Cultural competency in graduate medical education: A necessity for the minimization of disparities in healthcare

"Atlanta Is Like Wakanda … but With Real Big, Big Issues": A Focus Group Study of Community Strengths and Health Issues in Diverse Groups in Atlanta, Georgia

BACKGROUND AND OBJECTIVES

This qualitative study explored perceived community strengths and health issues among 3 underserved and under-studied populations in the Atlanta, Georgia-older adults, Black or African American persons, and refugees/immigrants/migrants.

METHODS

Eight focus groups were conducted with 92 participants who were members of the 3 populations in Atlanta between November 2022 and March 2023.

RESULTS

Although there were variations among groups, all groups emphasized diversity within their community as the foundation of community strength. Elements of the built environment such as parks, convenience stores, the Atlanta Beltline, and food outlets bolstered community strength. Furthermore, community members being able to voice concerns and the responsiveness of governmental institutions helped form strong relationships to build a strong community. Regarding health issues, common physical health concerns included hypertension and obesity, with varied mental health issues. Accessibility and affordability of healthy foods were significant social concerns, alongside challenges in healthcare access such as navigating complex systems and high medical costs.

CONCLUSION

Tailored interventions recognizing community strengths and addressing specific health issues are crucial for improving outcomes in marginalized communities, necessitating a health-in-all policies approach considering social, cultural, and structural determinants of health.

Towards addressing the awarding gap-Using critical race theory to contextualise the role of intersectionality in Black pharmacy student attainment

INTRODUCTION

The awarding gap between White and Black students in UK health curricula is well established. Critical race theory (CRT) is a lens to deconstruct pedagogic practice and consider the intersectionality of Black student lived experience to provide a realist critique of the phenomenon of Whiteness in higher education and the impact this has on Black attainment. Using one UK pharmacy programme as a case study, this paper aims to explore Black lived experience as a means of problematising and disrupting structural oppressions.

METHODS

Sixteen Black students from one UK pharmacy degree programme were purposively recruited to the study. Love and breakup letter methodology (LBM) was used to facilitate sharing experiences of intersectionality in relation to their undergraduate education, with data thematically analysed through the lens of CRT.

RESULTS

Two meta-themes (identity and inclusion; and cultural capital) and four subthemes (social capital; access; family expectations; and help-seeking) were identified. The intersectionality of Black students was articulated as not possessing the social capital and the 'language' to succeed within the White structures of the curriculum. The conflict of capital and the absence of Black culture gave rise to confined help-seeking behaviours. Whilst Black students experienced equality of access to the curriculum, an absence of rights to legitimate involvement (inclusion) worked to diminish participation in the curriculum.

DISCUSSION

This is the first study to consider the intersectionality of Black pharmacy students in relation to academic awarding gaps and has found that oppressive educational structures marginalise and other Black experience. Black students experience the curriculum as a place where their social and cultural capital is undervalued, and as a White space where they lack the artefacts to succeed, leading to peripheral participation and detachment. The approach used in this study can be adopted across medical and health education as a means to problematise racial inequality through the exemplar of White:Black awarding gaps.

Creating Competencies for Providing Care in a Diverse, Equitable, and Inclusive Manner: A Delphi Technique

OBJECTIVE

Competencies related to diversity could be essential to training and assessing student pharmacists in their readiness to provide equitable and inclusive care. Such competencies are lacking in pharmacy education; therefore, this study aimed to explore the development of diversity competencies and supporting factors needed to prepare students to meet the competencies and provide patient care in a diverse, equitable, and inclusive manner.

METHODS

Pharmacy diversity thought leaders were invited to participate in a 3-round modified Delphi survey. Survey items were created using a Backward Design. Qualitative data were analyzed using the Constant Comparative Method. Draft competency statements were created based on the collective comments from Round 1 along with themes related to the supporting factors needed to achieve the competencies. Consensus on themes, competency statements, and edits were identified in Round 2. Additional comments and feedback on edits were gathered in Round 3. Consensus was preset at 85.7%.

RESULTS

Seven competency statements were created. Knowledge, skills, attitudes, behaviors, values, curricular content/pedagogy, and resources needed to prepare students to meet the competencies and support faculty would need were identified.

CONCLUSION

Preliminary diversity competencies and supporting factors needed were developed using the perspective of thought leaders. Further evaluation, including the development of student-appropriate competencies, testing and validation of content and assessment tools, and determining place in the pharmacy curriculum, are future steps that should be considered in the competency development process.

Promoting cultural competency and osteopathic medicine awareness among premedical students through a summer premedical rural enrichment program

CONTEXT

Premedical preparatory programs at osteopathic medical schools that recruit students from medically underserved areas (MUAs) may promote interest in practicing osteopathic medicine in underserved or rural areas. In these programs, emphasis on cultural competency may increase diversity among medical school applicants and decrease healthcare disparities in the future.

OBJECTIVES

The goal of this study is to determine whether a summer premedical rural enrichment program (PREP) held at an osteopathic medical school located in a MUA will foster greater prioritization of cultural competency in medicine, enhance interest in practicing in rural or underserved areas, and increase familiarity with osteopathic medicine.

METHODS

An eight-week summer PREP was hosted at the California Health Sciences University College of Osteopathic Medicine (CHSU-COM) in Clovis, California. Seventy-eight diverse participants were recruited from the Central Valley, an underserved region of California. Attendees were required to finish the formal application process and were recommended to have completed medical school prerequisite courses. The curriculum included Medical College Admission Test (MCAT) preparation through team-based learning sessions, introduction to the osteopathic medical school curriculum, osteopathic philosophy, and osteopathic manipulative medicine, as well as integrated anatomy and physiology sessions, medical school application workshops, mock interviews, simulation workshops, and sociology and cultural competency sessions. Data were collected via a voluntary and anonymous survey administered before and after the program with questions about familiarity with osteopathy, interest in practicing in underserved areas, medical school preparedness, and a post-course survey about cultural competency. The surveys had students rate statements on a Likert scale.

RESULTS

Seventy-four of the 78 premedical students (95%) completed the pre-and postsurvey. There was a significant increase in agreement to statements evaluating medical school preparedness, osteopathic familiarity, and desire to practice medicine locally in the postprogram survey, compared to the preprogram survey. In the cultural competency postsurvey, 75.0% of the responses to questions that evaluated the positive effect of the course were "Agree" or "Strongly Agree." Of the reported postcourse outcomes, the average MCAT score was 504 ± 6.2 (38 students reported, 50.7%). Of the 27 participants who reported matriculation, 16 (59.2%) were admitted to osteopathic medical schools, 9 (33.3%) to allopathic medical schools, and 2 to other health programs.

CONCLUSIONS

After completing the PREP program, premedical participants reported that they have better understanding of cultural competency and improvement in preparation for medical school, including familiarity with osteopathic medicine, and interest in serving MUAs. These findings indicate that similar programs may have a positive impact on MUAs. These programs may help create diverse and culturally competent osteopathic physicians.