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=Cultural competency training for third-year clerkship students: effects of an interactive workshop on student attitudes.=

Carter MM, Lewis EL, Sbrocco T, Tanenbaum R, Oswald JC, Sykora W, Williams P, Hill LD.

J Natl Med Assoc. 2006 Nov;98(11):1772-8.

This study was funded by the NIH National Center on Minority Health and Health Disparities and was a joint effort between American University and the Uniformed Services University of the Health Sciences. The authors developed and evaluated the effectiveness of an interactive workshop designed to improve third-year students’ attitudes, beliefs and cross-cultural communication skills. The Uniformed Services University of the Health Sciences established the USU Center for Health Disparities Research and Education which aims to design and implement a series of research, education, minority student mentoring and community outreach initiatives to reduce health disparities. This four-year cultural competency curriculum for medical students which they are developing contains a Cultural Proficiency Workshop (CPW). This three-hour workshop employs a combination of didactic, interactive and experiential teaching methods. This was implemented as part of a required, six-week family medicine clerkship. Pre- and post- Cultural Attitudes and Beliefs Scale (CABS), pre-and post-knowledge test and course evaluation were developed for this workshop. The aims were to 1) examine the effect of the CPW on students’ attitudes and beliefs; 2) to examine the internal factor structure of the CABS; and 3) to explore the relationship between course evaluation ratings and changes in learners’ awareness, attitudes, and beliefs. Students participated in the CPW in small groups of 20-24 students per round. Data were collected across 1.5 academic years, involving 8 clerkship rounds. The workshop included didactics on health disparities and cultural competence; interactive student self-assessment exercises; tools for interacting with culturally diverse patient groups; and a skill-building, experiential learning component involving student role plays with trained actor/facilitators. Over the 18-month period, 196 third-year medical students participated in the three-hour CPW. The CABS revealed that all items changed significantly. The three internally consistent factors that were assessed were: Factor 1 – cultural beliefs regarding medical treatment, Factor 2 – self-awareness of cultural bias, and Factor 3 – self-related cultural competence in medical treatment. On Factor 1, a positive change regarding cultural beliefs about medical treatment was seen post-CPW. On Factor 2, the change suggests that students actually saw themselves as more biased following the workshop, suggesting an increase in self-awareness. Students also indicated that they felt they had more techniques to help treat patients from diverse backgrounds. This study demonstrated the importance of cultural competency training and provided an effective training method. However, it did not demonstrate an impact on health care, positive or negative. It also suggests the need to train not only students, but also faculty since they teach students.

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