Preparing to care for a culturally and linguistically diverse UK patient population

: an ethnographic investigation of how medical students develop their cultural competence

Abstract

The importance of cultural education has been largely recognised by medical schools globally, but training remains fragmented with a lack of consistency in structure, content, and process. Little is known about how students develop their cultural competence (CC) in educational and extracurricular settings. This study attempts to address the gaps of knowledge by aiming to a) provide an overview of cultural education in UK medical schools by systematically analysing their CC and diversity education curricula and b) provide a rich ethnographic description of the factors, both within and outside the educational settings, which may contribute to students’ CC development. The following research questions were investigated: 1) How are CC and diversity taught in UK medical schools? 2) How do students develop their CC in campus-based formal classroom teaching? 3) How do students develop their CC in clinical placements? 4) How do students develop their CC through extracurricular activities? Ethnography was adopted as my overarching approach in this study. This approach enabled me to bridge the distance between my interpretations and the meaning of students’ life experiences via collecting data through deep immersion and first-hand involvement. It incorporated a range of research methods, including document review, participant observation, individual in-depth interviews, and focus groups. I started with a document review that presented an overview of cultural education in UK medical schools with an analysis of 24 posters and 9 websites. To produce both the etic and emic stances of investigation of students’ views and experiences in developing CC, I conducted 109 hours of participant observation, 25 interviews, and 3 focus groups in a London inner-city medical school and its affiliated teaching hospitals. Different datasets were synthesised to answer the research questions. Ethical approval was approved by the University Research Committee (reference number: LRS-17/18-5013) and NHS R&D Office (IRAS reference: 234940). The document review shows that successful CC delivery relies on both strong institutional development (e.g. through leadership, infrastructure/faculty development, culturally relevant institutional schemes) and systematic educational interventions. The ethnographic case study provides an in-depth exploration of students’ views and their experiences in developing CC. The study shows that students develop their CC both consciously and unconsciously in classroom-based formal teaching, clinical placements, and through extracurricular activities. Their learning experiences in each setting are interrelated and constantly interacting with each other, which accumulatively contributes to students’ CC development. Some aspects of the learning are more apparent and easier for students to internalise; other aspects may remain hidden even if they are absorbed. This requires medical educators to identify, and then integrate and balance, resources that can contribute to students’ CC development with a holistic view. Integrating the results and discussions allowed me to generate a theoretical model that conceptualises medical students’ CC development. As a result of increased understanding in the context of medical education, the EDUCATIONIST guide, which consists of 12 educational tips, is proposed to inform pedagogical development. The key strength of this research is in its exploratory nature and its potential to shed light on understanding the development of CC among medical students in a global context. Universal themes can be contextualised culturally, which makes the study an important addition to the field.

Date of Award	1 Jan 2021
Original language	English
Awarding Institution	King's College London
Supervisor	Shuangyu Li (Supervisor) & Elaine Gill (Supervisor)