Empowering Students With Cultural Competence Knowledge: Randomized Controlled Trial of a Cultural Competence Curriculum for Third-Year Medical Students

Formal training in cultural competence for health care providers has become vital as the US population continues to become increasingly culturally diverse. However, a low percentage of medical schools offer formal training in this area, and there is a lack of curriculum evaluation reported in the literature

Anti-Black racism in clinical supervision:asynchronous simulated encounters facilitate reflective practice

Background: Racist interactions in clinical practice remain a pervasive reality for Black healthcare providers. We sought to develop a framework to inform supervisors' actions when confronting racism in clinical practice and protecting trainees under their oversight.Methods: We conducted a qualitative study in which experienced supervisors responded to seven short, videotaped interactions between: 1) Black trainees and a simulated patient (SP) in a racist role; 2) the trainees and their respective supervisors; and 3) the trainees and their supervisors together with the SP. The clinical exchanges exemplified different types of racist (entrenching) or antiracist (uprooting) behaviors by the supervisors. After viewing each clip, participants wrote their reflections confidentially; they later joined a structured debriefing together. We used thematic analysis to identify supervisors' behavioral patterns when confronting racist interactions.Results: Based on the input of 52 participants recruited into five two-hour-long sessions, we categorized the behaviors of supervisors facing anti-Black racial injuries involving learners under their oversight. We organized supervisor behaviors into five interlocking domains, each with a range of possible themes: 1) Joining: from conciliatory to confrontational in communicating with the aggressor; 2) Explicitness: from avoiding to naming racism; 3) Ownership: from individual to shared responsibility of the event and the response to it; 4) Involving: from excusing to including the aggrieved party when confronting the aggressor; and 5) Stance: from protective to paternalistic in supporting the learner's autonomy.Conclusions: Our qualitative findings can provide a framework for facilitated discussion toward reflective practice among healthcare providers who may have experienced, witnessed, or intervened in anti-Black racist interactions. They can also help medical educators to inform faculty development to fight anti-Black racism in clinical practice. The video materials we developed are available for viewing and download and can be used or adapted as springboards for reflective discussion or faculty development activities. </p

Knowledge of cultural competence among third-year medical students.

An increasingly diverse population and ongoing health disparities have brought national attention to cultural competence training in medical schools. However, few data exist on medical students' knowledge in cultural competence. The purpose of this study is to assess medical students' knowledge in cultural competence to identify training areas for curriculum development. All third-year medical students at a single institution during the period of November 2001 to February 2004 completed a questionnaire to assess their knowledge of cultural competence during their medicine clerkship. The 40-item questionnaire measured several domains of cultural competence: health disparities, stereotyping, exploring culture, perceptions of health and illness, and communication/language. The mean knowledge score was 55%, and no student scored >80%. Race and prior cultural training were not predictors of overall performance

Medical student intentions to practice internal medicine in underserved areas associated with debt, identity and extracurricular participation

Abstract Background Currently, Internal Medicine (IM) physicians do not reflect the ethno-racial diversity of the US population. Moreover, there is a shortage of IM physicians in Medically Underserved Areas (MUAs) in the US. The purpose of this study was to determine factors that influence medical students’ intent to practice IM in MUAs. We hypothesized students with intentions to pursue a career in IM and work in MUAs were more likely than their peers to identify as underrepresented in medicine (URiM), report greater student debt loads, and report medical school experiences in cultural competencies. Methods We analyzed de-identified data of 67,050 graduating allopathic medical students who completed the Association of American Medical Colleges’ (AAMC) Medical School annual Graduation Questionnaire (GQ) between 2012–2017 by multivariate logistic regression models, examining intent to practice IM in MUAs based on respondent characteristics. Results Of 8,363 students indicating an intent to pursue IM, 1,969 (23.54%) students also expressed an intent to practice in MUAs. Students awarded scholarships, (aOR: 1.23, [1.03–1.46]), with debt greater than $300,000 (aOR: 1.54, [1.21–1.95], and self-identified non-Hispanic Black/African American (aOR: 3.79 [2.95–4.87]) or Hispanic (aOR: 2.53, [2.05–3.11]) students were more likely than non-Hispanic White students to indicate intent to practice in MUAs. This pattern also existed for students who participated in a community-based research project (aOR: 1.55, [1.19–2.01]), had experiences related to health disparities (aOR: 2.13, [1.44–3.15]), or had experiences related to global health (aOR: 1.75, [1.34–2.28]). Conclusions We identified experiences and characteristics that associate with intention to practice IM in MUAs, which can aid future curricular redesign by medical schools to expand and deepen comprehension of health disparities, access to community-based research, and global health experiences. Loan forgiveness programs and other initiatives to increase recruitment and retention of future physicians should also be developed