The Experience of Colombian Medical Students in a Pilot Cultural Safety Training Program: A Qualitative Study Using the Most Significant Change Technique

Abstract

Problem: The Colombian government provides health services grounded in the Western biomedical model, yet 40% of the population use cultural and traditional practices to maintain their health. Adversarial interactions between physicians and patients from other cultures hinder access to quality health services and reinforce health disparities. Cultural safety is an approach to medical training that encourages practitioners to examine how their own culture shapes their clinical practice and how to respect their patients’ worldviews. This approach could help bridge the cultural divide in Colombian health services, improving multicultural access to health services and reducing health disparities. Intervention: In 2016, we conducted a pilot cultural safety training program in Cota, Colombia. A five-month training program for medical students included: (a) theoretical training on cultural safety and participatory research, and (b) a community-based intervention, co-designed by community leaders, training supervisors, and the medical students, with the aim of strengthening cultural practices related to health. Evaluation used the Most Significant Change narrative approach, which allows participants to communicate the changes most meaningful to them. Using an inductive thematic analysis, the authors analyzed the stories and discussed these findings in a debriefing session with the medical students. Context: Cota is located only 15 kilometers from Bogota, the national capital and biggest city of Colombia, so the small town has gone through rapid urbanization and cultural change. A few decades ago, inhabitants of Cota were mainly peasants with Indigenous and European traditions. Urbanization displaced agriculture with industrial and commercial occupations. One consequence of this change was loss of cultural health care practices and resources, for example, medicinal plants, that the community had used for centuries. Impact: A group of 13 final-year medical students (ten female and three male, age range 20–24) participated in the study. The medical students listed four areas of change after their experience: increased respect for traditional health practices to provide better healthcare; increased recognition of traditional practices as part of their cultural heritage and identity; a desire to deepen their knowledge about cultural practices; and openness to incorporate cultural practices in healthcare. Lessons Learned: Medical students reported positive perceptions of their patients’ cultural practices after participating in this community-based training program. The training preceded a positive shift in perceptions and was accepted by Colombian medical students. To the best of our knowledge, this was the first documented cultural safety training initiative with medical students in Colombia and an early attempt to apply the cultural safety approach outside the Indigenous experience.

Keywords:

• cultural safety
• transformative learning
• participatory research
• Colombia

Acknowledgments

The authors wish to thank Sara Romero, Astrid Romero, Patricia Hómez, Mélida Valbuena, and Marcela Balcero, the community leaders who supported the study, Erwin Hernández, Sandra Espitia, Rosa Margarita Durán,, and Francisco Lamus who provided feedback to the project, and Hila Silver and Cassandra Laurie who helped proofread the final version of the manuscript.

Disclosures

The authors report no conflicts of interest to disclose.

Ethical approval

The Sub-committee for Research of the Faculty of Medicine at La Sabana University provided ethical approval of the project (approval number: 445).

Previous presentations

Findings were presented at the 2018 North American Primary Care Research Group (NAPCRG) Annual Meeting. Chicago IL, USA. November 10th, 2018.

Contributors

All the authors designed the study, conducted the analysis, and wrote the article manuscript. JP, CM, DV, CK, IS, and CC conducted the community-based intervention. JP, CM, DV, and CK collected the data of the study. All the authors approved the final version of the manuscript and agreed to be accountable for all aspects of the work.

Additional information

Funding

This study was supported by the CeiBA Foundation and the Center of Intercultural Medical Studies (Colombia), and the Fonds de recherche du Québec – Santé (Canada). This did not influence the design and execution of the study.