cultural competence in medical european patterns and a€¦ · og ”sted og dato”: stereotypes,...

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Research Center for Migration, Ethnicity and Health

Janne Sørensen

Research coordinator

Allan Krasnik

Professor, Centre director

Cultural competence in medical educations – European patterns and a Danish case

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Project framework

Purpose: To support the future doctors with competencies that enable them to offer good quality health care to all groups in a diverse European population. Development of guidelines for implementation of cultural competences in medical education at European Universities.

13 partnere from 11 countries (10 EU + USA),

Coordinator: University of Amsterdam

Funds from EU – Lifelong Learning Programme

The project was carried out October 2013 - September 2015 2015.

Outcome – 3 articles (BMC Medical Education, Eur J Pub Health, Ugeskrift for Læger)


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Project components

1. Review of course materials from the medical education program at the University of Copenhagen

2. Survey of the CC level in the European medical education programmes

3. Survey of CC among faculty staff at the medical education program at the University of Copenhagen


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1. Review of course materials

• The purpose was to identify where CC and diversity are included in the curriculum

• Relevant courses (14) were selected based on the curriculum plan

• The course materials (Fall 2013) was found in Absalon – both the teacher's PP and available literature was reviewed

• Keywords that relate to CC:

Ethnicity, diversity, culture, migration, language, inequality, vulnerable, exposed, communication, stereotypes, socioeconomic status, demographic, religion, social conditions, norms, traditions


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Review of course materials

• There was limited but some relevant content in each of the 13 of the 14 selected courses (course materials from the clinical course in internal medicine was not available)

• CC is not systematically addressed in the courses - up to 11 parallel classes and large variations between the classes regarding CC



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2. Survey of the CC level in the EU medical education programmes

• Survey developed to uncover gaps and challenges in relation to implementation of CC in curriculum

• 32 questions divided in 5 domains including:

courses and curriculum, staff composition and competencies, resources, management, policies and support and students composition and competencies

• Quantitative component with three response categories: yes, no and partly. A free text field to add a qualitative component

• Distributed to C2MEs 12 European partners and 13 questionnaires were returned (two from Norway)

• The project represents 4% of EU’s 312 medical programmes


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0

2

4

6

8

10

12

1.1.1. The

curriculum

includes

learning

outcomes on

knowledge

about key

social science

concepts

including

"culture" and

"ethnicity"

1.1.2. The

curriculum

includes

learning

outcomes on

knowledge of

how social and

cultural factors

can effect

health, health

related

behaviors, and

healthcare

1.1.3. The

curriculum

includes

learning

outcomes on

knowledge

about key

patient

population

groups to be

identified for

any local site

1.1.4. The

curriculum

includes

learning

outcomes on

awareness of

implicit

attitudes,

including how

one's own

norms, values

and biases may

affect health

care provision

1.1.5. The

curriculum

includes

learning

outcomes on

awareness of

how culture

shapes

individual

behaviour and

thinking

(including the

cultures of

medicine).

1.1.6. The

curriculum

includes

learning

outcomes on

abilities to work

effectively with

an interpreter

1.1.7 The

curriculum

includes

learning

outcomes on

abilities to

identify and

take into

account socio-

cultural factors

that may

influence

patient care

1.1.8. The

programme

includes

evaluating the

students in the

7 key cultural

competencies

mentioned

above (1.1.1 to

1.1.7)

Nu

mb

er o

f In

form

an

ts

1.1. The curriculum of the medical programme includes learning outcomes on 7 key cultural

competencies Yes Partly No



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0

1

2

3

4

5

6

7

8

9

1.2.1. The medical educational

programme includes specific courses on

CC training

1.2.2. CC training is integrated in the

medical educational programme

courses

1.2.3. Course materials and literature

reflects cultural diversity

Nu

mb

er o

f In

form

an

ts

1.2. The medical education programme has included cultural competence as part of the

courses

Yes Partly No



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0

2

4

6

8

10

12

14

2.2.1. The medical education

programme monitors and evaluates CC

among the teaching staff

2.2.2. CC training is integrated in

courses on teaching skills for teaching

staff members

2.2.3. New staff is introduced to CC

approaches

Nu

mb

er o

f In

form

an

ts

2.2. The teaching staff receives training in cultural competence which is monitored and evaluated

regularly

Yes Partly No



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0

2

4

6

8

10

12

3.1. The organization

and/or the medical

education programme

has earmarked funding

for activities related

explicitly to support

cultural diversity among

students

3.2. The medical

education programme

has specific resources

for development of

courses and production

of CC related teaching

material and tools

3.3. The medical

education programme

provides specific

resources for

international exchange

of staff members

3.4. The medical

education programme

provides specific

resources for

development and

maintenance of

websites related to CC

3.5. The medical

education programme

provides specific

resources for expert

consulting regarding CC

Nu

mb

er o

f In

form

an

ts

3. Resources

Yes Partly No



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0

1

2

3

4

5

6

7

8

9

10

4.1.1. The medical education

programme strategy shows

commitment to CC values

4.1.2. The host

organization(institutional

framework such as a hospital,

University etc..) of the medical

education programme strategy

shows commitment to CC

values

4.1.3. The strategy is

supported by key stakeholders

within and outside the medical

education programme

4.1.4. The organization has

appointed a special curriculum

advisor to support CC in the

curriculum

Nu

mb

er o

f In

form

an

ts

4.1. The organization has a strategy for CC and cultural diversity

Yes Partly No



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0

1

2

3

4

5

6

7

8

9

5.2.1. The students acquire the ability to be aware of their

own cultural bias through the medical education programme

5.2.2. CC acquired by the students in the medical education

programme are adequate for future jobs in the health care

service of your country

Nu

mb

er o

f In

form

an

ts

5.2. The students acquire cultural competence adequate for future jobs through the medical

education programme

Yes Partly No



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Yes, to a high degree; 1

Yes, to some extent; 8

No, only quite limited; 3

0

1

2

3

4

5

6

7

8

9

6.1. Overall does your medical education programme strengthen students’ cultural competence?

Nu

mb

er o

f In

form

an

ts

6. General assessment



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Major limitations in the commitment and practice within the educational programs regarding:

•Curriculum content •Resources •Organizational strategies on different levels •Support and training of teachers and students

Only 1 out of 13 assess that the students acquire adequate CC to perform future jobs in the health care sector Medical Deans and Directors are key actors in a process of change focusing on strategies and resources for promoting:

•educational policies •definitions of targets and outcomes •training of teachers •assessing the effect among the students

Conclusions


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3. Survey of CC among faculty staff at the medical education program

• The survey was sent to:

• All scientific staff at Departments that teach at the medical education programme

• All clinical staff

• All external lectures

• The survey was distributed through the departments’ mail list and to external lectures

• The estimated number of recipients of the survey is between 1400-1430

• The response rate is approximately 14%(N=199)


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Charasteristics of informants

Age <30 years = 0.5%

31-50 years =36.9%

>50 years = 62.6

Gender Male =49,2%

Female = 49.2%

Department BMI = 1.5%

ICMM = 6.6%

IKM = 68.4%

ISIM = 2.6%

RI = 2%

INF = 4.1%

IFSV = 16.8%

Others = 1%

Self-rated Yes = 10.3%

minority status No = 89.7%

Completed courses Yes = 12.1%

or traning in CC No = 87.9%


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9,5 4,0

9,5 11,0

24,2

13,6

41,2

28,6

66,2

82,4

49,2

60,3

0

10

20

30

40

50

60

70

80

90

Care providers look at

health problems through

their own cultural lens

Medical education should

include training about

cultural issues

I recognize when my

reactions are based on

prejudices

During medical school

students must be

assessed for skills in

cultural competence

Percen

tag

e

Opinions about cultural competence in healthcare and medical education

Disagree Neither disagree nor agree Agree


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29,1

21,5 24,5

22,1 22,4 25,0

48,7

56,1 50,5

0

10

20

30

40

50

60

70

Prepared how to explore the patient’s

cultural and religious beliefs that could

have an impact on their care

Prepared how to work effectively with

interpreters

Prepared about migrant health

(epidemiology, social determinants,

access and barriers to care, etc.)

Percen

tag

e

Preparedness to teach cultural competence topics to medical student

Unprepared Neither unprepared nor prepared Prepared


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10,5 16,6

3,6 0,5

24,6 23,6

8,1 8,6

64,8 59,8

88,4 90,9

0

10

20

30

40

50

60

70

80

90

100

Prepared to teach students

from a range of diverse cultural

and religious backgrounds

Prepared to examine your own

cultural biases that may

influence your behavior as a

teacher

Prepared to engage, motivate

and encourage participation

among all students when

teaching

Prepared to create a safe and

open atmosphere for all

students when teaching

Percen

tag

e

Prepared to teach students from a range of diverse cultural and religious backgrounds

Unprepared Neither unprepared nor prepared Prepared


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11,1 12,0 8,6 7,6

19,8 19,1 23,2 20,7

69,0 68,8 68,2 71,7

0

10

20

30

40

50

60

70

80

Interested in receiving training

on how to explore the patient’s

cultural and religious beliefs

and practices that could have

an impact on care


on how to work effectively with

interpreters


about migrant health

(epidemiology, social

determinants, access and

barriers to care, etc.)


on how to help students

explore their own perspectives

and values and how these may

influence their future practice

Percen

tag

e

Interest in receiving training on teaching cultural competence topics and teaching a diverse classroom

Uninterested Neither uniterested nor interested Interested


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13,0 8,6 10,1

21,6 20,7 21,8

65,3 70,7

68,1

0

10

20

30

40

50

60

70

80

Interested in receiving training on how to

integrate cultural competence topics in

the medical curriculum


teach students from a range of diverse

cultural and religious backgrounds


examine your own cultural biases that

may influence your behavior as a teacher

Percen

tag

e

Interest in receiving training on teaching cultural competence topics and teaching a diverse classroom

Uninterested Neither uniterested nor interested Interested


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7,5

17,6

74,9

0

10

20

30

40

50

60

70

80

Unimportant Neither unimportant nor important Important

Importance of incorporating cultural competence topics into the medical school curriculum


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Conclusions

• Low response rate - probably considerable selection

• Widespread recognition of the need for CC

• Around half assess that that they have sufficient knowledge for teaching CC topics

• 60-90% assess that they are prepared for teaching a diverse student group

• Approximately 70% are interested in receiving training in different CC elements

• Approximately 75% think it is important to include CC in curriculum



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What could be done to encourage and support medical teachers to incorporate cultural competence into their teaching activities

Teachers level

Need for courses on the subject

• Change their education level. Most teachers are totally ignorant about their students background when different from them.

• Medical teachers should be encouraged to spend time abroad in countries and institutions where habits and values differ from their own.

• Train the trainers in these subjects. Make it a mandatory part of patient clinics

Ideas for teaching methods

• Generally more focus on communication. As part of communication cultural/religious background of student/patient/affiliation should be included.

• To illustrate what problems in health care that may be caused by lack of knowledge of cultural differences



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What could be done to encourage and support medical teachers to incorporate cultural competence into their teaching activities


Faculty or administration level

• Engage faculty with different cultural background

• Incorporate it in the curriculum of several courses where appropriate, and include it in the exams.

• Just start to put it on the curriculum

Other comments • I find it very biased the way to look at cultural differences. I do not find it very important in my line of work, and I think it often is a much bigger problem that cultural background must be emphasized instead of the human being instead.


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Any further thoughts or comments

Overall comments regarding the subject of cultural competencies

• A great initiative. Hope you will follow up with relevant training initiatives, because this is really relevant to move healthcare to the next level, where we want to fight the inequity in healthcare and involve the patient.


cultural competence in medical european patterns and a€¦ · og ”sted og dato”: stereotypes,...

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