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