Cultural Competency in Medical Education: Demographic Differences Associated With Medical Student Communication Styles and Clinical Clerkship Feedback

University of California, San Diego, San Diego, California, United States
Journal of the National Medical Association (Impact Factor: 0.96). 02/2009; 101(2):116-26. DOI: 10.1016/S0027-9684(15)30823-3
Source: PubMed


We tested the significance of associations among students' demographics, communication styles, and feedback received during clerkships.
US medical students who completed at least one required clinical clerkship were invited between April and July 2006 to complete an anonymous, online survey inquiring about demographics, communication styles (assertiveness and reticence), feedback (positive and negative), and clerkship grades. The effects of self-identified race/ethnicity, gender, and generation (immigrant, first- or second-generation American) and their 2-way interactions on assertiveness, reticence, total positive and total negative feedback comments were tested using factorial analysis of covariance, controlling for age, clerkship grades, and mother's and father's education; pairwise comparisons used simple contrasts. Two-sided P values < .05 were considered significant.
Medical students from 105 schools responded (N = 2395: 55% women; 57% white). Men reported more assertiveness than women (P = .001). Reticence (P < .001) and total positive comments (P = .006) differed by race/ethnicity; in pairwise contrasts, black, East Asian, and Native American/ Alaskan students reported greater reticence than white students (P < .001), and white students reported receiving more positive comments than black, and South and East Asian students. Race/ethnicity-by-generation (P = .022) and gender-by-generation (P = .025) interaction effects were observed for total negative comments; white first-generation Americans reported receiving the fewest and male immigrants reported receiving the most negative comments.
Demographic differences in students' communication styles and feedback they received highlight a need for cultural competency training to improve medical student-teacher interactions, analogous to training currently advocated to improve physician-patient interactions.

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Available from: Dorothy A Andriole, Jun 13, 2015
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    ABSTRACT: Background and Purpose. In 2003, The University of Utah initiated the Cultural Competency and Mutual Respect (CCMR) educational program for the Interdisciplinary Health Sciences Students (IHSS), professionals in medicine (MED), pharmacy (PHARM), nursing (NSG), physical therapy (PT), and others. This 3-year study assessed the pre/post learning outcomes of the CCMR program through Campinha-Bacote’s Inventory for Assessing the Process of Cultural Competence- Revised (IAPCC-R©).1-4 Subjects. A total of 2,124 IHSS students, participating in CCMR learning modules, completed the Inventory for Assessing the Process of Cultural Competence-Revised (IAPCC-R©), with 114 PT and MED subjects as controls. Methods. This study was approved by The University of Utah Health Sciences Center Institutional Review Board. Verbal and written permission was received for use of the IAPCC-R©. Following informed consent procedures, IAPCC-R© pre/post data was collected each semester from fall 2003 through spring 2006. Paired and nonpaired analyses were performed, comparing Cultural Competence (CC) scores and constructs, P < .05, for each discipline, along with demographics. Results. Study outcomes resulted in 1,974 usable, completed inventories, with overall IAPCC-R© pre/post scores demonstrating gains in progression towards cultural competence. In year 2, the curriculum was adjusted based upon student feedback and facilitator input; however, overall CC was not necessarily further enhanced. In terms of CC—Asian, Hispanic, and Other demographic IHSS subject categories outpaced Caucasians. Discussion. Overall CC was improved for all disciplines. In terms of the 5 constructs of CC, results indicated that PT, MED, PHARM, and NSG disciplines attained significant scores for the cultural constructs of “attitudes,” “knowledge,” and “skills” but not “encounters” and “desires.” Although posttest scores indicated marked progressions, approaching CC, IHSS did not yet demonstrate Cultural Proficiency. The constructs of cultural “desires” and “encounters” warrant further curricular enhancement and examination for progression towards attainment of Cultural Proficiency. Conclusion. Results of this 3-year investigation indicate that the IHSS are becoming more Culturally Aware as a result of CCMR program participation and are significantly progressing towards Cultural Competence. However, overall, these interdisciplinary health science student subjects have not achieved the level of Cultural Proficiency. Ongoing support is needed to assist facilitators in teaching matters of Cultural Competence, in a way that is sensitive to the core values, beliefs, and attitudes of health care professionals. Further investigation, in both academic and clinical education, is warranted to examine culturally competent practice opportunities within interprofessional health care interactions and to reduce health care disparities and medical errors for the patients/clients served.
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