Cultural awareness through medical student and refugee patient encounters

Purpose: This paper presents findings from a qualitative investigation of cultural awareness that medical students developed in the context of providing medical care to refugees. Our evaluation question was: What kinds of cultural awareness and communication lessons do medical students derive from clinical encounters with refugee patients? Methods: Thirty-eight semi-structured interviews were conducted to debrief a sample of 27 medical students. A multidisciplinary research team analyzed the debriefing texts following an interpretive "immersion-crystallization" approach. Results: Three domains in cultural awareness training encompassed 13 key lessons or themes. Students reported enhanced awareness about the use of interpretation services and cross-cultural communication. A second set of lessons reflected awareness of the refugees' cultural background, and a third learning component involved experiences of cultural humility. The refugee plight prompted reflection on the students' own culture, and validated the rationale for empathetic care and patient empowerment. Conclusion: As medical school curricula incorporate more cultural diversity training, a patient-based learning approach with selected 'hands-on' experiences will create opportunities for students to increase their cultural sensitivity and competency. This program's experiential model indicates that after refugee medical encounters, these beginning medical students reported greater awareness of communication issues, and sensitivity toward religious values, family patterns, gender roles and ethnomedical treatments. It will be important to test these kinds of preceptor/apprenticeship models of cultural sensitivity training at later stages of medical training; in order to assess long-term effects.