"Becoming the student of the patient": a framework for embedding cultural humility in a medical curriculum

Cultural humility is a lifelong commitment to self-reflection of biases, redressing power imbalances in the doctor-patient relationship to develop patient-centred care and advocacy partnerships with communities, with a focus on institutional accountability. It has the potential to be transformative and address social injustices. Yet there is little published evidence on embedding cultural humility in undergraduate medical curricula and how such curricula are received. We provide a framework for how we are embedding (and continue to embed) cultural humility into a spiral curriculum from Years 1-5 with increasing complexity at Queen's University Belfast. We offer this framework for others.

In developing the framework, we mapped the different dimensions of cultural humility using Tervalon and Murray-Garcia's original model of cultural humility, which allowed us to identify teaching and assessment that align to cultural humility delivered both by the authors of this paper and our colleagues. The Y1 and Y3 students were surveyed about their experiences of cultural humility teaching; the authors have also commented on anonymised student and tutor evaluative feedback relevant to the dimensions.

Framing cultural humility from Year 1 as their becoming the "student of the patient" resonated with students as a memorable way of being culturally humble. Students practise "becoming the student of the patient" through clinical encounters with patients and in simulated clinical experiential learning in Years 1-5. Language, both oral and written, also provides an entry point in discussions of power by developing students' critical consciousness of how clinical language can contribute to power imbalances between doctors and patients. To date, efforts to embed cultural humility have mainly focused on the intra-interpersonal dimension, as opposed to the institutional dimension.

Cultural humility should be introduced from the start of medical training and embedded with increasing complexity and experientially throughout undergraduate education. Language is fundamental to involving students in embedding cultural humility. Our journey to embed cultural humility is ongoing; we offer an argument as to how and why power and institutional commitment needs ongoing attention.