title: Reflective practice enriches clerkship students' cross-cultural experiences.
abstract: OBJECTIVE
  To describe a curriculum incorporating written reflection followed by reflective discussion with the goal of enhancing students' recognition and handling of cross-cultural and health disparity issues in different healthcare delivery settings. PROGRAM AND SETTING: This required curriculum was implemented within a 4-week family medicine clerkship (n = 188 students, 6 to 12 per rotation) in 23 successive rotations over 2 years. Electronic submission of a written assignment in response to structured questions was followed by in-class discussion in week 4.
  
  
  RESULTS
  Outcomes were students' session evaluations, thematic analysis of student responses, and analysis of faculty facilitators' reflections about discussion sessions. Students' cultural knowledge about their patients' health beliefs around diabetes was assessed using multiple choice questions at the beginning and end of the clerkship.
  
  
  RESULTS
  One hundred percent of students submitted narratives. Student evaluations demonstrated high acceptance, appreciation of sessions and faculty. Analyses of written assignments and in-class discussions identified recurring themes. Students achieved greater synthesis and more nuanced understanding of cross-cultural encounters after discussion. Self-rating of confidence in addressing cultural issues after the curriculum was high at 3.17 +/- SD 0.57 (1-4). Cultural knowledge scores improved significantly. Core components for success were clerkship director support, required participation, experienced faculty facilitators without evaluative roles, a structured assignment and formal forum for trigger question discussion.
  
  
  CONCLUSIONS
  Written reflection followed by facilitated peer discussion adds value to simple 'exposure' to cross-cultural clinical experiences for medical students.
authors.affiliation: UCI - Department of Family Medicine, University of California, Irvine, School of Medicine, Orange, CA 92868, USA. dalie@uci.edu
authors.forename: Desiree
authors.initials: D
authors.lastname: Lie
authors.forename: Johanna
authors.initials: J
authors.lastname: Shapiro
authors.forename: Felicia
authors.initials: F
authors.lastname: Cohn
authors.forename: Wadie
authors.initials: W
authors.lastname: Najm
mesh_terms: D002982:Clinical Clerkship; D003431:Cross-Cultural Comparison; D054521:Cultural Competency / Q000193:education* / Q000523:psychology*; D003479:Curriculum; D006801:Humans; D013337:Students, Medical / Q000523:psychology*