Is medical education keeping up with social progress? Take cross-cultural care as an example.

Is medical education keeping up with social progress? Take cross-cultural care as an example.

The development of cross-cultural care competence (CCC) in medical education is generally aimed at providing appropriate care for different cultural groups and achieving holistic care. In global medical education, developing students' awareness, attitudes, communication skills, and abilities to provide care for to diverse cultural groups are regarded as important core competencies for the development of  students in health-related disciplines or health care professionals. In general, multicultural groups are broadly defined and include race, ethnicity, gender, age, religion, and etc. However, in East Asian medical education, cross-cultural education is often limited to the needs of particular ethnic groups or communities, while other cultural groups are relatively ignored. As Taiwan's social democracy progress, and acceptance of diversity has become a social norm. However, whether our health care and medical education are keeping up with the progress of the increasingly diverse society is worth further discussion. This series of studies is based on an article published in 2014 by the research team in the internationally renowned journal of Medical Education. In a following study, we extended the exploration of Taiwanese students' perceptions of CCC to identify gaps in local medical education, and thereby, promote more systematic provision of CCC. The findings of the study are as follows:

1.Medical students were aware that they are inadequately prepared to deal with health inequalities and the needs of different cultural groups. There is also no evidence that there are courses to enhance students’ preparedness of relevant skills in the training from the pre-clinical to clinical stages. Meanwhile, teachers also indicate that students across different training stages were inadequately prepared to deal with health inequalities and the needs of diverse cultural groups.

2.Despite the similarities in teachers’ and students’ responses, teachers felt that students were less prepared than how they perceived themselves to be. Aside from the finding that CCC training seems to be insufficient as indicated in the previously discussed results, students also felt that CCC training from the foundational to the preclinical stages were not clearly presented.

Although the quantitative data reflected some important findings, large-scaled interviews are needed to obtain more in-depth understanding of these issues. The following discussion is based on the follow-up qualitative data, focusing particularly on the theme of "equality of health care for sexual and gender minorities (SGM)". Discussion of the readiness of medical students to care for LGBT patients include the following:

1. Although there is wide social acceptance and openness toward the LGBT community, there are still uncertainties in the ways to interact with the LGBT community;

2. There may be stigma and bias against LGBT patients in the training process;

3. Medical students recognized that having gender stereotypes may negatively affect clinical reasoning;

4. Medical students perceived themselves to be ready to care for LGBT patients, but they equate “treating all patients the same way” as being prepared;

5. Medical students acknowledged they lack relevant professional skills;

6. Medical curricula do not systematically and explicitly strengthen students’ learning of issues related to LGBT patient.

In sum, the two studies showed that medical students' self-perceived preparedness and proficiency are not consistent with the need for increased awareness of health inequalities and needs of different cultural groups. At the same time, students also lacked preparedness to provide qualitied care for LGBT patients. These findings indicate that CCC training has not been clearly and adequately valued in medical education. Hence, medical educators need to design and implement more effective courses, training, and faculty development so that medical students/trainees can develop CCC awareness and relevant competencies that would improve their readiness and proficiency to meet the needs of diverse cultural groups.

Application and Highlights:

1. Taiwan's medical education is placing increased emphasis on students' cultural competence, which is closely related tomedical professionalism’s qualities of empathy, reflection, communication and altruism. Cultural competence is one of the six core competencies of the ACGME and is currently one of the standards for Taiwan's medical education accreditation. Thisseries of studies is part of a large-scale cross-school research on medical students’ cultural competence in Taiwan. Resultsfrom these studies established a baseline for the development of curriculum design and healthcare education, and provideda basis for subsequent research to identify gaps and issues and curriculum development.

2.Based on these, the research team conducted longitudinal study on the curriculum to provide clear and adequate medical education training and faculty development to enhance future healthcare providers’ awareness of health inequalities, and preparedness and proficiency for the needs of diverse groups. Data from the study is currently being collated for future publications.

Research Team Members: Peih-Ying LU, Anna S C Hsu,Jer-Chia Tsai, Alexander Greene

Representative Department:Center for Medical Education and Humanizing Health Professional Education

Introduction of Research Team:

Lu P-Y was the professor of department of medical humanities and education in school of medicine, the dean of college of humanities and social sciences, the director of center for medical education and humanizing health professional education, and the committee of TMAC and WFME.

Contact Email: peyilu@kmu.edu.tw

Publication:

1.Lu P-Y, Hsu ASC, Green A, Tsai J-C (2022). Medical students’ perceptions of their preparedness to care for LGBT patients in Taiwan: Is medical education keeping up with social progress? PLoS ONE, 17(7): e0270862. https://doi. org/10.1371/journal.pone.0270862.

2.Lu P-Y, Tsai J-C, Green A, Hsu ASC (2021). Assessing Asian Medical Students’ Readiness for Diversity: Localizing Measures of Cross-Cultural Care Competence. TEACHING AND LEARNING IN MEDICINE, 33(3), 220-234.

Full-Text Article:

1. https://pubmed.ncbi.nlm.nih.gov/35797357/

2. https://pubmed.ncbi.nlm.nih.gov/33181028/