Integrating Theory, Content, and Method to Foster Critical Consciousness in Medical Students: A Comprehensive Model for Cultural Competence Training

Abstract

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.

The ‘exotic other’ in medical curricula: Rethinking cultural diversity in course manuals

“…As possible solutions to the challenges of dealing with cultural diversity, othering and stereotyping, scholars have proposed the concepts of 'intersectionality' (Tsouroufli et al 2011;Mclean 2012;Powell Sears 2012;Monrouxe 2015;Verdonk et al 2015;Muntinga et al 2016), 'critical consciousness' (Kumagai and Lypson 2009;Dao et al 2017;Halman et al 2017) and 'insurgent multiculturalism' (Wear 2003). The intersectionality framework, introduced as concept to alleviate health disparities, 'maintains that racial and ethnic minority groups hold multiple social statuses, called social locations, which interact with one another to uniquely shape the health views, needs and experiences of the individuals within the groups' (Powell Sears 2012).…”

Cultural hegemony? Educators’ perspectives on facilitating cross-cultural dialogue

“…Implementation will require training faculty and students to handle culturally sensitive topics and curriculum design to explicitly incorporate issues related to cross-cultural issues. This process by itself may be a transformative experience for faculty and students (44). …”

Missing the target? Teaching undergraduate medical students to “go upstream” and advocate on social determinants of health

“…This initiative includes five intersecting knowledge and skill-sets, including recognizing the structures that shape clinical interactions, developing an extra-clinical language of structure, rearticulating "cultural" formulations in structural terms, observing and imagining structural interventions, and developing structural humility. 10 This framework has been utilized by educators in pre-health curriculum, 11 pre-clinical education, 12 and as a checklist by clinical trainees. 13 Within this framework, we developed and piloted a brief curricular intervention to allow medical students to practice advocacy.…”