Reflective Practice Enriches Clerkship Students' Cross-Cultural Experiences

UCI - Department of Family Medicine, University of California, Irvine, School of Medicine, Orange, CA 92868, USA.
Journal of General Internal Medicine (Impact Factor: 3.42). 05/2010; 25 Suppl 2(S2):S119-25. DOI: 10.1007/s11606-009-1205-4
Source: PubMed

ABSTRACT To describe a curriculum incorporating written reflection followed by reflective discussion with the goal of enhancing students' recognition and handling of cross-cultural and health disparity issues in different healthcare delivery settings. PROGRAM AND SETTING: This required curriculum was implemented within a 4-week family medicine clerkship (n = 188 students, 6 to 12 per rotation) in 23 successive rotations over 2 years. Electronic submission of a written assignment in response to structured questions was followed by in-class discussion in week 4.
Outcomes were students' session evaluations, thematic analysis of student responses, and analysis of faculty facilitators' reflections about discussion sessions. Students' cultural knowledge about their patients' health beliefs around diabetes was assessed using multiple choice questions at the beginning and end of the clerkship.
One hundred percent of students submitted narratives. Student evaluations demonstrated high acceptance, appreciation of sessions and faculty. Analyses of written assignments and in-class discussions identified recurring themes. Students achieved greater synthesis and more nuanced understanding of cross-cultural encounters after discussion. Self-rating of confidence in addressing cultural issues after the curriculum was high at 3.17 +/- SD 0.57 (1-4). Cultural knowledge scores improved significantly. Core components for success were clerkship director support, required participation, experienced faculty facilitators without evaluative roles, a structured assignment and formal forum for trigger question discussion.
Written reflection followed by facilitated peer discussion adds value to simple 'exposure' to cross-cultural clinical experiences for medical students.

Download full-text


Available from: Désirée Lie, Jul 04, 2015
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: This paper addresses the importance of considering cultural characteristics prior to implementing reflective practice into nursing courses. Reflective practice implementation in Eastern countries raises challenges related to differences in the cultural characteristics between Eastern and Western countries. This paper will use Hofstede’s framework to explore and identify the influence of culture on reflective practice in Western and Eastern nursing education and the implications this has for the future implementation of reflective practice in Eastern nursing education.
    Nurse Education Today 08/2014; DOI:10.1016/j.nedt.2014.08.007 · 1.46 Impact Factor
  • Source
    Culture Medicine and Psychiatry 05/2013; 37(2). DOI:10.1007/s11013-013-9315-1 · 1.29 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Background: To reduce cognitive dissonance about one's beliefs or behavior, individuals may compare their behavior to personal and/or normative standards. The details of this reflection process are unclear. Aims: We examined how medical students compare their behavior or beliefs to standards in discussions about implicit bias, and explored if and how different reflective pathways (preserving vs. reconciling) are associated with each standard. Methods: Third-year students engaged in a small-group discussion about bias. Some students and group facilitators also participated in a debriefing about the experience. Using qualitative methods, the transcripts from these 11 sessions were analyzed for evidence of student comparison to a standard and of reflection pathways. Results: Of 557 text units, 75.8% could be coded with a standard and/or a path of reflection. Students referenced personal and normative standards about equally, and preserved or reconciled existing beliefs about equally. Uses of normative standards were associated with preservation-type reflection, and uses of personal standards with reconciliation-type reflection. Conclusions: Normative expectations of physicians are sometimes used to provoke students' consideration of implicit biases about patients. To encourage critical reflection and reconciliation of biased beliefs or behavior, educators should frame reflective activities as a personal exercise rather than as a requirement.
    Medical Teacher 10/2012; 35(4). DOI:10.3109/0142159X.2012.733453 · 2.05 Impact Factor