Cross-cultural medical education: Using narratives to reflect on experience

Introduction. Educating students in a multi-cultural society is a challenge as teachers, students and the community they serve all tend to representvarious social groups. Skills alone are not adequate for competency in understanding cultural aspects of consultations. A combination of knowledge, skills and attitude is the most widely accepted current approach to teaching culturally competent communication to medical students. Collaborative reflection on narratives of experienced clinicians’ cultural encounters served to construct an understanding of how to develop these attributes.Process. An interest group of medical teachers met to address the specific needs of teaching a relevant cross-cultural curriculum. Participants offerednarratives from their professional life and reflected on these encounters to understand how to improve the current curriculum to better address theneeds of the students and patients they serve.Results. Through narratives, participants were able to reflect on how their experience had allowed them to develop cultural awareness. All storiesrepresented how attitudes of respect, curiosity and unconditional positive regard were held above all else. The process of collaborative reflection withpeers unpacked the complexity and potential in the stories and different learning opportunities were discovered. Learning was personalised becausethe stories were based on real experiences.Conclusion. The use of collaborative reflection on narratives of clinical encounters could facilitate insights about cultural aspects of medical practice. Elements such as curiosity, respect and unconditional positive regard are illustrated in a unique way that allows students to appreciate the real-life aspects of cross-cultural clinical encounters

Hamstring muscles: Architecture and innervation

Knowledge of the anatomical organization of the hamstring muscles is necessary to understand their functions, and to assist in the development of accurate clinical and biomechanical models. The hamstring muscles were examined by dissection in six embalmed human lower limbs with the purpose of clarifying their gross morphology. In addition to obtaining evidence for or against anatomical partitioning ( as based on muscle architecture and pattern of innervation), data pertaining to architectural parameters such as fascicular length, volume, physiological cross-sectional area, and tendon length were collected. For each muscle, relatively consistent patterns of innervation were identified between specimens, and each was unique with respect to anatomical organization. On the basis of muscle architecture, three regions were identified within semimembranosus. However, this was not completely congruent with the pattern of innervation, as a primary nerve branch supplied only two regions, with the third region receiving a secondary branch. Semitendinosus comprised two distinct partitions arranged in series that were divided by a tendinous inscription. A singular muscle nerve or a primary nerve branch innervated each partition. In the biceps femoris long head the two regions were supplied via a primary nerve branch which divided into two primary branches or split into a series of branches. Being the only muscle to cross a single joint, biceps femoris short head consisted of two distinct regions demarcated by fiber direction, with each innervated by a separate muscle nerve. Architecturally, each muscle differed with respect to parameters such as physiological cross-sectional area, fascicular length and volume, but generally all partitions within an individual muscle were similar in fascicular length. The long proximal and distal tendons of these muscles extended into the muscle bellies thereby forming elongated musculotendinous junctions. Copyright (C) 2005 S. Karger AG, Basel

Experiential learning outside the comfort zone: Taking medical students to downtown Durban

Introduction. The ability to communicate across cultures requires a combination of knowledge, skills and attitude. Our current medical school curriculum includes innovative methods of teaching communicative knowledge and skills. Our aim is to encourage students to examine their attitudes toward patients from social groups and cultures other than their own and, ultimately, to interact with empathy in a multicultural society.Method. An experiential learning technique where students were given various tasks intended to improve their attitude towards cross-cultural learning.Results. A number of students expressed appreciation at being in a multicultural group, having a shared experience, and engaging in open and respectful discussion about similarities and differences.Conclusion. Students need to be involved in activities that encourage them to examine their attitudes and develop respect for patients from cultures other than their own. We suggest ways in which learning experiences of this type can be integrated within the medical undergraduate programme

Chain of Testimony: The Holocaust Researcher as Surrogate Witness

Despite extensive critical debate, a positivist view of historical research which aspires to a dispassionate engagement with sources is still rife. Yet certain types of traumatic material, such as survivors' testimony and the Scrolls of Auschwitz, evoke powerful emotions and can stimulate in the researcher various kinds of phantasy. Is there some way that we can address these issues without ‘psychologising’ the Holocaust and Holocaust research? Can we simultaneously respect the historical material, the memory of the victims and the often unruly feelings that Holocaust research can excite? Can rigorous analysis sit comfortably alongside a more psycho-dynamically reflexive stance, and might the process of research be enriched by it? This paper discusses these issues through the concept of a ‘chain of testimony’ into which the researcher is inserted, thereby becoming in some sense a surrogate witness. It reflects upon the psycho-social dimensions of my own work and that of other children of Holocaust survivors, as well as other researchers in the field, including those examining the Scrolls of Auschwitz