The ‘exotic other’ in medical curricula: Rethinking cultural diversity in course manuals

Abstract

Introduction: Implementation of cultural diversity training in medical education faces challenges, including ambiguity about the interpretation of ‘cultural diversity’. This is worrisome as research has demonstrated that the interpretation employed matters greatly to practices and people concerned. This study therefore explored the construction of cultural diversity in medical curricula.

Methods: Using a constructivist approach we performed a content analysis of course materials of three purposefully selected undergraduate curricula in the Netherlands. Via open coding we looked for text references that identified differences labelled in terms of culture. Iteratively, we developed themes from the text fragments.

Results: We identified four mechanisms, showing together that culture is unconsciously constructed as something or someone exotic, deviant from the standard Dutch or Western patient or disease, and therefore problematic.

Conclusions: We complemented earlier identified mechanisms of othering and stereotyping by showing how these mechanisms are embedded in educational materials themselves and reinforce each other. We argue that the embedded notion of ‘problematic stranger’ can lead to a lack of tools for taking appropriate medical action and to insecurity among doctors. This study suggests that integrating more attention to biological and contextual differences in the entire medical curriculum and leaving out static references such as ethnicity and nationality, can enhance quality of medical training and care.

Keywords:

• Cultural diversity
• medical curriculum
• ethnicity
• constructivism
• course material

Note

Acknowledgments

We are grateful to the two medical schools for participating in this study and sincerely thank them for granting us access to educational materials. We are thankful to the members of the Globalization Research Group of the School of Health Professions Education, Maastricht University, for their valuable feedback. Editing of the manuscript by Angelique van den Heuvel, Department of Educational Development and Research, Maastricht University, is gratefully acknowledged.

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article.

Glossary

Culture: Although very many definitions and interpretations of this concept exist, a possible description relevant for medical education could be: A complex layered framework that gives shape and meaning to our material, mental and social worlds. It is a constantly changing pattern of customs, convictions and meanings that are learned, shared and passed on through interpersonal transactions and based on experiences in people’s daily lives. It helps people (patients, doctors) to construct a sense of themselves and understanding of others. A person’s cultural identity (for example as a director, Turk, woman, Christian, general practitioner or diabetes patient) and the meaning attached to this identity both change depending on the context (at home, in the workplace, on holidays, abroad, in the doctor’s office, etc.), on the persons they have contact with, and over time.

Cultural diversity: Refers to the existence of a variety of cultural meanings, customs, convictions and beliefs within (a certain part of) society (region, institution, setting, etc.).

Notes

1 The term ‘native’ has different connotations in diverse contexts. In Yanow and Van der Haar’s study, it refers to ‘autochthons’, that is, the original Dutch people whose parents were both born in the Netherlands.

Additional information

Notes on contributors

Albertine Zanting

Albertine Zanting, MA, PhD, researcher and Senior policy advisor on Cultural diversity at the School of Health Professions Education, Maastricht University, Maastricht, the Netherlands.

Agnes Meershoek

Agnes Meershoek, MSc, PhD, Associate Professor at the Health, Ethics and Society Department, School Caphri, Maastricht University, Maastricht, the Netherlands.

Janneke M. Frambach

Janneke M. Frambach, PhD, Assistant Professor at the School of Health Professions Education, Maastricht University, Maastricht, the Netherlands.

Anja Krumeich

Anja Krumeich, Professor in Translational Ethnographies in Global Health and Education, at the Health, Ethics and Society Department, Maastricht University, Maastricht, the Netherlands.