When and How Do We Teach Cultural Awareness?

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In “Integrating Theory, Content, and Method to Foster Critical Consciousness in Medical Students: A Comprehensive Model for Cultural Competence Training,” Dao and colleagues1 describe a new first-year medical school course which consists of 43 instructional hours. The concept of critical consciousness is developed and the students are engaged in it. Critical consciousness is designed to serve as a basis for each student to attain cultural competency. However, a critical awareness of the complexity of one’s self and others cannot be taught, experienced, or learned in 43 hours of class time in the first year of medical school. First-year students are attempting to memorize and learn enormous amounts of information which they believe is critical for their medical school success. During this time, students frequently experience classes that address important but not immediately essential learning issues as offering relief from many arduous tasks. Learning and knowing oneself, and the ability to empathize with one’s patients and appreciate their worlds, are critical components of medicine. But they are not the issues that confront first-year students.
Learning to be aware of oneself while interacting with patients is not cultural competence. Competence implies knowing specific facts and using this knowledge to perform clearly identified tasks. For example, medical students learn surgical principles and how to tie surgical knots and are trained to be competent in tying the knots. We must teach entering medical students that, when they are engaged in clinical care, patients may exhibit behaviors or thoughts which are alien and potentially uncomfortable to them. Yet understanding one’s patients is critical for providing effective medical care. In teaching this to first- or second-year students we must also demonstrate how their own beliefs, feelings, and thoughts can interfere with their appreciation of their patient’s needs and care. We need to follow these introductory learning experiences with focused experiences in all clerkships to enable learners to address the physician’s self and that of their patients.
The challenge of medical education and physician self-learning in developing cultural awareness is how to ensure that the need to obtain knowledge of oneself and of one’s patients takes hold and is used throughout one’s medical career. We learn by experiencing, doing, and observing. During clerkships and residency, learning about self-awareness and cultural awareness is reinforced and developed by the surrounding medical and nursing staffs. In more isolated practice settings it is more difficult to learn and sustain. Attaining and sustaining this awareness is a lifelong endeavor. Self-awareness, not classroom time, is the foundation for cultural awareness.
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