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Authors Institution
Elizabeth Fracica
Adeel Zubair
Sagar Chawla
Dr. James Newman
Mayo Medical School
Mayo Clinic
Theme
International Dimensions
A Rapid Intervention to Improve Somali Cultural Competency in Minnesota Medical Students
Background

       Medical Schools across the United States are beginning to realize the importance of incorporating cultural education into medical school curricula in order to help students understand how to effectively care for a more diverse patient population (1,2). Several landmark studies have shown that poor provider cultural competency is associated with worse patient outcomes (3,4). A systematic review of 34 studies of interventions designed to improve the cultural competence of health professionals showed that cultural competency training not only improves the attitudes, knowledge, and skills of healthcare providers, but also improves patient satisfaction (7). Despite the growing body of research supporting cultural competency training, most medical schools have not incorporated such programs into their curricula. This is due, in part, to the lack of specific evidence-based guidelines for cultural competency training in curriculum development (5). In addition, there is limited research which addresses the effect of cultural competency training on patient adherence to therapy, equity of services across racial groups, or health outcomes (7). In general, eight key content areas in cultural competency education have been identified for future healthcare providers: general cultural concepts, racism and stereotyping, physician-patient relationships, language, specific cultural content, access issues, socioeconomic status, and gender roles and sexuality (8). While Minnesota medical schools are no exception in that they have not traditionally incorporated such cultural concepts into their curricula, they are the exception in that Minnesota is home to the largest Somali population in the U.S., according to the 2010 U.S. Census Report. Minnesota Medical students will be expected to treat many Somali patients throughout their training, despite their lack of formal training in Somali culture. In hopes of better understanding and addressing part of this educational need, we designed a culturally-immersive lunch experience for a group of Minnesota Medical Students, based on these eight key cultural competency content areas. We were unable to find any previously published surveys designed to assess Somali cultural competency, and thus, we also designed our own survey to assess student understanding. We received 47 completed pre-surveys and 18 post-surveys. We hoped to determine if the cultural competency of Minnesota Medical students could be improved by active participation in an immersive experience surrounding Somali culture based on these survey responses.    

                                         

Summary of Work

In this study, we assessed baseline student knowledge and attitudes towards Somali patients as well as the extent of improvement in cultural competency through administering a survey to 48 medical students before and after a culturally-immersive lunch meeting.

Survey: 25 questions total, 20 T/F Knowledge questions, 5 Attitude-Based Questions

  • Designed to assess student understanding of Somali culture as it pertains to the 8 key content areas of cultural competency. (Pre and Post-survey were the same).
  • Survey administered at the start of the meeting and at a follow up meeting 2 months later

Structure: A one hour, culturally immersive lunch meeting consisting of a 40 minute lecture from a Mayo Clinic translator native to Somalia. Key presentation topics included:

  • The history of Somalia
  • Public health information on Somalis (demographic, socioeconomic, epidemiologic, etc.)
  • Barriers Somalis face to accessing healthcare in the U.S.
  • Gender-specific issues
  • Cultural differences students might expect to encounter in the clinic when caring for Somalis

Cultural Immersion: A Somali translator (native to Somalia) presented to the students about his culture. Students received traditional Somali food, learned and practiced some basic Somali phrases, wore hijabs, and received a list of Somali recipes.

Acknowledgement

We would like to thank the Mayo Clinic Department of Internal Medicine and Mayo Medical School for their continued support and guidance.  We would especially like to thank our wonderful speakers on Somali culture without which this study would not have been possible: Mr. Mahamoud Jimale and Misbil F. Hagi Salaad, RN.

Summary of Results

A total of 47 students completed the pre-survey, and 18 students completed the post-surveys.

From the surveys, several important points emerged:

Knowledge:

  • Students had relatively poor baseline understanding of Somali culture that showed improvement following the intervention.
  • The averages obtained using the mode of the first survey vs. the second survey improved by 15%.
  • The average of the pre-survey scores was 65%.

Attitude:

  • Students felt that Somali population faced more challenges in scheduling appointments both before and after the lunch. (Pre-survey: 1.6304, 1=strongly agree, Post-survey: 1.5294, 1= strongly agree).
  • Students became more confident in their knowledge of Somali culture following the meeting. (Pre-survey: 4.1304; 4=disagree, Post-survey: 3.59; 3=neutral).
  • In response to, “I look forward to interacting with Somali patients,” most students responded positively (1.8723, 1 = Strongly agree) before and after the intervention.
  • When responding to the statement, “I feel like the quality of care I provide to Somali patients might be compromised due to a lack of understanding of their culture. True/ False,” 85% of the students agreed.

It is important to note that while the pairings for statistical analysis were significantly effective, the power of this study was too low to generate statistically significant results due to the diminished responses in the follow-up survey. We anticipate the results would have shown further student improvement had there been a better response.

 

Conclusion

        A growing body of research has demonstrated that negative patient outcomes are, in part, associated with poor healthcare provider cultural competency. Further, studies have shown cultural competency training can result in improvements in provider knowledge, attitudes, and skills as they pertain to caring for ethnically and racially diverse patient populations, as well as improving patient satisfaction. Traditionally, medical schools have not incorporated such training into their curricula, and thus, many medical schools have yet to implement formal cultural competency training. In hopes of addressing this educational need at our own institution, given the extent to which Minnesota medical students are expected to interact with Somali patients, we held a rapid culturally-immersive intervention in Somali culture for medical students. Our study results were not statistically significant due to the small sample size, though we were able to note upward trends in Somali culture knowledge as well as better understand student baseline knowledge and attitudes. Though not formally measured, our intervention was one of the most highly attended medical student lunch meetings of the year. Over half of the entire first and second year medical school class was present at this meeting. This in itself speaks to the need for more formal education on cultural competency as it pertains to the patient populations medical students will be treating in the near future. It also speaks to the students’ ability to recognize their weaknesses and their desire to educate themselves so that they might become better clinicians. We live in an ever-diversifying and globally linked world. Is it not our responsibility to educate our future physicians to be able to best serve in this diverse world as culturally competent providers for people of all ages, races, ethnicities, religions, and nationalities? It is time we start training our medical students to provide equal care and the best care for all of their future patients.

References

1.) Betancourt, JR. 'Cross-cultural medical education in the United States: key principles and experiences..'Journal of Medical Science. 25.9 (2009): 471-478. Web. 19 Aug. 2013.

2.) Kagawa-Singer, Marjorie, and Shaheen Kassim-Lakha. 'A Strategy to Reduce Cross-cultural Miscommunication and Increase the Likelihood of Improving Health Outcomes.' Academic Medicine. 78.6 (2003): 577-587. Web. 19 Aug. 2013.

3.) Smedley BD, Stith AY, Nelson AR, eds: Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Washington, DC: Board on Health Sciences Policy, Institute of Medicine of the National Academies; 2003.

4.) Yancy, CW, and . 'Cardiovascular disease outcomes: priorities today, priorities tomorrow for research and community health..' Ethnicity & Disease. 22.3 (2012): S1-S7. Web. 19 Aug. 2013.

5.) Dykes, Daryll C., and Augustus A. White, III. 'Culturally Competent Care Pedagogy: What Works?.' Clinical Orthopaedics and Related Research. 469.7 (2011): 1813-1816. Web. 19 Aug. 2013.

6.) Beach MC, Price EG, Gary TL, et al. Cultural competency: a systematic review of health care provider educational interventions. Med Care. 2005;43(4):356–373. [PMC free article][PubMed]

7.) Alexander M, Grumbach K, Remy L, Rowell R, Massie BM: Congestive heart failure hospitalizations and survival in California: patterns according to race/ethnicity. Am Heart J 1999, 137:919-927.

8.) Dolhun EP, Munoz C, Grumbach K. Cross-cultural education in U.S. medical schools: development of an assessment tool. Acad Med. 2003;78: 615–22.

Designed & Managed by Innovative Technology®
Background
Summary of Work

Somali Culture Pre- and Post-Survey

1. Somalia borders Ethiopia.

True False

2. The civil war was mostly caused by tribal conflicts.

True False

3. Alcoholism is not a common problem in the Somali population.

True False

4. Somali marriages are typically polygamous, like many other African countries.

True False

5. The major religion in Somalia is Islam.

True False

6. Somalia was colonized by Britain, France, and Italy.

True False

7. Because many Somalis were nomads, they are unfamiliar with the Western style of medicine.

True False

8. HIV/AIDS is a major issue in the Somali population.

True False

9. Somalis will not come in for care unless they display bad symptoms.

True False

10. They may miss appointments because they do not use calendars.

True False

11. Traditional healers do not play a big role in Somali healthcare.

True False

12. Somalis may expect a prescription if they have cold-like symptoms, even if the medical provider assures them it is self-limited.

True False

13. Somali patients prefer to be called by their first names.

True False

14. If a Somali patient does not shake your hand, it is likely because you have done something to offend them.

True False

15. Elderly members of the Somali society are typically cared for by family members.

True False

16. If the father has become incapacitated, the wife is next in charge according to Somali customs.

True False

17. Brain death is not well understood in Somali culture. They believe that death comes with ceasing of cardiac function, only.

True False 18.

The majority of Somalis do not have health insurance.

True False

19. About 10% of Somalis are illiterate.

True False

20. Somalis are afraid of immunizing their children because they believe it will cause autism.

True False

 

Attitude-based Questions:

1. I feel uncomfortable treating Somali patients: Yes/No.

a. If Yes, why:

        i. I do not know much about their culture

        ii. I am afraid

        iii. I do not understand how to meet their needs

        iv. I am frustrated by their practices

        v. I greatly dislike having to use a translator

        vi. Other: ____________________________

 

2. My knowledge of the Somali culture is excellent:

Strongly Agree      Agree      Neutral       Disagree       Strongly Disagree

 

3. I look forward to interacting with Somali patients.

Strongly Agree       Agree      Neutral         Disagree        Strongly Disagree

 

4. I feel like the quality of care I provide to Somali patients might be compromised due to a lack of understanding of their culture.

Strongly Agree        Agree        Neutral        Disagree         Strongly Disagree

 

5. Somali patients face more challenges than most of my other patients in scheduling an appointment.

Strongly Agree         Agree        Neutral         Disagree        Strongly Disagree

 

I am a:

a. First year medical student

b. Second year medical student

c. Third year medical student

d. Fourth year medical student

e. Other: _______________

Acknowledgement
Summary of Results
Conclusion
References
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