COMSEP 2008 Atlanta Meeting
Enhancing Cultural Competence Education in a Pediatric Core Clerkship- Preliminary Results of a Qualitative Analysis of Students - Reflective Responses to Disparities in Access to Health Care
Sajjad A.Yacoob, Frank R. Sinatra, Madeleine Bruning,
Keck School of Medicine at the University of Southern California
Introduction: The Keck School of Medicine at the University of Southern California developed a four-year integrated curriculum in cultural competence. It was not clear, however, the best ways to design a curriculum that is contextually meaningful for students. Can the “implicit” nuances of professional behavior be captured and made into “explicit” lessons? Although students may recognize that humanistic care is an essential element of “doctoring”, the exercises or methods used to teach intangible attitudes are commonly perceived by students as disconnected from the required clerkship.
Objective: To determine whether incorporating a reflective writing component was an effective teaching strategy to increase the students’ awareness and response to identified disparities in health care access through qualitative analysis.
Method: A convenience sample of 164 third year medical students in the Pediatric Core Clerkship participated in this curriculum intervention. Using one of the clerkship’s core competencies as the pillar, “Provide health care to a diverse, multicultural patient population and recognize the impact of social, cultural and spiritual beliefs and practices upon the physician and patient relationship and management of disease”, an existing literature/evidence based case assignment was modified to incorporate a reflective component. The central premise of this approach was a deliberate and conscious decision to make the assignment contextually relevant to actual patient care. Selected current resources were accessible to the students through the web-based course platform and a list of “guiding questions” to prompt reflective thinking/action were available for students to review. One hundred and sixty two students papers from two sites were read and coded by faculty members.
Results: The students’ reflective writings identified eight general elements related to disparities in access to health care. More importantly, their statements revealed the impact of the encounter upon their learning and how this might affect their future behaviors and actions as physicians. Themes from these reflective statements were grouped into three categories: Knowledge-attainment of facts/information, Process- howstudents’ utilized the new knowledge to help their patients and Awareness- students’ feelings/beliefs about the encounter.
Conclusion: Preliminary findings from a qualitative analysis indicate that a reflective writing component enables students to increase their awareness and response to disparities in access to health care, allowing students to take pause about humanistic care and compassionate role of the physician. Addresses LCME curriculum requirements related to culturally sensitive care, life-long learning and self knowledge.