Student reflections on learning cross-cultural skills through a ‘cultural competence’ OSCE

Figures & data

Table

Practice points
•A ‘Cultural Competence’ OSCE can be helpful in the teaching of knowledge and skills in cross-cultural care, but should not be used as an isolated cross-cultural care teaching tool.
•Medical students note that the OSCE station helped to bring theoretical concepts from lectures on cross-cultural care into practice.
•Creating a ‘cultural competence’ OSCE requires careful attention to faculty development, training of standardized patients, and preparation of students.
•A ‘cultural competence’ OSCE station that focuses on eliciting patients' perspectives and exploring social and cultural factors for medication non-adherence can serve as a unique and valuable teaching tool.

Table 1.  Comparison of demographic characteristics of study participants to the overall class and participants’ self-rating on this ‘cultural competence’ station

Student sample description	Total participants n = 22 (%)	Total in class n = 166 (%)
Sex
Female	14 (64)	90 (54)
Male	8 (36)	76 (46)
Race/Ethnicity
White/Caucasian	10 (45)	71 (43)
Black and Hispanic*	5 (23)	42 (25)
Asian-American^†	7 (32)	48 (29)
Other	0 (0)	5 (3)
Students’ self-rating
Students who reported ‘doing well’ on the station	6 (27)	–
Students who reported feeling challenged by the station	13 (59)	–
Students who reported doing ‘poorly’ or ‘failing’ the station	3 (14)	–

*2 African-American, 2 Latino, 1 Haitian. ^†4 East Asian, 3 South Asian.

Table 2.  Student Perspectives on the Primary Purpose of this OSCE station

Student reflections on the central ‘rake home’ points from this case	% of responses (total exceeds 100% due to overlapping responses)	Sample student quotes in response to “What did you think was the essence of this case?”
Eliciting the patients’ perspectives and  understanding of their illness (the ‘explanatory model’)	41% (9)	“Just how to approach a patient who doesn’t speak English as a first language, the ways of asking questions about what they understand about the disease and how they take their medications.” “I guess thinking about patients understanding of their disease and the medication you give them to take which was really key to think about.”
Asking patients about how they take their medications,  and about whether they utilize complementary or alternative therapies	45% (10)	“Just that for all real patients, you should ask if they’re taking their medications and how regularly they take them and if they’re taking them at the prescribed dose. If they have any problems affording the medications, side effects that may be causing them not to take their medications and just how they feel on the meds; what they think they’re taking the medication for.” “I think just, well one thing would be just remembering to ask about alternative types of medications, instead of just regular prescription medications, asking about any vitamins or herbal supplements, or any types cause I think our patient said something about, you know, herbal tea, that she got from some kind of cultural store. So that was one at least one concrete thing that I will remember.”
Exploring the range of reasons for medication non-adherence  including literacy, language barriers, health beliefs, insurance status, financial barriers	41% (9)	“I think that the point of the case would have been to figure out everything that might be potentially leading to medication non-compliance, and therefore, out of control hypertension.” “I think it's good to get to the idea of why people are not compliant, and so I think, not just because there are side effects, so they don’t want to take the medication, because maybe they don’t have money to afford all of the medication, so try and stretch it out, and maybe it wasn’t explained to them at the beginning that you need to take every single day, regardless of how you’re feeling. So I think that was a take home point, to stress all the issues of non-compliance.”