Applying theory to the design of cultural competency training for medical students: a case study.

Although literature suggests that providing culturally sensitive care promotes positive health outcomes for patients, undergraduate medical education currently does not provide adequate cultural competency training. At most schools, cultural competency, as a formal, integrated, and longitudinal thread within the overall curriculum, is still in its infancy. In this article, the authors summarize the current practice of cultural competency training within medical education and describe the design, implementation, and evaluation of a theoretically based, year-long cultural competency training course for second-year students at Wake Forest University School of Medicine. Evaluation of the results indicate that the course was successful in improving knowledge, attitudes, and skills related to cultural competence as well as bringing about positive changes in the medical school's approach to cultural competency training. Also discussed are the implications of the outcomes for the development of culturally competent physicians and how using appropriate theory can help achieve desired outcomes.     

Integrating ultrasound into modern medical curricula

Ultrasonography is widely practiced in many disciplines. It is becoming increasingly important to design well‐structured curricula to introduce imaging to students during medical school. This review aims to analyze the literature for evidence of how ultrasonography has been incorporated into anatomy education in medical school curricula worldwide. A literature search was conducted using multiple databases with the keywords: “Ultrasound OR Ultrasonographic examination*” and “Medical student* OR Undergraduate teaching* OR Medical education*” and “Anatomy* OR Living anatomy* OR Real‐time anatomy.*” This review found that ultrasound curricula vary in stage of implementation, course length, number of sessions offered to students as well as staffing and additional course components. Most courses consisted of didactic lectures supplemented with demonstration sessions and/or hands‐on ultrasound scanning sessions. The stage of course implementation tended to depend on the aim of the course; introductory courses were offered earlier in a student's career. Most courses improved student confidence and exam performance, and more junior students tended to benefit more from learning anatomy with ultrasound guidance rather than learning clinical examination skills. Students tended to prefer smaller groups when learning ultrasound to get more access to using the machines themselves. Ultrasonography is an important skill, which should be taught to medical students early in their careers as it facilitates anatomical education and is clinically relevant, though further objective research required to support the use of ultrasound education as a tool to improve clinical examination skills in medical students. Clin. Anat. 30:452–460, 2017. © 2017 Wiley Periodicals, Inc.     

Pathology graduate medical education (overview from 1926 to 2005)

Postgraduate training of pathologists in the United States dates from 1926. From 1926 to 1936, certification was developed as a measure of competence for the public. In 2000, competence was redefined by the Accreditation Council for Graduate Medical Education (ACGME) Outcome Project for all physicians-in-training as mastering "the six competencies." These consist of (1) patient care, (2) medical knowledge, (3) practice-based learning and improvement, (4) interpersonal and communication skills, (5) professionalism, and (6) systems-based practice. The Outcome Project emerged in parallel with the American Board of Medical Specialties' Maintenance of Certification Project for all physicians. Outcome measures and benchmarks are the methods by which competence in medical practice will be measured for the public. Trends in pathology graduate medical education previously reported in 2001 (Hum Path 2001;32[7]:671-676) are updated through 2005 and reviewed. Demographic data regarding number and size of programs, curricula initiatives for pathology, changes in assessment, and outcomes information on certificates issued are discussed. Factors shaping pathology residency training are reviewed, as well as future trends that will impact training curricula.     

Inclusion of person-centred care in medical and nursing undergraduate curricula in the UK: Interviews and documentary analysis

ObjectiveWe aimed to understand how person-centred care (PCC) is represented in UK professional standards for undergraduate medical/nursing education and explored how these are reflected in programme provision.MethodsWe identified PCC components in medical (GMC) and nursing (NMC) professional standards and university curricula documents provided. We also identified themes from interviews with high-level informants for medical/nursing undergraduate programmes using framework analysis.ResultsThe GMC appears to promote a more paternalistic model of care with discrete PCC components in specific sections and the NMC a more collaborative model with PCC distributed throughout. These differences persisted into education delivery. Medical educators perceived greater barriers to inclusion of PCC than nursing educators; however, both consistently identified cultural and organisational attributes. Clarity was lacking regarding PCC definition, how to teach/assess PCC, and competence expectations.ConclusionDevelopment of a PCC skills competence framework would increase consistency and support teaching and assessment in undergraduate curricula. Further research to understand the perspectives of healthcare professionals involved in placements would help inform PCC teaching recommendations.Practice ImplicationsHigh-level support from senior HEI leaders; multi-disciplinary approaches to curricula development, teaching, and assessment; and greater inclusion of service users would ensure higher quality PCC education for undergraduate students.     

Academic guidelines for the creation of a medical school curricula in Mexico

Medical training curricula is a constantly evolving field. The objective of the present study is to analyze the changes the field has undergone. Our sources of information include demographic and health surveys, surveys carried out with students and faculty members and medical school guidelines from prestigious teaching centers. We compared medical curricula offered in Mexico as well as international trends. We analyzed context requirements, current status and future trends in biological, sociomedical and clinical disciplines; research and teaching methods; adequate academic programs. We describe the state of affairs in medical teaching in Mexico and the challenges that academic programs are currently facing. We propose a curricula with horizontal and vertical planning according to skills and competences that focus on health problems to foster scientific reasoning. Teaching strategies that are student-focused and foster significant/long-lasting learning. We suggest the need to include early clinical activities, communication skills and training in technological resources. Finally, there is a need to define a teaching profile that is consistent with training programs, to include experts in technology and modern teaching methods in order to establish permanent monitoring mechanisms, and to offer incentives to academics and administrative personnel.     

Training inter-physician communication using the Dynamic Patient Simulator

PURPOSE: Clear and adequate communication between physicians is essential in modern medicine. Nevertheless, the medical curricula in The Netherlands lack an identifiable part in their education concerning inter-physician communication training. To train medical students in inter-physician communication skills using the Dynamic Patient Simulator (DPS), the Academic Medical Center at the University of Amsterdam and the Leiden University Medical Center joined in a 2-year project sponsored by the Dutch government. DPS is an educational computer program to create and simulate virtual patients with a wide variety of medical conditions in different clinical settings and over different time frames. To evaluate whether DPS is a suitable method for training medical students in inter-physician communication, we assessed if medical students felt that they had improved their inter-collegial communication skills after the pilot with DPS. Besides, we inquired students on DPS' usability and their satisfaction with DPS. METHODS: We first developed and implemented 20 patient simulations in DPS to be practiced upon by two students asynchronously during a week. These students were situated in different medical institutions, geographically spread over The Netherlands and had to treat the virtual patient as a team supported by DPS. The students had to report their findings and treatment plan in the electronic referral form of DPS. A total of 134 students participated in the pilot. To evaluate inter-physician communication training using DPS we conducted a survey amongst these students who were entering their internships. The evaluation focused on self-assessment of their communication skills, usability of the DPS program, and their satisfaction with DPS as educational format, using multiple questionnaires. DISCUSSION: The outcome of the evaluation showed significant progression in students' feeling of improvement of their skills in different aspects concerning the referral of a patient after participating in the pilot. Besides, students evaluated the usability of DPS positive and were highly satisfied with the education in inter-physician communication training using DPS. Based on these outcomes, nowadays this form of training is incorporated in the curricula on a regular basis.     

Development of a curriculum in cultural determinants of health and health disparities

IntroductionCurrent sociopolitical events coupled with requirement modifications by the Liaison Committee on Medical Education have reinvigorated a need for training in cultural awareness and health disparities in undergraduate medical education. Many institutions, however, have not established longitudinal courses designed to address this content. Additionally, little is known about the change in learners’ awareness of cultural determinants of health and health disparities after enrollment in such curricula. In 2016, the authors developed a yearlong required course entitled Cultural Determinants of Health and Health Disparities for first year medical students at a large university medical school in the United States. The course launched in the 2017 academic year.MethodsTwo cohorts participated in twelve 2.5 to 3-hour multi-modal sessions focused on various aspects of healthcare delivery for marginalized populations and factors that contribute to health disparities. The Multicultural Assessment Questionnaire was used pre and post course to assess students’ self-evaluated changes in knowledge, skills, and awareness related to cultural competency in healthcare.ResultsStudents’ self-reported knowledge, skills, and awareness scores regarding cultural competence in health care increased from pre to post-course assessment. On the knowledge scale, students’ mean score increased from 2.63 to 2.97 (P < .001), with 16% reporting a decreased score, 30% reporting no change, and 54% reporting growth. On the skills scale, students’ mean score increased from 2.64 to 3.38 (P < .001), with 11% reporting a decreased score, 17% reporting no change, and 72% reporting growth. On the awareness scale, students’ overall score increased from 3.76 to 3.97 (P < .05), with 16% reporting a decreased score, 50% reporting no change, and 34% reporting growth. There were no changes in KSA scores across cohorts pre and post course.ConclusionPerceived knowledge, skills, and awareness related to the importance of cultural competence in healthcare delivery increased at the end of the academic year. This type of longitudinal course model could be broadly adopted at other institutions to enhance patient, peer, and future provider awareness regarding cultural impacts on care and health disparities among vulnerable populations.     

Implantación del Examen Clínico Objetivo y Estructurado en la Facultad de Medicina de la Universidad Autónoma de Madrid

The Objective Structured Clinical Examination (OSCE) evaluates clinical skills of medical students at the end of medical school training. Professional competence is the set of knowledge and clinical skills that helps to solve professional problems with the correct attitude. The Conference of Deans from all 40 Schools of Medicine in Spain agreed that all students completing their medical training in the 2015/16 academic year should take an exam to assess 8 competency areas: medical history, physical examination, communication skills, clinical judgment, diagnosis, management and treatment, prevention and health promotion, inter-professional relationships, and ethical and legal aspects. The Madrid Autonomous University Medical School took part in this national project, and conducted its first OSCE, with 25 tests, for the 197 students that concluded their training in 2016. This paper describes the 7 stages, or essential processes followed in order to establish the OSCE. This experience may be useful for the understanding and implementation of this complex competence evaluation process.     

Preparing graduates for the first year of residency: are medical schools meeting the need?

PURPOSE: Changes in graduate medical education associated with full implementation of the Balanced Budget Act of 1997 have required medical schools to review and revise their curricula. As limited funding increases pressures to streamline training, residencies will potentially expect an entry level of skill and competence that is greater than that which schools are currently providing. To determine whether medical school curricular requirements correlate with residency needs, this multidisciplinary pilot study investigated expectations and prerequisites for postgraduate specialty training. METHOD: A questionnaire about 100 skills and competencies expected of new first-year residents was sent to 50 U.S. residency directors from surgery, internal medicine, family medicine, pediatrics, and obstetrics-gynecology programs. Each director was asked to state expectations of a first-year resident's competence in each skill at entry to residency and after three months of training. Skills deemed most appropriately acquired in residency were also identified. Competencies included diagnosis, management, triage, interpretation of data, informatics and technology, record keeping, interpersonal communications, and manual skills. RESULTS: A total of 39 residency directors responded, including seven surgery, nine medicine, seven family medicine, eight pediatrics, and eight obstetrics-gynecology. In addition to physical examination skills, 13 competencies achieved more than 70% agreement as being entry-level skills. There was wide variability as to the relative importance of the remaining skills, with residency directors expecting to devote significant resources and time in early training to ensure competence. CONCLUSIONS: Medical schools should consider the expectations of their students' future residency directors when developing new curricula. Assuring students' competencies through focused curricular change should save both time and resources during residency.     

Undergraduate teaching project on clinical laboratory medicine

Undergraduate teaching in clinical laboratory medicine is at the center of contemporary medical education. Students are expected to learn advanced laboratory medicine and basic diagnostic skills such as blood sampling, peripheral blood cell counting, blood typing, cross match test, urinalysis, electrocardiography, and bacteriological examinations through their training program. In our department, we have compulsory lectures, a basic practical training course and an advanced training course for the medical students. The compulsory lectures are programmed for the students in the fourth grade to obtain basic knowledge of clinical laboratory medicine and the patho-physiology of diseases. The teaching staff makes every effort to make their lectures exciting and interesting. As we experienced as medical students in the past, boring lectures give students nothing but a nap. For every senior teaching staff in our school, it is obligatory to be evaluated on their lectures by the students and other teaching staff every year to improve their teaching skills and materials. Teaching materials utilizing personal computers and the Internet are becoming more and more important. The basic practical training course is for the students in the fifth grade. The laboratory technicians help us teach students basic diagnostic skills in this program. The students in the advanced training course have to attend morning conferences in the department, including reverse clinico-pathological conferences and laboratory investigations. The reversed clinico-pathological conferences are popular among the students. Through our training programs, we hope that the students raise many questions that they solve themselves in the future, as well as learning established clinical laboratory medicine.     

Teaching disability and rehabilitation medicine at the Medical School in Split, Croatia

We describe the unsatisfactory situation of teaching disability and rehabilitation to medical students, focusing on countries of Central/Eastern Europe (CEE), sourcing a selection of relevant literature and reports of competent colleagues from these countries. Further, we present a model of teaching disability and rehabilitation medicine as it is now taught at the Medical School in Split, after the program for teaching Physical Medicine and Rehabilitation to the 5th year medical undergraduates was reformed in the academic year 2001/2002 to make it a satisfying educational experience that focuses on rehabilitation medicine, allowing acquisition of the competence necessary for managing persons with disability in the community. In an anonymous evaluation questionnaire, 96% of students thought that the new program was very good, that it contributed significantly to their general medical education, and was useful for their future work as general practitioners. We believe that the new program, which is broad in scope and content, well received by students, and attains its objectives, deserves to be introduced to a wider medical community.     

《医学免疫学》外训课程的设置及教学体会

《医学免疫学》是现代高等医学教育的重要基础课程,是医学留学生的必修课。结合外训学生自身特点,量身定制免疫学外训课程,分析和总结外训教学的经验和体会,为学校更好地开展留学生培训,进一步提高外训学生的教学质量提供参考依据。     

Medical and psychology students' self-assessed communication skills: A pilot study

Objective

The purpose of this study was to describe how psychology and medical students assess their own competency and skills before and after training, in which role-play was used to teach interpersonal and communication skills.

Method

Interpersonal and communication skills were assessed with a semi-structured questionnaire before and after the training.

Results

The students of both medicine and psychology estimated their skill levels to be higher after the course. The psychology students estimated their skills for communication, motivating interviewing, empathy and reflection, and change orientation to be better at the end of the course. Medical students estimated their communication skills, motivating interviewing skills, and change orientation skills to be better at the end of the course.

Conclusion

Even a short period of training in interpersonal and communication skills can positively affect the self-assessed skills of the medical students.

Practice implications

In the future, it would be worthwhile to pay attention to reflective teaching practices in the training of both medical and psychology students. The cognitive and emotional components of these practices help students to develop their own communication skills.     

Attitudes of medical students and family practice residents toward geriatric patients.

The federal government, as well as teaching institutions, are concerned about the current negative attitudes of doctors, medical students, and paramedical personnel toward the elderly. Increased life expectancy at birth and lowered birth rates are changing the demographics of America. As the number of elderly citizens increases, greater demands are being placed on medical educators to train physicians who can meet the "geriatric imperative." The Institute of Medicine has recommended that comprehensive humanistic medical education in geriatrics be integrated throughout the curricula of medical schools. Research is needed to see if change can be implemented in physician training to improve attitudes toward the elderly. Previous attempts to improve medical students'' attitudes toward the elderly have met with mixed success. Control groups have seldom been used. It is important to determine whether the effects of medical education extends beyond the immediate boundaries of a training curriculum. This article reports the results of a study on negative attitudes toward the elderly among residents, medical students, and physician''s assistant students in the family medicine department at the King/Drew Medical Center in Los Angeles, California.     

IMPROVing communication about diversity,equity, and inclusion in health professions education

There has never been a stronger call for authenticity in health professions education than this moment in time. The health inequities laid bare by the COVID-19 syndemic (a concept that describes the clustering of SARS-CoV-2 infection and disease by political, social, and economic factors) compels health professions educators to learn how to best engage in, sustain, and deepen conversations on diversity, equity, and inclusion (DEI) within our learning environments. Health professions curricula should address such concerns through explicit faculty training programs in dialogue models of communication. In this commentary, I propose that medical improv can help refocus health professions training to the humanistic values of empathy for others and respect for multiple viewpoints. Medical improv refers to teaching methods that adapt improvisation principles and exercises to enhance professional competencies in the health professions, such as communication. I describe a training series implemented at one institution to prepare faculty facilitators to engage in conversations about DEI in a discussion-based core course on the social determinants of health for first year medical students called “Humanity in Medicine.” Key elements of dialogue training, including examinations of identity and positionality, caretaking and team-making, and conversations with a skeptic, are viewed through the lens of improv exercises as a pedagogy in communication. I report on facilitator and medical students' positive response to facilitator training and the Humanity in Medicine course. Potential next steps towards a formal evaluation of the method, and outcomes assessments of the use of improv in health professions training are discussed.     

Cultural competence teaching in U.S. pediatric clerkships in 2006.

PURPOSE: Cultural sensitivity may be especially important in the care of children, and national pediatric associations have issued policy statements promoting cultural competence in medical education. The authors conducted a national survey to investigate the current state of cultural competence teaching and learning within U.S. pediatric clerkships. METHOD: The authors surveyed 125 U.S. pediatric clerkship directors concerning the presence or absence of cultural curricula, content, teaching methods, and evaluation. Question types were multiple-choice single/best answer, checklists, five-point Likert-type scales, and free-text responses. RESULTS: Of 100 respondents (80% response rate), most agreed or strongly agreed that teaching culturally competent care is important (91%), enhances the physician/patient/family relationship (99%), and improves patient outcomes (90%). Twenty four of 98 respondents (25%) reported cultural competence teaching. The most common teaching methods were lectures (63%), experiential learning through community activities (58%), and small-group discussions (54%). Only 14 respondents reported any curricular evaluation, the commonest methods being student surveys, clinical case presentations, and standardized patient experiences. Top factors facilitating curriculum development were culturally diverse populations of patients, students, faculty, and hospital staff, and faculty interest and expertise. Top challenges included lack of protected time for program development, funding, and faculty expertise. CONCLUSIONS: Few U.S. pediatric clerkships currently provide cultural competence curricula. The authors' suggestions to promote cultural competence teaching include providing faculty development opportunities and developing and disseminating teaching materials and evaluation tools. Such dissemination is important to graduate physicians, who can provide culturally sensitive pediatric care to the changing U.S. population.     

Teaching brief motivational interviewing to medical students using a pedagogical framework

ObjectiveMedical schools are charged with assisting medical students to acquire the confidence, knowledge and skills for behavior change conversations in primary healthcare. The present study evaluated teaching brief motivational interviewing (MI) to pre-clinical medical students.MethodsForty-six students participated in an educational intervention premised on the Learn, See, Practice, Prove, Do, Maintain pedagogical framework, comprising 2 × 2-h lectures, a 2-h role-play triad session, and 3 × 2-h small group simulated patient encounters supported by scaffolding strategies. Measures of brief MI knowledge (MI Knowledge and Attitudes Test & Multiple-Choice Knowledge Test) and confidence (MI Confidence Scale) were taken at baseline, post-training, and 3-month follow-up, and skills (Behavior Change Counseling Index) were assessed at three intervals during simulated patient encounters.ResultsStudents who received brief MI training improved in knowledge and confidence from baseline to post-training and gains remained at 3-months. Brief MI skills improved across the simulation sessions.ConclusionPre-clinical medical students can attain knowledge, confidence and skills in brief MI after participation in a short intervention and improvements are sustainable.Practice implicationsOur results support the use of an evidence-based pedagogical framework for teaching brief MI in pre-clinical years of medical curricula and our scaffolding strategy affords promise.     

“A change would do you good”: Training medical students in Motivational Interviewing using a blended-learning approach – A pilot evaluation

Objectives This study aims to assess medical students’ interest in a Motivational Interviewing (MI), the objective need for a special training, and students’ satisfaction with and the effectiveness of such a course.Methods A mandatory MI course was implemented for sixth-semester medical students. Their interest in learning MI was evaluated, along with their satisfaction with the course, which was delivered in a blended-learning teaching approach. Participants’ baseline MI skills and general communication skills were assessed. MI non-adherent behavior, like persuading and confronting patients, was noted. Successful learning was measured with a multiple-choice test administered before and after the course that assessed subjective knowledge and skills.Results Students were highly interested in learning MI. At baseline, they showed good communication skills but moderate MI skills. Satisfaction with the course was high. The course was effective, as subjective and objective knowledge and skills improved significantly.Conclusions This pilot study suggests that basic MI skills can be successfully taught in a blended-learning teaching approach. Further research should investigate sustainability and transfer to clinical practice.Practice implications Medical schools should consider providing students with special training in MI to help students counsel patients towards behavioral changes.     

Invite, listen, and summarize: a patient-centered communication technique.

The need for physicians to have patient-centered communication skills is reflected in the educational objectives of numerous medical schools' curricula and in the competencies required by groups such as the Accreditation Council for Graduate Medical Education. An innovative method for teaching communications skills has been developed at the University of Colorado School of Medicine as part of its three-year, longitudinal course focusing on basic clinical skills required of all physicians. The method emphasizes techniques of open-ended inquiry, empathy, and engagement to gather data. Students refer to the method as ILS, or Invite, Listen, and Summarize. ILS was developed to combat the high-physician-control interview techniques, characterized by a series of "yes" or "no" questions. The authors began teaching the ILS approach in 2001 as one basic exercise and have since developed a two-year longitudinal communications curriculum. ILS is easy to use and remember, and it emphasizes techniques that have been shown in other studies to achieve the three basic functions of the medical interview: creating rapport, collecting good data, and improving compliance. The skills are taught using standardized patients in a series of four small-group exercises. Videotaped standardized patient encounters are used to evaluate the students. Tutors come from a variety of disciplines and receive standardized training. The curriculum has been well received. Despite the fact that the formal curriculum only occurs in the first two years, there is some evidence that it is improving students' interviewing skills at the end of their third year.