Cultural competency of GP trainees and GP trainers: a cross-sectional survey study

Figures & data

Table 1. Participant characteristics and information about caring for people with a migration background.

	GP trainees N = 92	GP trainers N = 186
Female	72 (78.3%)	104 (55.9%)
GP training institute
- VUmc	46 (50.0%)	92 (49.5%)
- AMC	46 (50.0%)	94 (50.5%)
Year of residency		N.A.
- First year	56 (60.9%)
- Third [last] year	36 (39.1%)
Years of experience as a junior doctor before the start of GP training	2.5 [2.0–4.0]	N.A.
Years of experience as a GP trainer	N.A.	8.0 [4.0-14.0]
Years of experience as a GP	N.A.	20.0 (±7.5)
Ethnicity of participants^a
- Dutch origin	71 (77.2%)	155 (83.8%)
- European origin	3 (3.3%)	11 (5.9%)
- Origin outside Europe	18 (19.6%)	19 (10.3%)
Migrant patients in general practice
-≤10%	46 [50.0%]	84 (45.2%)
−11–25%:	18 [19.6%]	46 (24.7%)
−26–50%	21 (22.8%)	41 (22.0%)
- >50%	7 (7.6%)	15 (8.1%)
Countries of origin of migrant patients mentioned in the top 3^b
- Turkey	59 (68.6%)	125 (69.4%)
- Morocco	47 (54.7%)	130 (72.2%)
- Syria	30 (34.9%)	52 (28.9%)
Affinity with care of migrant patients
- Special affinity	6 (6.5%)	11 (5.9%)
- Affinity	25 (27.2%)	60 (32.3%)
- Neutral	45 (48.9%)	95 (51.1%)
- Little affinity	13 (14.1%)	20 (10.8%)
- No affinity	3 (3.3%)	0 (0.0%)
Perceived barriers due to language and/ or cultural differences
- Strongly disagree	1 (1.1%)	7 (3.8%)
- Disagree	3 (3.3%)	29 (15.6%)
- Neutral	9 (9.8%)	31 (16.7%)
- Agree	71 (77.2%)	106 (57.0%)
- Strongly agree	8 (8.7%)	13 (7.0%)

Mean (±SD) for normally distributed continuous variables.

Median [IQR] for skewed distributed continuous variables.

N (%) for categorical variables.

^a 1 (0.4%) missing in the GP supervisors group.

^b 35 (11.6%) missing of the total number of participants (N = 278).

Table 2. Scores on knowledge, culturally competent consultation attitudes and skills and their sub-sections for GP trainees and GP trainers.

	Interpretation of scores^a GP trainees			Interpretation of scores^a GP trainers
	Low level N (%)	Moderate level N (%)	High level N (%)	Low level N (%)	Moderate level N (%)	High level N (%)
Knowledge	86 (93.5%)	6 (6.5%)	0 (0.0%)	150 (80.6%)	36 (19.4%)	0 (0.0%)
- General knowledge	85 (92.4%)	7 (7.6%)	0 (0.0%)	172 (92.5%)	13 (7.0%)	1 (0.5%)
- Specific diagnosis	57 (62.0%)	32 (34.8%)	3 (3.3%)	99 (53.2%)	65 (34.9%)	22 (11.8%)
Culturally competent consultation attitudes	41 (44.6%)	38 (41.3%)	13 (14.1%)	79 (42.5%)	77 (41.4%)	30 (16.1%)
- Awareness of social context and patients’ specific factors	51 (55.4%)	25 (27.2%)	16 (17.4%)	89 (47.8%)	48 (25.8%)	49 (26.3%)
- Awareness of how culture shapes an individual’s behaviour and thinking, and curiosity about understanding or learning more about patients’ perspectives	22 (23.9%)	33 (35.9%)	37 (40.2%)	57 (30.6%)	61 (32.8%)	68 (36.6%)
Culturally competent skills [range score 0-5]	28 (30.4%)	50 (54.3%)	14 (15.2%)	90 (48.4%)	82 (44.1%)	14 (7.5%)
-The ability to adapt communication to patients’ [health] literacy, to assess when external help with communication is needed and how to work with an interpreter in consultation	32 (34.8%)	41 (44.6%)	19 (20.7%)	113 (60.8%)	53 (28.5%)	20 (10.8%)
-The ability to compromise with patients or their family as needed, to adapt flexibly and creatively to new situations	42 (45.7%)	30 (32.6%)	20 (21.7%)	89 (47.8%)	52 (28.0%)	45 (24.2%)

^a interpretation scores: <60% of maximum score = low; 60–80% of maximum score = moderate; >80% of maximum score = high score.

Table 3. The relationship between several factors and the assessed cultural competence.

	Knowledge		Culturally competent consultation attitudes		Culturally competent skills
	GP trainees	GP trainers	GP trainees	GP trainers	GP trainees	GP trainers
	Beta (95%CI)	Beta (95%CI)	Beta (95%CI)	Beta (95%CI)	Beta (95%CI)	Beta (95%CI)
Sex	–	–	–		–	–
0 Female
1 Male
GP training institute		–	–			–
0 VUmc	–				–
1 AMC	0.8 (-0.1 − 1.6)*				−0.3 (-0.6 − 0.0)*
Year of residency		–	–			–
0 First year of residency	–				–
1 Last year of residency	1.5 (0.6 − 2.4)*				0.3 (-0.0– 0.6)*
Years of experience as a junior doctor before the start of GP training^a	–	N.A.	–	N.A.	–	N.A.
Years of experience as a GP trainer	N.A.	–	N.A.	-	N.A.
0 Quartile1						–
1 Quartile2						0.2 (-0.1 − 0.6)
2 Quartile3						0.4 (0.0 − 0.7)*
3 Quartile4						−0.0 (-0.3 − 0.3)
Years of experience as a GP	N.A.	–	N.A.	–	N.A.	–
0 Quartile1
1 Quartile2
2 Quartile3
3 Quartile4
Percentage of migrant patients in general practice	–		–		–	–
0 ≤ 10%		–		–
1 > 10%		1.6 (0.9 − 2.3)*		0.3 (0.1 − 0.4)*
Ethnicity of participants	–	–	–	–	–	–
0 European origin
1 Origin outside Europe		1.1 (-0.1–2.2)*			0.4 (0.0–0.8)*
Affinity with care of migrant patients^b	–	–	–	–	–	–
0 No affinity
1 Neutral
2 Affinity
Self-perceived CC1	–	–	–		–	–
0 Score 1-5				–
1 Score ≥6				0.2 (0.0 − 0.4)*

0= the reference group.

* Significance at p ≤ 0.10.

^a Continuous variable.

^b The categorical variable perceived barriers in care of migrants was excluded from the analysis due to collinearity with affinity with care for migrants in both groups.

Figure 1. Perceived education of GP trainees and GP trainers in relation to migrant health care, according to the questionnaire.

^aCommunication skills to overcome language barriers and functional illiteracy, such as clarifying the request for help, exploring concerns and emotions, and giving explanations tailored to the patient’s level of literacy.

^bCommunication skills for holding consultations with an interpreter (e.g. maintaining control).