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The learning and teaching of cultural diversity in undergraduate medical education in the UK.

By Nisha Dogra

Abstract

The aim of this thesis is to identify and analyse the origins, organisation, contents, delivery and outcomes of the learning and teaching of 'cultural diversity' within undergraduate medical education in the UK. Literature reviews of the history of medical education and relevant educational theory were conducted. Two ideal type models of 'cultural diversity' teaching programmes, designated as the 'cultural expertise' model and the 'cultural sensibility' model, were devised. Comparisons were made between the educational philosophy, educational process, educational content and outcomes of the two models. The models were then utilised as benchmarks against which to analyse and compare approaches and programmes to the teaching of 'cultural diversity'. The main research objective was to identify perceptions and evaluations of the teaching and learning of 'cultural diversity' held by a range of stakeholders in medical education including policymakers, school heads, teaching staff, researchers, students and users. Qualitative interviews of 61 respondents and documentary analysis were undertaken. The key findings are that the origins of 'cultural diversity' education have been driven more by political than educational agendas. As a result, the development of 'cultural diversity' teaching has not been systematic and has been inadequately informed by available theory or evidence. Programmes have evolved through the advocacy of individuals, many of who have not been involved in the development of education strategy. Contents and assessment processes are driven largely by ideas that are consistent with the 'cultural expertise' ideal type but the desired outcomes in clinical practice and for students are more in line with the 'cultural sensibility' model. Ambivalence towards assessment in this area, and the management of students who demonstrate inappropriate attitudes needs resolution since the current position undermines the development of the subject. Specific recommendations for each stakeholder group are included and the thesis concludes with ideas for future research

Publisher: University of Leicester
Year: 2004
OAI identifier: oai:lra.le.ac.uk:2381/4520

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  1. Action against non credible students Community involvement
  2. Am white but would not describe myself as
  3. am white but would not describe myself as such
  4. Applicability of cultural diversity teaching to interdisciplinary teamwork
  5. Are differences made by the skill or information that doctors have?
  6. Are you aware of the GMC perspective on this issue? If so, what is your understanding of it? b. What is your perspective on the GMC including this issue in Tomorrow's Doctors?
  7. Assumption that there is as such a core curriculum for medicine Contents
  8. Assumptions about what actually happens in practice - singular view as though all practice re diversity and managing it is the same.
  9. Assumptions about what doctors can and cannot understand.
  10. Assumptions that older students are "more mature", is that borne out in practice.
  11. Balance between self-reflection and issues such as institutional racism
  12. Balance between what teachers think is necessary and demands made by students 8 1. Cultural bias of teachers
  13. Balancing cultural and clinical need
  14. Being driven to do it to show we are doing it rather than because it is perceived to be important
  15. can you think of how it impacts on practice? For medical schools only
  16. can you think of reasons why this might be the case?
  17. Caucasian F Under 30 Yes In training
  18. Caucasian white female
  19. Caucasian- white doi
  20. Celtic, English and working class F 51-55(53)
  21. Challenging students about how the course has helped or not
  22. Community liaison - is that cultural diversity?
  23. Concept that if people are working in an area with diversity, automatically must be dealing with issues of diversity (a bit like the idea that if Asian seeing Asians must be meeting their needs)
  24. Concepts of negotiation and shared care
  25. Concerns that if do too much on diversity, students will be disengaged.
  26. Conflict of interest e. g. Islamic male students dismissing women
  27. Conflict of interest, patient versus family and confidentiality (raised by A) - clinicians may recognise needs of Asian family's wish to be involved but dismiss the needs of white families based on stereotypes.
  28. Consistency with what programmes do and what people say they do, e. g. is there consistency with Positively Diverse (what was described by one interviewee as being said by the person involved was not what was on the website)
  29. Cultural diversity is now the norm in the community, still seen as new in the curriculum
  30. Cultural diversity officers Ill. Experts to teach students and increase student experience, e. g. Leeds curriculum has lots of different workshops taking place and very little actual focus on self-reflection.
  31. Cultural diversity tests not needed - effective communication Teacher issues
  32. (1998). Cultural safety: a new concept in nursing people of different ethnicities. doi
  33. (2002). Culture, language, and the doctor-patient relationship.
  34. Different aspects being covered in different components of the course
  35. Different roles we have for ourselves
  36. Disadvantages versus advantages of teaching it discretely.
  37. Diversity teaching is just common sense doi
  38. Divisions within disciplines e. g. sociology regarding what is important
  39. Does cdt really just mean racism - is it a nice way of saying let's talk about racism without being explicit.
  40. Does diversity teaching equal equality teaching
  41. Does it need to be popular? doi
  42. Does teaching cultural diversity generate stereotypes 7 1. Range of humanities option so all students do at least one
  43. does the teaching of cultural diversity have an impact on clinical practice?
  44. Early induction to ways of learning doi
  45. Encourage difference compared with minimise it or exaggerate it
  46. Equality of care does it or does it not equal same care (implies needs are the same)
  47. Equitable outcomes of care - what does this mean
  48. Get students to face their prejudices and biases - meet those people, which they have negative and positive perspectives on.
  49. GMC policy as a backup to support arguments
  50. (2003). have any personal training/experience in cultural diversity issues? Appendix Five: Table 10: Information on medical scbools according to diversity programmes, Times ranking and minority populations as at
  51. How am I going to reassure them (gay people) if it's appropriate to reassure them? How is reassuring gay people different from reassuring other people
  52. How are the teaching and political agendas sets? (x talks of "getting into the conscious".
  53. How do we in a sense encourage students to explore people's different ideas and beliefs and concerns without hanging it on a label of race or religion?
  54. How do you think cultural diversity should be taught?
  55. How do you think that the way that these terms are used and understood might influence medical education?
  56. How do you understand the term "cultural diversity"? doi
  57. How long does influence of teaching last (if it has any to start with)
  58. How much time - very few said how much more said what it should not be e. g. a single seminar (unclear whether this represented programmes or practices they have witnessed or participated in)?
  59. How useful is knowledge without an ability to communicate
  60. (1994). Human diversity and professional competence - training in clinical and counselling psychology revisited.
  61. I suppose.
  62. Important that students are trained to think about the people that they are going to be looking after and the families that they are dealing with
  63. Impression that if have practical teaching and experience stereotypes, these will be challenged by the very nature of the experience itself (e.
  64. In your opinion, how do you think programmes that endeavour to teach cultural diversity might be evaluated?
  65. In your opinion, how might their impact on clinical practice be measured?
  66. In your view, could these form models of best practice. (Prompt: have they used an evidence-based approach/been subject to critical evaluation?
  67. Integrating different parts of the curriculum whilst retaining discipline integrity.
  68. Interest in people and the humanities) selection procedures
  69. International health and diversity are interchangeable or the same
  70. Isolation of teachers trying to change the identity and focus
  71. Issue of language - instead of black people have less assumptive descriptions
  72. Knowing they are different - implies all difference is physically visible 3 1. Support from big shots
  73. Language for talking about diversity, the language for the dialogue doi
  74. Listening to people's experiences and not categorising them
  75. lower middle class, doi
  76. Matching the balance of theory with application for students
  77. Meaning or consequences for PRHO monitoring
  78. Medicine as a subculture doi
  79. Mutual learning opportunities for patients to learn about doctors too
  80. Need to encourage learners to explore their baggage - if the baggage comes out there is a chance for an honest discussion
  81. Need to involve all parties, as increased participation reduces perceived threats
  82. Needs of patients from similar background are met and we just need to know about others
  83. Negative views of whites, a bit like whites are ill informed and ignorant re cultural issues and others are not 2 1. Not just an ill considered add on
  84. Negotiating with patients when their value base conflicts with yours. Interview responses
  85. Obvious differences commonly identified, more subtle differences may be ignored
  86. Only interested in outcomes and yet process in this type of teaching may be equally important (links with evaluation) 4 1. Coordination across the curriculum
  87. Other areas of human diversity - from your perspective where do they fit in?
  88. People not knowing how different parts of the curriculum fit together
  89. Problems in clinical care cut across all cultures.
  90. Putting policies into practice - does it actually mean anything Curriculum design issues
  91. Raising awareness in medical students that they are going to have to keep looking at people as individuals
  92. Relationship of cultural diversity and other bits of the curriculum
  93. Role of individuals in pushing forward curriculum as opposed to faculties
  94. Rooting diversity in a specific subject - advantages and disadvantages. How much is conceded to students who don't value the teaching?
  95. Science versus humanities debate? 3 9. Response to GMC - lip service and knee jerk
  96. Scottish ancestry and from
  97. Seizing on what is fashionable and maximising opportunities
  98. Setting the context 5 0. Being able to meet needs of diverse population not just about being nice 5 1. Long term or short term evaluations
  99. Should not be separated out but concern that if this is not done, cultural diversity won't be taught at all.
  100. Should student feedback be gathered? b. If so how might this be done? c. How might student feedback be effectively used? d. What might be your perspective if students said that they did not feel this kind of teaching was necessary?
  101. Should they be taught with cultural diversity or should cultural diversity be a separate course? MCQS Case based problem OSCE Portfolio/reflective diary Self-assessment Other (please specify)
  102. Some degree of consistency needed across medical schools
  103. Some respondents thought they had very good understanding of the issues but then said some very inconsistent things in interviews (e.
  104. Student follow up doi
  105. Students see a great deal of bad practice
  106. Students want security of knowledge
  107. System impacting on doctors to effectively be able to do their jobs
  108. Teachers aware of their own experiences and gripes and when developing cdt how 9 1. The value of teaching in the NHS or the lack of it and to some extent universities Student issues
  109. Teaching diversity as a foundation Policies
  110. Teaching groups of white only and black only groups, advantages and disadvantages
  111. Teaching versus learning doi
  112. The kinds of case scenarios used - do they really test what we want to test
  113. the policy is decided by white men who hold the power
  114. Too inclusive a concept
  115. Treating cultural diversity as other parts of the curriculum
  116. Trivialising the agenda and issue by getting teachers with unclear teaching agendas 6 1. No two people are the same but then for teaching about black issues needs a black person
  117. (2003). Under 30 Appendix Seven: Table 14: Summary of content analysis undertaken on the information available from UK medical school websites as at
  118. Undergraduate and postgraduate continuity doi
  119. What do minority groups "owe" majorities and vice versa.
  120. What do you think should be taught at undergraduate level about cultural diversity?
  121. What main topics do you think that cultural diversity teaching should encompass at undergraduate level?
  122. What specific training programmes to teach cultural diversity are you aware of?
  123. White Anglo Saxon Protestant doi
  124. white male doctors are bad at dealing with patients; conversely not all minorities are intrinsically good at dealing with patients.
  125. White middle class, doi
  126. Who decided which value base we work from
  127. Work with limitations as may be only way to gets started.
  128. Would it be helpful to have guidelines on what should be taught? b. What form might these take and who might develop them? I would now like to move on to specific programmes you may be aware of

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