Posters

We are pleased to present abstracts for the following posters.

Peer-facilitated cultural humility education: building a toolkit for cultural awareness in medicine

Axiaq Ariana, Corrigan Mairead, Casement Daria, Kearney Grainne, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast

Introduction

Despite inclusive movements such as LGBT+ and BLM, and medical student enthusiasm for better cultural training, medical education has been reluctant to co-evolve. This leaves medical students unequipped in dealing with an increasingly culturally-diverse patient population. To address these shortcomings, we aimed to harness cultural awareness (CA) amongst 1st year medical students through a student-led teaching initiative on Cultural Humility (CH). As an emerging domain of cultural competence, CH emphasises on lifelong development of skills, knowledge, and attitudes in ‘becoming the student of the patient’, aiming to address power imbalances within the doctor-patient relationships. CH uses self-critique to reflect upon the practitioner’s own cultural background, any resultant biases, and their impact on patient communication. It focusses on the dynamic and expansive nature of culture incorporating not merely religion and ethnicity but other characteristics such as gender, age and sexual orientation.

Methods

This study assessed the knowledge and perceptions of first year medical students on introduction to cultural humility. Following introduction to an author-developed CH learning resource, a baseline survey was conducted to collect data about students’ understanding of CH. This preceded an interactive student-led workshop with a reflective exercise that aimed to encourage medical students to embrace their own cultural diversity and that of others, with emphasis on the multifactorial nature of culture, using prompts inspired from culturally-related peer experiences. Students then embarked on an early clinical contact programme, where the students implemented their understanding of CH into practice. Consequently, students were instructed to write reflective blogs. Blogs consented for data inclusion were analysed through an author-selected framework.

Results

188 out of 312 participants offered their responses. Higher scores were recorded for perceived importance of CH (4.83/5) than understanding (3.86/5) and perceived preparedness for implementation of CH (3.98/5). Free-text response analysis of surveys identified learning gaps (namely demonstrating cultural sensitivity in patient interviewing) and preferred pedagogies. From the ten blogs collected, analysis followed a 5R framework: Respect, Reflection, Regard, Relevance and Resiliency. Findings identified a demand for better training in identifying patient-specific sensitive topics and a preference for appreciation of cultural characteristics without explicit labelling of patient qualities as being culturally-engendered.

Conclusions

CH aims to make medical education more patient-centred. This study investigated the multimodal inclusion of CH as a CA toolkit into the undergraduate curriculum. Outcomes from this study provided insight into the application of CA teaching and the students’ perception of its clinical applicability in their learning. 

A workshop to empower BAME students to challenge microaggressions and racism

Laila Juul-Dam, Sabina Pogoson, Zahra Khan, Dr Mairead Corrigan, Queen’s University Belfast

Overview

The workshop was conceived by two medical students, in response to personal and other students’ lived experiences of racism and microaggressions. Anecdotal evidence about the unintended consequences of Active Bystander Training (ABT) for removing agency from those experiencing microaggressions and racism and experiences of microaggressions from White students in ABT tutorials, were other reasons for developing it. The workshop aims to be a safe space outside the curriculum for BAME students to discuss experiences of microaggressions and racism to promote emotional wellbeing and to discuss strategies for challenging these behaviours. The students co-developed the workshop in the summer of 2022 with a dental student, who was funded through a summer studentship scheme by the Centre of Medical Education (CME) at Queen’s University Belfast (QUB). It will be facilitated by BAME students.

Methods

In the workshop, students will watch videoed role-plays of racist scenarios on clinical placement and on campus based on lived experiences. Students will be encouraged to self-reflect on their personal experiences and on the scenarios. An online workbook for the students provides space for them to write their reflections with some prompts to generate discussion. Students can use the workbook to record their confidence and journey in challenging microaggressions and racism before and at different points in time after the workshop, as an aid to self-reflection. The workshop includes an aide-memoire of the strategies discussed in the workshop, a glossary and signposting for student support and reporting incidents.

The strategies focus on ‘Four Ds’ developed from the literature and from the university’s assertiveness training for students. The first ‘D’ asks the students to ‘Discern’ whether the experience in the scenario is a microaggression, to write down their feelings and to what extent they would challenge it. The next two ‘D’s’ are strategies that students may employ. These include ‘Disarming’ the perpetrator and allaying hostility by letting them know what impact their words had. ‘Defying’ is when the student may choose to challenge the perpetrator by asking them to clarify their statement or action. Students will discuss the strengths and limits of each strategy and the wording that may be used. The last D ‘Deciding’ is a positive affirmation that informs students that they control the impact of the microaggressions on their emotions and learning. The first workshop is due to take place in the autumn.

Unconscious Bias Training for our Simulated Patients: Showcasing a new and innovative workshop

• Dr Anna Hammond, academic lead for Clinical Skills and Reasoning, general practitioner, Hull York Medical School (HYMS)
• Tom Frere, simulated patient, actor, experienced facilitator, Hull York Medical School (HYMS)
• Jane Whittaker, simulated patient, actor and experienced facilitator, Hull York Medical School (HYMS)
• Cal Stockbridge, simulated patient, actor and experienced facilitator, Hull York Medical School (HYMS)

Overview

We have a large bank of simulated patients who interact with our students in teaching and assessment across all five years of our MB BS course, and were mindful of their different backgrounds and experiences when developing this session. Despite our best efforts with recruitment, we are mindful that that our simulated patient pool is less ethnically diverse than our student cohort.

Methods

We used both large group and breakout sessions in designing this interactive, multimedia two hour workshop which was delivered this via Zoom to our simulated patients. 

We were careful to position this training as a safe space to share and learn, explaining that, because we are human, we all have unconscious biases, and our swift automatic responses are impacted by our previous experiences, upbringing and environment. Every day and clinical reasoning theory were used to help describe how we all have unconscious biases. These beliefs, attitudes and stereotypes can affect our understanding and decisions in a way that we are not aware of – if steps aren’t taken to avoid acting on such biases it can lead to unfair treatment and discriminatory practice (General Medical Council). 

The workshop facilitators will describe an aide memoire (STAR) developed to help simulated patients challenge their automatic thinking when responding to students, checking whether their responses are being influenced by unconscious biases.

We were hugely impressed with the level of reflections and discussions during this session and will present both simulated patent feedback and our own reflections on the learning from this activity.