A discourse analysis of General Medical Council (GMC) guidelines for the inclusion of cultural diversity issues in medical education and practice

Abstract

Background

Several studies have highlighted the insufficient inclusion of cultural diversity in medical schools’ curricula and the extent of health inequalities highlighted by the COVID-19 pandemic. This study aimed to critically review a range of GMC publications to identify the inclusion of cultural diversity topics in their guidelines, as according to recent studies, doctors are inadequately prepared to serve a diverse population.

Methods

Twenty-four relevant GMC publications were analysed. An inductive thematic analysis was conducted to review the content of the guidelines; and discourse analysis was used to critically understand the linguistics used whilst also considering the cultural and social context.

Results

The GMC publications primarily focused on discouraging discrimination and promoting equality. Themes around diversity in medical practice were less commonly covered. There was considerable internal inconsistency across the guidelines. Guidelines aimed at medical schools and medical students were more likely to consider cultural diversity issues compared to those intended for doctors.

Conclusions

Cultural diversity teaching can only be as effective as the policy that drives it. Despite the inclusion of cultural diversity issues in GMC guidelines, this study suggests considerable ambiguity in how these issues are represented and understood. The guidelines require careful revision and should be written to reduce the likelihood of variable interpretation, thereby promoting better cultural diversity inclusion in medical schools’ curricula, and consequently better patient care.

Keywords:

• Curriculum
• communication skills
• general
• patient management
• professionalism

Glossary

Cultural Diversity: ‘Refers to the manifold ways in which the cultures of groups and societies find expression. These expressions are passed on within and among groups and societies. Cultural diversity is made manifest not only through the varied ways in which the cultural heritage of humanity is expressed, augmented and transmitted through the variety of cultural expressions, but also through diverse modes of artistic creation, production, dissemination, distribution and enjoyment, whatever the means and technologies used.’ (UNESCO 2005, p. 4)

Cultural Awareness: ‘Is the foundation of communication and it involves the ability of standing back from ourselves and becoming aware of our cultural values, beliefs and perceptions.’ (Quappe and Cantatore 2005)

Cultural Competence: ‘Cultural competence’ in health care entails: understanding the importance of social and cultural influences on patients’ health beliefs and behaviours; considering how these factors interact at multiple levels of the health care delivery system (e.g. at the level of structural processes of care or clinical decision-making); and, finally, devising interventions that take these issues into account to assure quality health care delivery to diverse patient populations. (Betancourt et al. 2003, p. 297)

Disclosure statement

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

Additional information

Notes on contributors

Bheatriz Elsas Parish

Bheatriz Elsas Parish, BSc (Hons), MBBS, is a recently qualified doctor from Barts and The London School of Medicine.

Nisha Dogra

Nisha Dogra, BM, FRCPsych, MA, PhD, is an Emeritus Professor at the University of Leicester and a retired consultant in child and adolescent psychiatry.

Riya Elizabeth George

Riya Elizabeth George, BSc (Hons), MSc, MSc, PhD, PGCERT, is a Reader in Clinical Communication and Diversity Education at Barts and The London School of Medicine and Dentistry.