Preparing to Care for a Culturally and Linguistically Diverse UK Patient Population: How Healthcare Students Develop Their Cultural Competence

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Understanding and providing culturally competent care is core to create a healthcare system and workforce that can deliver accessible and effective healthcare for the whole population.1 However, although the importance of cultural education has been largely recognised by health schools globally, training remains fragmented with a lack of consistency in structure, content, and process.2,3 Little is known about how students develop their cultural competence (CC).4 My PhD addressed the gaps of knowledge by a) generating an overview of cultural education in UK medical schools and b) providing a rich description of the factors, both within and outside the educational settings, which may contribute to students' CC development. Ethnography5 was adopted as my overarching methodological approach. A participatory approach6 was adopted by including document review, participant observation, individual interviews, and focus groups. The document review showed that successful CC delivery relies on both strong institutional recognition (e.g. faculty development) and systematic educational interventions. The findings provided insights into the personal experiences and multi-faceted factors around CC development among students who themselves come from culturally diverse backgrounds. The study showed that students develop their CC both consciously and unconsciously in classroom-based formal teaching, clinical placements, and extracurricular activities. Their learning experiences in each setting are interrelated and constantly interacting with each other, which accumulatively contributes to their CC development. Integrating the results and discussions allowed me to generate a theoretical model that conceptualises medical students' CC development. As a result of increased understanding in the context of medical education, the EDUCATIONIST guide, which consists of 12 educational tips, was proposed to inform pedagogical development. During the ESRC Postdoctoral Fellowship, I plan to expand my PhD research to other pre-registration healthcare programmes (e.g. nursing, midwifery, dentistry, pharmacy, physiotherapy, nutrition and dietetics) and systematically explore how CC is currently been taught in these health programmes. The added research component will generate a comprehensive understanding of CC education across pre-registration healthcare disciplines. The consolidated results may allow health educators to develop and evaluate strategies to support the enhancement and development of cultural curricula across healthcare programmes. The key strength of this research is in its exploratory nature and its potential to shed light on understanding the development of CC among healthcare students in a global context. Effectively supporting pre-registration healthcare students to develop their CC will also contribute to the multidisciplinary work among healthcare professionals and improve patient-centred care. Findings from the ESRC fellowship research will be published in leading medical education journals and presented at international conferences (e.g. the BSC Annual Conference, the Medical Sociology Conference, the AMEE Conference). During the fellowship, I will expand my network with leading CC, health education, and medical sociology research groups. I will receive training to consolidate and improve my methodological skills, particularly in conducting mixed-method health research. To ensure findings reach a wider audience, I will disseminate the results of my research via presenting in department research seminars (e.g. the weekly 'Research Update Conference' at the School of Immunology and Microbial Sciences), university designated groups (e.g. the Faculty Equality, Diversity and Inclusion Committee/Athena Swan), student groups (e.g. Medical Students' Association/Student Steering Groups to Promote Curriculum Inclusivity at KCL), and networking with relevant academic groups (e.g. the UK Group in Diversity in Medicine and Healthcare).