title: Cultural competency in medical education: demographic differences associated with medical student communication styles and clinical clerkship feedback.
abstract: OBJECTIVE
  We tested the significance of associations among students' demographics, communication styles, and feedback received during clerkships.
  
  
  METHODS
  US medical students who completed at least one required clinical clerkship were invited between April and July 2006 to complete an anonymous, online survey inquiring about demographics, communication styles (assertiveness and reticence), feedback (positive and negative), and clerkship grades. The effects of self-identified race/ethnicity, gender, and generation (immigrant, first- or second-generation American) and their 2-way interactions on assertiveness, reticence, total positive and total negative feedback comments were tested using factorial analysis of covariance, controlling for age, clerkship grades, and mother's and father's education; pairwise comparisons used simple contrasts. Two-sided P values < .05 were considered significant.
  
  
  RESULTS
  Medical students from 105 schools responded (N = 2395: 55% women; 57% white). Men reported more assertiveness than women (P = .001). Reticence (P < .001) and total positive comments (P = .006) differed by race/ethnicity; in pairwise contrasts, black, East Asian, and Native American/ Alaskan students reported greater reticence than white students (P < .001), and white students reported receiving more positive comments than black, and South and East Asian students. Race/ethnicity-by-generation (P = .022) and gender-by-generation (P = .025) interaction effects were observed for total negative comments; white first-generation Americans reported receiving the fewest and male immigrants reported receiving the most negative comments.
  
  
  CONCLUSIONS
  Demographic differences in students' communication styles and feedback they received highlight a need for cultural competency training to improve medical student-teacher interactions, analogous to training currently advocated to improve physician-patient interactions.
authors.affiliation: Washington University School of Medicine, 4444 Forest Park, Ste 6700, St Louis, MO 63108, USA. kathyleemd@gmail.com
authors.forename: Katherine B
authors.initials: KB
authors.lastname: Lee
authors.forename: Sanjeev N
authors.initials: SN
authors.lastname: Vaishnavi
authors.forename: Steven K M
authors.initials: SK
authors.lastname: Lau
authors.forename: Dorothy A
authors.initials: DA
authors.lastname: Andriole
authors.forename: Donna B
authors.initials: DB
authors.lastname: Jeffe
mesh_terms: D001242:Assertiveness; D002982:Clinical Clerkship; D003142:Communication; D054521:Cultural Competency; D018864:Cultural Diversity; D004521:Educational Measurement; D005006:Ethnicity / Q000706:statistics & numerical data; D030141:Feedback, Psychological; D005260:Female; D006801:Humans; D008297:Male; D008913:Minority Groups / Q000706:statistics & numerical data; D012737:Sex Factors; D013337:Students, Medical / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D014481:United States