Ault et al, 2019;Gómez-Trillos et al, 2020;Joseph et al, 2017;Joseph & Guerra, 2015;Kamara et al, 2018). One study attributed this to the use of hypothetical explanations which "inhibited patient engagement and dynamic discussion between GC and patient" (Kamara et al, 2018) while another study noted that this may have been due to the "GC's pace and use of technical language" which can leave patients feeling that they would be unable to understand even if they did ask questions (Joseph et al, 2017) All study participants received healthcare via medical interpreters in the past and most stated they preferred Spanish-speaking providers due to the absence of a language barrier, a finding consistent with previous literature which supports that provider language concordance is preferred among Spanish-speaking patients (Carmichael et al, 2021;de Leon et al, 2022;Gonzalez et al, 2010).…”

“…The results of the present study suggest that language concordance between the GC and patient allowed patients to feel emotionally supported, empowered, and comfortable in sessions, a finding that has been supported in recent genetic counseling studies (Carmichael et al, 2021;de Leon et al, 2022;Garza et al, 2020). Furthermore, while not directly studied here, cultural concordance could have also played a role, which is suggested by previous research as highlighted by this quote: "Women from ethnic minorities may find it difficult to develop a trusting relationship with health-service providers of different cultural backgrounds, especially ones with whom they have had no prior relationship" (Browner et al, 2003).…”

“…This same finding was identified in a study that assessed Spanish‐speaking patients' thoughts on prenatal genetic counseling, where over half of patients were seen by a bilingual GC (Thompson et al, 2015), as well as in the general healthcare literature with language concordant patient and provider (Ngo‐Metzger et al, 2007). A recent study found that bicultural, and oftentimes bilingual, GCs thought patients felt more comfortable asking questions to GCs with whom they shared aspects of identity (i.e., race, ethnicity, or culture; Carmichael et al, 2021). Another recent study found that bilingual GCs also felt that language concordance allowed them to build a relationship with their Spanish‐speaking patients more quickly and enhanced the exchange of information in the session (de Leon et al, 2022).…”