Integrating Cultural Humility into Medical Education Using a Structured and Interactive Workshop

Figures & data

Table 1 Pre-Intervention and Post-Intervention Scores of the Cultural Humility Workshop of 133 Participants

Variable*	Mean Pre-Test Score	Mean Post-Test Score	P value
Total perception Score	3.89 (0.04)	4.22(0.08)	<0.001
Total knowledge Score	0.52 (0.02)	0.67 (0.02)	<0.001
Perception Questions
Personal negative healthcare encounter	2.75 (0.12)	2.99 (0.15)	ns
Observed negative healthcare encounter	3.94 (0.1)	4.12 (0.1)	ns
Confident doing cross-cultural patient Interview	3.73(0.09)	4.07(0.09)	0.009
Power over patients preventing care	3.93(0.08)	4.25 (0.09)	0.007
Confident learning from patient	4.44 (0.06)	4.6 (0.06)	ns
I judge patients	3.57 (0.09)	3.7 (0.12)	ns
Confident in increasing respect of patients and negotiation	4.56 (0.06)	4.66 (0.06)	ns
Building trust with marginalized patients	4.19 (0.07)	4.45(0.08)	0.014
Knowledge Questions
Asian culture	0.83 (0.03)	0.98(0.02)	0.001
African American culture	0.86(0.04)	0.95 (0.03)	0.048
Hispanic culture	0.35(0.04)	0.66(0.04)	<0.001
Health equality	0.63(0.04)	0.83(0.04)	0.001
Health equity and inequity	0.52 (0.05)	0.61 (0.05)	ns
Allostasis	0.62 (0.04)	0.66 (0.05)	ns
Cultural humility	0.07 (0.02)	0.26(0.05)	<0.001
Cultural humility primary characteristic	0.62 (0.04)	0.74 (0.05)	ns
Intersectionality	0.46(0.05)	0.7(0.05)	0.001
Institution accountability	0.49 (0.05)	0.47 (0.05)	ns
Reducing Power Imbalance	0.47(0.05)	0.63(0.05)	0.018
Lifelong self-reflection	0.42 (0.04)	0.48 (0.05)	ns

Notes: () = Standard error of the mean; (95% CI) = 95% Confidence interval of the difference; Variable*: A brief synopsis of each perception question and the theme of each knowledge question is listed. The full description of each question can be found in the Appendix; The total knowledge score is the total score obtained by the participants on the 12 knowledge questions and the total perception score is the total score on a likert scale of 1–5 obtained by the participant on the 8 perception questions; ns= non-significant p value.

Table 2 Total Numbers of Sociocultural Identities Recognized by Participants, Including Identities Recognized as Privileged, Oppressed and Those Changing Over Time, Total n=92

Recognized Sociocultural Identities
Sociocultural identity	no	Percentage
Gender	85	92.4
Race/Ethnicity	77	83.7
Age	73	75.7
Place of birth	67	72.8
Personality	64	69.6
Appearance	53	5.6
Religion	52	56.5
Personal Habits	47	51.1
Sexual orientation	42	45.7
Marital Status	36	39.1
Income	30	32.6
Parental status	24	26.1
Education	23	25
First generation to go to college	20	21.7
Hobby	18	19.6
English as a second language	16	17.3
Family background	13	14.1
Career	9	9.8
Disability	5	5.4
Mental illness	4	4.3
Illness	3	3.3
Identity that Changed Over Time	no	Percentage
Personality	37	40.2
Appearance	33	35.8
Age	32	34.78
Religion	13	14.13
Marital Status	11	11.95
Parental status	6	6.52
Oppressed identity	no	Percentage
Race/ethnicity	50	54.34
Gender	37	40.2
Religion	26	28.26
Age	21	22.82
Appearance	18	19.56
English as a second language	7	7.6
Privileged identity	no	Percentage
Gender	45	48.91
Race/ethnicity	39	42.39
Appearance	23	25
Age	18	19.56
Sexual orientation	18	19.56
Personality	16	17.39

Table 3 Significant Associations Between Demographic Factors and Reported Privileged or Oppressed/Subjugated Sociocultural Identities by Participants

Sociocultural Identity	Variable	Variable	P value	OR; 95% CI
Race identity categories	Non-Hispanic White	Other races*
Race privilege identity (n= 84)	21/36 (58%)	16/48 (41%)	0.016	1.65; 1.24 −3.18
Oppressed race identity (n= 84)	12/35 (34%)	33/49 (67%)	0.004	0.57; 0.38–0.87
	Previous Training	No Previous Training
Race privilege identity (n=84)	16/26 (62%)	22/63 (35%)	0.03	2.98; 1.16 −7.67
Gender Identity categories	Male	Female
Gender privilege identity (n= 86)	29/39 (74%)	14/47 (30%)	<0.001	2.36; 1.49–3.73
Oppressed gender identity (n= 86)	2/38 (5%)	31/48 (65%)	<0.001	0.34; 0.23–0.51
	Born in USA	Born outside USA
Gender privilege identity (n=67)	30/55 (55%)	2/10 (17%)	0.025	4.6; 1.1 −19.3
Language identity categories	Born in USA	Born outside USA
English as 2nd language oppressed identity (n= 85)	0/60 (0%)	5/12 (42%)	<0.001	0.12; 0.6 −2.3

Notes: Other races*: African Americans, Asian Americans and Hispanic Americans; Statistical analysis was done using Chi square analysis to determine significant associations between demographic factors (race, gender, country of birth, educational status, and previous training in cultural humility) and participants reported sociocultural Identities (race privilege, race oppression, gender privilege, gender oppression, English as 2nd language oppressed identity); Only significant results are reported; (n): total number of participants who reported on the specific sociocultural Identity; Each value is recorded as the number of participants who selected the oppressed or privileged identity divided by the denominator of all participants in that demographic variable; OR; 95% CI: Odds ratio, 95% confidence interval.

Table 4 Power Assignment by Participants (from −100 to +100) of Reported Sociocultural Identities

Identity	Mean Power Score	Mean Power Score	p value; 95% CI
	Male	Female
Gender Identity	73.13% (8.7%)	−7.66% (8.1%)	<0.001 (56.07% to 105.49%)
	White	Non-White
Race Identity	61.8% (9.13%)	13.4722% (6.99%)	<0.001 (25.67% to 70.98%)
	Medical Students	Residents
Education identity	40.64% (10.59%)	80.71% (6.59%)	0.005; (−66.19% to −13.95%)
	Previous Training	No Previous Training
Appearance identity	41.42% (10.56%)	11.84% (6.99%)	0.038 (1.9% to 57.27%)
Education identity	82.5% (7.04%)	44.62% (9.66%)	0.005 (12.85% to 62.9%)

Notes: Statistical analysis was done using Student T test to determine significant associations between power assignment by participants (from −100 to +100) and reported sociocultural Identities (gender, race, education, and appearance). Only significant results are reported; 95% CI OR: 95% confidence interval.