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Jooren S, van Uden D, Leij-Halfwerk S, Jans L, van den Brink G. A Case Study Exploring Perceptions About Diversity in Higher Education Related to a Dutch Physician Assistant Program. J Physician Assist Educ 2021; 32:195-199. [PMID: 34347663 DOI: 10.1097/jpa.0000000000000379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Sophie Jooren
- Sophie Jooren, BSc, is a research assistant for the Master Physician Assistant HAN University of Applied Sciences, Nijmegen, The Netherlands
- Daniëlla van Uden, BSc, is a research assistant for the Master Physician Assistant HAN University of Applied Sciences, Nijmegen, The Netherlands
- Susanne Leij-Halfwerk, PhD, senior lecturer-researcher for the Master Physician Assistant HAN University of Applied Sciences, Nijmegen, The Netherlands
- Liesbeth Jans, MSc, is the owner of Lancae, Arnhem, The Netherlands
- Geert van den Brink, MSc, is program director for the Master Physician Assistant HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - Daniëlla van Uden
- Sophie Jooren, BSc, is a research assistant for the Master Physician Assistant HAN University of Applied Sciences, Nijmegen, The Netherlands
- Daniëlla van Uden, BSc, is a research assistant for the Master Physician Assistant HAN University of Applied Sciences, Nijmegen, The Netherlands
- Susanne Leij-Halfwerk, PhD, senior lecturer-researcher for the Master Physician Assistant HAN University of Applied Sciences, Nijmegen, The Netherlands
- Liesbeth Jans, MSc, is the owner of Lancae, Arnhem, The Netherlands
- Geert van den Brink, MSc, is program director for the Master Physician Assistant HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - Susanne Leij-Halfwerk
- Sophie Jooren, BSc, is a research assistant for the Master Physician Assistant HAN University of Applied Sciences, Nijmegen, The Netherlands
- Daniëlla van Uden, BSc, is a research assistant for the Master Physician Assistant HAN University of Applied Sciences, Nijmegen, The Netherlands
- Susanne Leij-Halfwerk, PhD, senior lecturer-researcher for the Master Physician Assistant HAN University of Applied Sciences, Nijmegen, The Netherlands
- Liesbeth Jans, MSc, is the owner of Lancae, Arnhem, The Netherlands
- Geert van den Brink, MSc, is program director for the Master Physician Assistant HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - Liesbeth Jans
- Sophie Jooren, BSc, is a research assistant for the Master Physician Assistant HAN University of Applied Sciences, Nijmegen, The Netherlands
- Daniëlla van Uden, BSc, is a research assistant for the Master Physician Assistant HAN University of Applied Sciences, Nijmegen, The Netherlands
- Susanne Leij-Halfwerk, PhD, senior lecturer-researcher for the Master Physician Assistant HAN University of Applied Sciences, Nijmegen, The Netherlands
- Liesbeth Jans, MSc, is the owner of Lancae, Arnhem, The Netherlands
- Geert van den Brink, MSc, is program director for the Master Physician Assistant HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - Geert van den Brink
- Sophie Jooren, BSc, is a research assistant for the Master Physician Assistant HAN University of Applied Sciences, Nijmegen, The Netherlands
- Daniëlla van Uden, BSc, is a research assistant for the Master Physician Assistant HAN University of Applied Sciences, Nijmegen, The Netherlands
- Susanne Leij-Halfwerk, PhD, senior lecturer-researcher for the Master Physician Assistant HAN University of Applied Sciences, Nijmegen, The Netherlands
- Liesbeth Jans, MSc, is the owner of Lancae, Arnhem, The Netherlands
- Geert van den Brink, MSc, is program director for the Master Physician Assistant HAN University of Applied Sciences, Nijmegen, The Netherlands
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Deliz JR, Fears FF, Jones KE, Tobat J, Char D, Ross WR. Cultural Competency Interventions During Medical School: a Scoping Review and Narrative Synthesis. J Gen Intern Med 2020; 35:568-577. [PMID: 31705475 PMCID: PMC7018865 DOI: 10.1007/s11606-019-05417-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 07/15/2019] [Accepted: 09/16/2019] [Indexed: 02/04/2023]
Abstract
Many medical accreditation bodies agree that medical students should be trained to care for diverse patient populations. However, the teaching methods that medical schools employ to accomplish this goal vary widely. The purpose of this work is to summarize current cultural competency teaching for medical students and their evaluation methods. A scoping review was completed by searching the databases PubMed, Scopus, MedEdPORTAL, and MEDLINE for the search terms "medical education" and "cultural competency" or "cultural competence." Results were summarized using a narrative synthesis technique. One hundred fifty-four articles on cultural competency interventions for medical students were systematically identified from the literature and categorized by teaching methods, length of intervention, and content. Fifty-six articles had a general focus, and ninety-eight articles were focused on specific populations including race/ethnicity, global health, socioeconomic status, language, immigration status, disability, spirituality at the end of life, rurality, and lesbian, gay, bisexual, transgender, and queer. About 54% of interventions used lectures as a teaching modality, 45% of the interventions described were mandatory, and 9.7% of interventions were not formally evaluated. The authors advocate for expansion and more rigorous analysis of teaching methods, teaching philosophies, and outcome evaluations with randomized controlled trials that compare the relative effectiveness of general and population-specific cultural competency interventions.
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Affiliation(s)
- Juan R Deliz
- Washington University School of Medicine, 660 S Euclid Ave, CB 8126, St. Louis, MO, 63110, USA.
| | - Fayola F Fears
- Washington University School of Medicine, 660 S Euclid Ave, CB 8126, St. Louis, MO, 63110, USA
| | - Kai E Jones
- Washington University School of Medicine, 660 S Euclid Ave, CB 8126, St. Louis, MO, 63110, USA
| | - Jenny Tobat
- Washington University School of Medicine, 660 S Euclid Ave, CB 8126, St. Louis, MO, 63110, USA
| | - Douglas Char
- Department of Emergency Medicine, Washington University School of Medicine, Campus Box 8072, 660 South Euclid Ave, St. Louis, MO, USA
| | - Will R Ross
- Division of Nephrology, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
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Muntinga ME, Krajenbrink VQE, Peerdeman SM, Croiset G, Verdonk P. Toward diversity-responsive medical education: taking an intersectionality-based approach to a curriculum evaluation. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2016; 21:541-59. [PMID: 26603884 PMCID: PMC4923090 DOI: 10.1007/s10459-015-9650-9] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 11/12/2015] [Indexed: 05/13/2023]
Abstract
Recent years have seen a rise in the efforts to implement diversity topics into medical education, using either a 'narrow' or a 'broad' definition of culture. These developments urge that outcomes of such efforts are systematically evaluated by mapping the curriculum for diversity-responsive content. This study was aimed at using an intersectionality-based approach to define diversity-related learning objectives and to evaluate how biomedical and sociocultural aspects of diversity were integrated into a medical curriculum in the Netherlands. We took a three-phase mixed methods approach. In phase one and two, we defined essential learning objectives based on qualitative interviews with school stakeholders and diversity literature. In phase three, we screened the written curriculum for diversity content (culture, sex/gender and class) and related the results to learning objectives defined in phase two. We identified learning objectives in three areas of education (medical knowledge and skills, patient-physician communication, and reflexivity). Most diversity content pertained to biomedical knowledge and skills. Limited attention was paid to sociocultural issues as determinants of health and healthcare use. Intersections of culture, sex/gender and class remained mostly unaddressed. The curriculum's diversity-responsiveness could be improved by an operationalization of diversity that goes beyond biomedical traits of assumed homogeneous social groups. Future efforts to take an intersectionality-based approach to curriculum evaluations should include categories of difference other than culture, sex/gender and class as separate, equally important patient identities or groups.
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Affiliation(s)
- M. E. Muntinga
- />Department of Medical Humanities, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - V. Q. E. Krajenbrink
- />VU University Medical Center School of Medical Sciences, Amsterdam, The Netherlands
| | - S. M. Peerdeman
- />VU University Medical Center School of Medical Sciences, Amsterdam, The Netherlands
- />Department of Neurosurgery, VU University Medical Center, Amsterdam, The Netherlands
| | - G. Croiset
- />VU University Medical Center School of Medical Sciences, Amsterdam, The Netherlands
| | - P. Verdonk
- />Department of Medical Humanities, EMGO Institute for Health and Care Research, School of Medical Sciences, VU University Medical Center, Amsterdam, The Netherlands
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van Rosse F, Suurmond J, Wagner C, de Bruijne M, Essink-Bot ML. Role of relatives of ethnic minority patients in patient safety in hospital care: a qualitative study. BMJ Open 2016; 6:e009052. [PMID: 27056588 PMCID: PMC4838722 DOI: 10.1136/bmjopen-2015-009052] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Relatives of ethnic minority patients often play an important role in the care process during hospitalisation. Our objective was to analyse the role of these relatives in relation to the safety of patients during hospital care. SETTING Four large urban hospitals with an ethnic diverse patient population. PARTICIPANTS On hospital admission of ethnic minority patients, 20 cases were purposively sampled in which relatives were observed to play a role in the care process. OUTCOME MEASURES We used documents (patient records) and added eight cases with qualitative interviews with healthcare providers, patients and/or their relatives to investigate the relation between the role of relatives and patient safety. An inductive approach followed by selective coding was used to analyse the data. RESULTS Besides giving social support, family members took on themselves the role of the interpreter, the role of substitutes of the patient and the role of care provider. The taking over of these roles can have positive and negative effects on patient safety. CONCLUSIONS When family members take over various roles during hospitalisation of a relative, this can lead to a safety risk and a safety protection for the patient involved. Although healthcare providers should not hand over their responsibilities to the relatives of patients, optimising collaboration with relatives who are willing to take part in the care process may improve patient safety.
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Affiliation(s)
- Floor van Rosse
- Department of Public Health, Academic Medical Center, Amsterdam, The Netherlands
- Department of Public and Occupational Health, VU University Medical Center (VUmc), EMGO Institute for Health and Care Research, Amsterdam, The Netherlands
| | - Jeanine Suurmond
- Department of Public Health, Academic Medical Center, Amsterdam, The Netherlands
| | - Cordula Wagner
- Department of Public and Occupational Health, VU University Medical Center (VUmc), EMGO Institute for Health and Care Research, Amsterdam, The Netherlands
- NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - Martine de Bruijne
- Department of Public and Occupational Health, VU University Medical Center (VUmc), EMGO Institute for Health and Care Research, Amsterdam, The Netherlands
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Willen SS. Confronting a "big huge gaping wound": emotion and anxiety in a cultural sensitivity course for psychiatry residents. Cult Med Psychiatry 2013; 37:253-79. [PMID: 23549710 DOI: 10.1007/s11013-013-9310-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
In his seminal volume From anxiety to method in the behavioral sciences, George Devereux suggests that any therapeutic or scientific engagement with another human being inevitably will be shaped by one's own expectations, assumptions, and reactions. If left unacknowledged, such unspoken and unconscious influences have the capacity to torpedo the interaction; if subjected to critical reflection, however, they can yield insights of great interpretive value and practical significance. Taking these reflections on counter-transference as point of departure, this article explores how a range of unacknowledged assumptions can torpedo good faith efforts to engender "cultural sensitivity" in a required course for American psychiatry residents. The course examined in this paper has been taught for seven successive years by a pair of attending psychiatrists at a longstanding New England residency training program. Despite the instructors' good intentions and ongoing experimentation with content and format, the course has failed repeatedly to meet either residents' expectations or, as the instructors bravely acknowledged, their own. The paper draws upon a year-long ethnographic study, conducted in the late 2000s during the most recent iteration of the course, which involved observation of course sessions, a series of interviews with course instructors, and pre- and post-course interviews with the majority of participating residents. By examining the dynamics of the course from the perspectives of both clinician-instructors and resident-students, the paper illuminates how classroom-based engagement with the clinical implications of culture and difference can run awry when the emotional potency of these issues is not adequately taken into account.
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Affiliation(s)
- Sarah S Willen
- Department of Anthropology, University of Connecticut, Storrs-Mansfield, CT, USA.
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Willen SS, Carpenter-Song E. Cultural competence in action: "lifting the hood" on four case studies in medical education. Cult Med Psychiatry 2013; 37:241-52. [PMID: 23620365 DOI: 10.1007/s11013-013-9319-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ilott I, Kottorp A, la Cour K, van Nes F, Jonsson H, Sadlo G. Sustaining international partnerships: the European Master of Science Programme in Occupational Therapy, a case study. Occup Ther Int 2013; 20:58-67. [PMID: 23559568 DOI: 10.1002/oti.1349] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Accepted: 03/06/2013] [Indexed: 11/08/2022] Open
Abstract
International partnerships are a mechanism for supporting the academic development of occupational therapy and promoting cultural competence. This case study describes the factors that have helped to sustain a post-qualifying programme implemented by five higher education institutions in Denmark, the Netherlands, Sweden, Switzerland and the UK since 1999. Data collection methods were documentary analysis and the reflections of a purposive sample of six key informants. Cohort and outcome data, from 193 students from 31 countries who enrolled between 1999 and 2011, are reported. Each cohort comprises students from an average of eight countries to optimize inter-cultural dialogue. Four factors support sustainability. These are 1) supportive professional European networks; 2) timeliness and alignment with European higher education policy; 3) partnership structures and processes that emphasize joint decision making and accountability; and 4) the stimulus and satisfaction associated with internationalization. The main limitations are considering the OT-EuroMaster as an intrinsic case study and using opportunistic data collection that undermines the rigor and transferability of the findings. Future opportunities include doctoral networks, transnational research and sharing our curricula design with other Regions to spread the collaborative, capacity building endeavours more widely.
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Affiliation(s)
- Irene Ilott
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.
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Seeleman C, Stronks K, van Aalderen W, Bot MLE. Deficiencies in culturally competent asthma care for ethnic minority children: a qualitative assessment among care providers. BMC Pediatr 2012; 12:47. [PMID: 22551452 PMCID: PMC3393627 DOI: 10.1186/1471-2431-12-47] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2011] [Accepted: 05/02/2012] [Indexed: 11/21/2022] Open
Abstract
Background Asthma outcomes are generally worse for ethnic minority children. Cultural competence training is an instrument for improving healthcare for ethnic minority patients. To develop effective training, we explored the mechanisms in paediatric asthma care for ethnic minority patients that lead to deficiencies in the care process. Methods We conducted semi-structured interviews on care for ethnic minority children with asthma (aged 4-10 years) with paediatricians (n = 13) and nurses (n = 3) in three hospitals. Interviews were analysed qualitatively with a framework method, using a cultural competence model. Results Respondents mentioned patient non-adherence as the central problem in asthma care. They related non-adherence in children from ethnic minority backgrounds to social context factors, difficulties in understanding the chronic nature of asthma, and parents’ language barriers. Reactions reported by respondents to patients’ non-adherence included retrieving additional information, providing biomedical information, occasionally providing referrals for social context issues, and using informal interpreters. Conclusions This study provides keys to improve the quality of specialist paediatric asthma care to ethnic minority children, mainly related to non-adherence. Care providers do not consciously recognise all the mechanisms that lead to deficiencies in culturally competent asthma care they provide to ethnic minority children (e.g. communicating mainly from a biomedical perspective and using mostly informal interpreters). Therefore, the learning objectives of cultural competence training should reflect issues that care providers are aware of as well as issues they are unaware of.
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Affiliation(s)
- Conny Seeleman
- Department of Public Health, Academic Medical Centre/University of Amsterdam, PO Box 22660, 1100, DD, Amsterdam, the Netherlands.
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