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Paul CR, Devries J, Fliegel J, et al. Evaluation of a Culturally Effective Health Care Curriculum Integrated into a Core Pediatric Clerkship. Ambulatory Pediatrics 2008;8: 195-199

Paul CR, Devries J, Fliegel J, et al. Evaluation of a Culturally Effective Health Care Curriculum Integrated into a Core Pediatric Clerkship. Ambulatory Pediatrics 2008;8: 195-199

Reviewer: William Raszka, MD University of Vennont

What is the problem and what is known about it so far?
The LCME mandates that students demonstrate an understanding of the manner in which people of diverse cultures and belief systems perceive health and illness. Although several curricula for culturally effective health care (CEHC) have been developed, most are dedicated to the pre-clinical years with limited outcome data. Few CHEC have been integrated into clinical practice.

Why did the researchers do this particular study?
Investigators in Michigan sought to evaluate a CEHC curriculum integrated into the clinical experience of third-year Pediatric Clerkship students.

Who was studied?
Third year medical students on the 6 different blocks of the pediatric clerkship students during one year were studied.

How was the study done?
After content review, the CEHC curriculum was divided into three units one of which was incorporation ofCEHC into patient care. Only the application of CEHC in direct patient care was evaluated. The patient care module consisted of six subunits two of which were folk illness and communication. Folk illness was defined as a culturally constructed diagnostic category often in contlict with biomedical paradigms. The proper use of medically knowledgeable translators was emphasized in the communication subunit, which also explored how mediation ofgender and modesty can be a key element in successful communication. A total of 22 students were in the intervention group at a community hospital where CEHC was incorporated into daily practice and 69 completed a standard clerkship at the main teaching hospital. Instructional methods in the intervention group included lectures, role playing, rounds with the hospital's transcultural nurse and the use of students' real-time patient cases during rounds and clinic. Knowledge and attitudes were measured at the beginning and end ofthe clerkship while skills were measured only at the end.

What did the researchers find?
Students in the intervention group demonstrated significantly higher gains in the knowledge scores (42% vs. 5%, observed role modeling (85% vs. 31%), self-perceived skill (82% vs. 19%), and attitude (21% vs. 0%) but not in self-perceived knowledge. The intervention group performed significantly beuer in a three station end ofclerkship OSCE addressing gender/modesty, communication, and folk illness.

What were the limitations of the study?
The study did not seem to span an entire academic year but only a portion. A limited number ofstudents (only 22 in the intervention group) participated. Selection) bias could have been introduced as students were not randomly assigned to sites. We also do not know the demographics of the students participating vs. those not.

What were tbe implications oftbe study?
Tbis study shows that a multifaceted curriculum stressing a general approach to applying principles of CEHC in clinical practice can successfully be incorporated into a pediatric core clerkship with excellent, measurable outcomes. One ofthe most important aspects ofthe study is the observed rate of role modeling in the intervention group. While CE HC principles can be taught, to become integrated into daily patient care, it needs to be demonstrated by faculty in real-time clinical practice.

Ed note: The good news is that this CHEC curriculum could be incorporated into the clerkship experience. [ was, however. struck by the fact that the curriculum was not incorporated into the experience at the main teaching hospital but rather the community hospital. The major teaching hospitals or sites often have too much inertia, cultural baggage, or faculty resistance to be able implement innovative programs such as this. (WVR)

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