Teaching of cultural diversity in medical schools in the United Kingdom and Republic of Ireland: cross sectional questionnaire survey
BMJ 2005; 330 doi: https://doi.org/10.1136/bmj.38338.661493.AE (Published 17 February 2005) Cite this as: BMJ 2005;330:403All rapid responses
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As an undergraduate medical student in 1997 I authored and began a
peer teaching course at Leeds Medical School, entitled 'A Touch of Spice'.
It is a course that is still successfully run by Leeds medical students
for their peers today. It aims to teach basic phrases in Hindi and Urdu
and about South Asian culture for use with South Asian patients.
This course is not within the curriculum and this has been quite
deliberate. There is still a barrier it seems to medical schools
'teaching' attitudes to undergraduates and the last thing intelligent
young people with free spirits require is didactic 'teaching of
attitudes'. One of the reasons our course is so successful is that South
Asian medical students teach their colleagues about a community and
culture that is partly their own heritage.
'A Touch of Spice' has been funded and run by the medical students
representatives council. The course has a teacher's guide book, phrase
booklets for the students to use, a cassette to help with pronunciation
and handouts are given to students after each session. The course does not
aim to teach fluent communication but instead to make students more
comfortable with the situations they will inevitably find themselves in.
Many readers will be familiar with the 2am night shift when a patient
arrives in extremis and there is no common language and the added barrier
of culture. To compound issues, it is not a situation that had even been
mentioned in 5 years of a modern undergraduate medical education.
If the gap between knowledge about how to behave towards patients
from diverse backgrounds and the way we actually behave towards them is to
be reduced then innovation from the students or the communities themselves
is what will take education forwards more than recommendations from the
GMC or medical educators in medical education units.
Competing interests:
None declared
Competing interests: No competing interests
I salute Dogra, Connin, Gill, Spencer and Turner for conceptualizing
a brave topic. Without any attempt to dishearten them or the learned
teachers all over the world who struggle – or at least, pretend to
struggle – with the Utopian dream to produce culturally-sensitive doctors,
I would like to underscore that the place to learn how to be a nice human
being is not the medical school.
Long before entry to medical school, the fetters of the ‘way of life’
have already enshackled vulnerable minds. It is indeed a desperate race
between the loss of equilibrium through simply or passively just being
present in this world and the struggle to regain that mental equipoise.
That race is won or lost well before medical school entry. The systematic
repression of the child’s mind has been the privilege of every individual
parent of every possible ethnic subdivision; some do it to perfection
while others are less efficient. The immeasurable is always more important
the measurable. Prejudice – our way of life is right, theirs is not -- is
fed immeasurably to every child along with breast milk. What medical -- or
for that matter any -- school can try to do is, at best, to wash away
hopefully at the stains of the mind, a weak attempt at de-repression.
With shame having been conquered and banished to the confessional
stall, the magnificent role of human society as ‘the parent’ has been lost
and is resurrected only by the judge or the jury in the dock or during
elections, rigged openly or otherwise. Or is the media the final parent,
perpetrator and judge of all matters human and inhuman? Religion, as it is
practiced today, has been and will remain the greatest divisive force in
this world, and so it will remain till we learn afresh how to pray. We
should pray so that we learn not to pass our prejudices along with the
breast milk. The eternal destiny of the mind is the elusive goal of our
existence. A universal prayer also useful for medical students and
teachers alike may run something like this:
…bile blood tears sweat pain sorrow delight wisdom form rainbows;
then will I accept the lobotomy of
color race polity nationality religion
and their offsprings, belief and rhetoric
that stoke fires between them and us;
till then a world dweller remain I, belief-blind distinction-dead
free from shackles of belonging to this or that.
Children of runaway sophistry
drink crystals of unfettered thought
partake of mind's eternal destiny. (1)
Reference
Gupta VK. When. Eternal Portraits. Best Poets and Poems of 2003.
Available at : www.Poetry.com
Competing interests:
None declared
Competing interests: No competing interests
Cultural competence
The authors comment that there is a great deal of uncertainty what
constitutes diversity teaching. We would like to suggest that the aim of
this teaching should be the development of cultural competence.
Cultural competence consists of a set of behaviours and attitudes
that enable professionals to work effectively in cross-cultural
situations. [1] [2] [3] It recognises that each individual has a unique
cultural identity. This identity is a complex mix. Some of the identity is
collective, and similar to other members of the same culture (such as
Asian, Londoner or female), but some of it is specific to that individual.
No two individuals are the same but there is some degree of shared
collective culture.
Awareness of a particular culture, such as Moslem, can provide a
useful “short cut” to understanding the general values, beliefs and
behaviours of an individual but there is a danger that it can stereotype
that individual. The result is that individual needs are not identified
and met. The elucidation of the cultural beliefs of a person requires
specific communication skills.
It is important to be able to identify both the collective and
individual values and beliefs that are held by any person. This should be
the aim of any teaching to develop cultural competence, rather than
continuing with a reductionist approach that can stereotype individuals.
However, there is a greater challenge to undergraduate teaching. Wear
proposes that an important aspect of professional development is a
critical understanding of culture.[4] This understanding requires
learners to look at their biases, challenge their assumptions, know
people beyond labels, confront the effects of power and privilege, and
develop a far greater capacity for compassion and respect. Without this
appreciation, it is unlikely that healthcare will be improved.
[1] Cross TL, Bazron B, Dennis K,Isaacs M. Towards a Culturally
Competent System of Care: A Monograph on Effective Services for Minority
Children Who Are Severely Emotionally Disturbed. Georgetown University
Child Development Center: Washington DC, 1989.
[2]Lavizzo-Mourey R, Mackenzie ER. Cultural competence: essential
measurements of quality for managed care organizations. Annals of Intern
Medicine 1996; 124: 919-921.
[3] Davis K. Exploring the Intersection Between Cultural Competency
and Managed Behavioral Health Care Policy: Implications for State and
County Mental Health Agencies. National Technical Assistance Center for
State Mental Health Planning: Alexandria VA, 1997.
[4] Wear D Insurgent Multiculturalism: Rethinking How and Why We
Teach Culture in Medical Education. Academic Medicine 2003;78: 549-554.
Competing interests:
None declared
Competing interests: No competing interests