Clinical teachers' perspectives on cultural competence in medical education

Globalisation and migration have inevitably shaped the objectives and content of medical education worldwide. Medical educators have responded to the consequent cultural diversity by advocating that future doctors should be culturally competent in caring for patients. As frontline clinical teachers play a key role in interpreting curriculum innovations and implementing both explicit and hidden curricula, this study investigated clinical teachers' attitudes towards cultural competence training in terms of curriculum design, educational effectiveness and barriers to implementation.

This study was based on interviews with clinical teachers from university-affiliated hospitals in Taiwan on the subject of cultural competence. The data were transcribed verbatim and translated into English. The interviews were analysed using grounded theory to identify and categorise key themes.

Five main themes emerged: (i) there was a clear consensus that students currently lack sufficient cultural competence; (ii) the teachers agreed that increased exposure to cultural diversity improved students' cultural understanding; (iii) present curriculum design was generally agreed to be inadequate, and it was argued that devoting space to developing cultural competence across the curriculum would be a worthwhile endeavour; (iv) different methods of performance assessment were proposed; and (v) the main obstacles to teaching and assessing cultural competence were perceived to be a lack of commonly agreed goals, the low priority accorded to it in an overloaded curriculum and the inadequacy of teachers' cultural competence.

Eliciting the viewpoints of the key providers is a first step in curriculum innovation and reform. This study demonstrates that clinical teachers acknowledge the need for explicit and implicit training in cultural competence, but there needs to be further debate about the overall goals of such training, the time allotted to it and how it should be assessed, as well as a faculty-wide development programme addressing pedagogical needs.