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

理解和提供符合文化的医疗服务是建立一个医疗体系和劳动力的核心，这个体系和劳动力可以为全体人口提供可获得和有效的医疗服务然而，尽管文化教育的重要性已在很大程度上得到全球卫生学校的认可，但培训仍然是分散的，在结构、内容和过程上缺乏一致性关于学生如何培养他们的文化能力，我们所知甚少我的博士通过以下方式解决了知识差距：a)概述了英国医学院的文化教育；b)对教育环境内外可能有助于学生CC发展的因素进行了丰富描述。人种学是我的主要研究方法。采用了一种参与式的方法，包括文件审查、参与性观察、个人访谈和焦点小组。文献综述表明，CC的成功实施既依赖于强有力的制度认可（如师资发展），也依赖于系统的教育干预。这些发现为来自不同文化背景的学生提供了有关CC发展的个人经历和多方面因素的见解。研究表明，学生在以课堂为基础的正式教学、临床实习和课外活动中有意无意地发展了他们的CC。他们在各种环境下的学习经历是相互关联、不断互动的，积累起来有助于他们的CC发展。整合结果和讨论使我能够生成一个概念化医学生CC发展的理论模型。由于对医学教育的了解有所增加，提出了包含12条教育提示的《教育家指南》，以便为教学发展提供参考。在ESRC博士后期间，我计划将我的博士研究扩展到其他预注册医疗保健项目（如护理、助产、牙科、药学、物理治疗、营养和营养学），并系统地探索目前CC在这些健康项目中的教学情况。增加的研究部分将产生跨注册前医疗保健学科的CC教育的全面了解。综合结果可使卫生教育工作者制定和评估战略，以支持在卫生保健方案中加强和发展文化课程。这项研究的关键优势在于它的探索性，以及它在理解全球背景下卫生保健学生CC发展方面的潜力。有效地支持预先注册的医疗保健学生发展他们的CC，也将有助于医疗保健专业人员之间的多学科工作，并改善以病人为中心的护理。ESRC奖学金研究的结果将发表在主要的医学教育期刊上，并在国际会议上发表（如BSC年会、医学社会学会议、AMEE会议）。在奖学金期间，我将扩大我的网络与领先的CC，健康教育和医学社会学研究小组。我将接受培训，以巩固和提高我的方法技能，特别是在进行混合方法的健康研究方面。为了确保研究成果能够传播到更广泛的受众，我将通过在部门研究研讨会（例如，免疫和微生物科学学院的每周“研究更新会议”）、大学指定团体（例如，教员平等、多样性和包容性委员会/Athena Swan）、学生团体（例如，医学生协会/促进KCL课程包容性的学生指导小组）、并与相关学术团体建立联系（例如英国医学和医疗保健多样性小组）。

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).