Examining First-Year Medical Students’ Attitudes toward Cross-Cultural Training in Medical Education

Abstract

In recent years, cultural competency instruction has become an important component of the medical education curriculum. [1][2][3][4][5] The push to include cultural competence is, in part, a response to the prediction that by 2060, less than half of the US population will identify ethnically as non-Hispanic White, and almost a third of the population will be Hispanic. 6 It is also expected that the number of individuals with limited proficiency in English will increase. 6 Such demographic changes make cultural competence an essential component in providing appropriate health care. The Liaison Committee on Medical Education (LCME) has codified the importance of cultural competence in its standards for medical students noting that "developing an understanding of the manner in which people of diverse cultures and belief systems perceive health and illness" is necessary to deliver health care effectively. 7Cultural competence can be defined as the integration of behaviors, attitudes, and knowledge that are effective in cross-cultural situations. 8 To that end, cultural competence has been identified as a major component of the year-long Becoming A Physician I (BAP I) course developed for first-year students at the Texas A&M Health Science Center College of Medicine (TAMHSC-COM). BAP I is intended to be a professional formation course that focuses on ethics, professionalism, communication, cultural competence, end-of-life care, systems-based practices, and evidenced-based medicine. This study was undertaken for three reasons:Purpose: The purpose of this study was to understand how first-year medical students perceived their knowledge, skills, and attitudes in five cultural competence domains and how those perceptions changed after several targeted cultural competence interventions within a medical school course. This study also examined the students' perceived importance of including information about these cultural competency domains in their medical curriculum. Method: As part of a professional formation course, first-year students at a Texas medical school were asked to complete an online version of the Pre-Medical Education Student Survey on Cross-Cultural Issues (Pre-MESS-CCTI) before and after an intervention regarding cultural competence. The intervention consisted of: 1) an introductory in-class lecture on cultural competence, 2) outside readings and video excerpts regarding cultural competence, and 3) a clinically-based case discussion presented in four modalities. Responses were analyzed using a repeated-measures General Linear Model.Results: Of the 200 students in the course, 161 agreed to participate in the study. A total of 144 valid pre-and post-course assessments were submitted for a 72% response rate. Results indicate significant increases in knowledge and skills across all five domains and a significant decrease on two of the five attitude scales. No statistically significant changes were found pre-and post-intervention on the importance of cross-cultural training in medical education. Conclusions:Res...