Understanding what residents want and what residents need: the challenge of cultural training in pediatrics.
BACKGROUND
There is increasing recognition of the need for sophistication in the way culture is understood and taught in medicine.


METHODS
A two-phase study designed to understand how best to approach cultural training with pediatric residents was conducted. A needs assessment, consisting of resident and faculty focus groups, was carried out from which a workshop was developed for pediatric residents. The aims were to increase knowledge of local cultures and resources as well as to encourage self-reflection and awareness of cultural issues.


RESULTS
Focus group participants were consistent in identifying needs for training in: (1) a specific knowledge base of local cultural groups; (2) skills to better negotiate cultural encounters; (3) reconciling general cultural knowledge with an understanding of individual patient/family beliefs and practices. Analysis of focus group and workshop data suggests that culture is seen as both an obstacle and challenge. Cultural training in medicine uncovers a clash of epistemologies: the promotion of culturally-centered medicine is 'strange' to learners situated within a pedagogical tradition based on a 'familiar' reductionistic view of health.


CONCLUSIONS
Reconciling these divergent epistemologies requires a paradigm shift in how medicine understands culture and cultural training. These findings raise questions for consideration in other residency programs.
Macdonald
Mary Ellen
ME
McGill University, Montreal, Quebec, Canada. mary.macdonald@mcgill.ca
Carnevale
Franco A
FA
Razack
Saleem
S
D000046:Academic Medical Centers; D000328:Adult; D001291:Attitude of Health Personnel / Q000208:ethnology; D002983:Clinical Competence; D054521:Cultural Competency / Q000193:education*; D003479:Curriculum; D004521:Educational Measurement; D005180:Faculty, Medical; D017144:Focus Groups; D006801:Humans; D007396:Internship and Residency / Q000379:methods*; D008875:Middle Aged; D020380:Needs Assessment; D010372:Pediatrics / Q000193:education*; D011792:Quebec