Self-Assessed Competency at Working with a Medical Interpreter Is Not Associated with Knowledge of Good Practice

BACKGROUND: Specific knowledge and skills are needed to work effectively with an interpreter, but most doctors have received limited training. Self-assessed competency may not accurately identify training needs. PURPOSES: The purpose of this study is to explore the association between self-assessed competency at working with an interpreter and the ability to identify elements of good practice, using a written vignette. METHODS: A mailed questionnaire was sent to 619 doctors and medical students in Geneva, Switzerland. RESULTS: 58.6% of respondents considered themselves to be highly competent at working with a professional interpreter, but 22% failed to mention even one element of good practice in response to the vignette, and only 39% could name more than one. There was no association between self-rated competency and number of elements mentioned. CONCLUSIONS: Training efforts should challenge the assumption that working with an interpreter is intuitive. Evaluation of clinicians' ability to work with an interpreter should not be limited to self-ratings. In the context of large-scale surveys, written vignettes may provide a simple method for identifying knowledge of good practice and topics requiring further training

Reflective Practice Enriches Clerkship Students’ Cross-Cultural Experiences

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

Understanding trauma and child maltreatment experienced in Indigenous communities

This chapter critiques historical and contemporary child protection approaches that are viewed as replicating the colonialist practices of child removal and destruction of families/parenting and communities. Using Australia and Canada as examples, it focuses upon three different sources of the disadvantage and distress that Indigenous communities typically experience: the impacts of Colonisation; intergenerational trauma; and the ongoing social, economic, legal and political inequalities that stem from deep-seated inequity. Public health approaches that are culturally safe and non-stigmatising, community controlled and which embrace early intervention and prevention are needed. Principles are provided for system reforms and innovations in policy and practice. The chapter promotes understanding of the complexity that exists, and why the solutions must be multi-level, and multi-facetted in order to turn around the over-representation of Western viewpoints that drives child protection and the resultant gross over-representation of Indigenous children in these systems. This chapter highlights that despite the scope and scale of issues being faced, Indigenous communities nonetheless have well-developed and resilient informal helping and relational networks that can facilitate healing approaches. Examples are given of community initiatives, strategies, programs and services that herald positive processes and outcomes for Indigenous children, families and communities