Effectively teaching cultural competence in healthcare education

INTRODUCTION: According to current census projections, by the year 2050 racial and ethnic minority groups will make up over half of the United States population. With the rise of a more multicultural and diverse population, there has been growing concern with regards to the health disparities and how healthcare professionals can increase positive healthcare outcomes. In an effort to contend with the growing population, the subsequent disparities that will be faced by a more diverse population, and the difficulties many healthcare practitioner’s will encounter while communicating and working with this population group, many healthcare educators have turned their attention to training and educating the next generation of healthcare providers on the practice of cultural competence. For many institutions, however, there is still uncertainty over the most effective means for teaching cultural competence throughout the healthcare curriculum. Data collected from a 2017-2020 study conducted at Boston University in the M.S. in Oral Health Sciences Program, a credential enhancing program for predental students with the aim of providing students with admission into an accredited dental institution, evaluates an effective mechanism for training healthcare professionals in cultural competence skills. This study hypothesizes that one effective and powerful tool for teaching the next generation of health professionals to be culturally competent providers is through role-playing, case-based, simulated exercises which emphasize the importance of the provider patient relationship, holistic approaches to healthcare, and compassion when working with patients. METHODS: A course session was created in an Evidence Based Dentistry Course within the M.S. in Oral Health Sciences Program. From 2017-2019 the course session was composed of three parts: a role-playing enactment of two patient case-based encounters, a real-time class group discussion following both patient encounters, and a PowerPoint presentation emphasizing the key take-away points from the role-playing exercise. At the conclusion of the session, students were asked to participate in a post-session survey regarding the student’s feelings about the session. In 2020, due to the COVID-19 pandemic, a switch in course session modality in the Evidence Based Dentistry course to an online format, prompted a change in the session format. In 2020, students were asked to read both patient encounters on their own, reflect, discuss, and comment on the learning platform Blackboard Learn discussion board on their takeaways from the case, and participate in PowerPoint presentation presented by facilitators. At the conclusion of the 2020 session, students were asked to complete a post-session survey on the effectiveness of the session. In addition to qualitative data obtained from the post-session surveys, in 2020, student discussion board posts were coded and analyzed qualitatively using the coding software NVivo 12 to determine whether students understood the important takeaways from the discussion board portion of the session. RESULTS: According to results from the course session implemented from 2017-2019, overall, the role-playing exercise significantly improved participants understanding of key components of cultural competence. From 2017-2019 students were strongly able to identify the importance of communication in patient encounters, were able to understand the strategies such as communication and compassion in patient encounters, were better able to identify the importance of building a trusting patient -physician relationship, and most importantly, students were able to recognize their own cultural biases when treating patients. Results from 2020, revealed that even with a change in course modality and format to a discussion board format, students were still able to understand the key take-aways of cultural competence from the session. DISCUSSION: This study reveals that students were able to understand cultural competence after completion of both iterations of the course session from 2017-2019 & 2020 and that this session can be an effective method for training the next generation of healthcare professionals the practice of cultural competence. While this study provides insight into the future of cultural competence training, it is important to recognize that more studies must be conducted to provide additional answers to several questions about the most effective mechanism for teaching cultural competence, what to teach in cultural competence education, and when to begin training students the practice of cultural competence