title: Assessing cultural competency skills in gastroenterology fellowship training.
abstract: OBJECTIVE
  To assess and teach cultural competency skills at the fellowship training level through the use of objective structured clinical examinations (OSCEs).
  
  
  METHODS
  We revised four scenarios to infuse a specific focus on cross-cultural care, and to render them appropriate for gastroenterology fellows. Three are discussed here: (1) Poor Health Literacy; (2) Disclosing/Apologizing for a Complication to a Patient Who Mistrusts the Healthcare System; and (3) Breaking Bad News to a Fatalistic Patient. A fourth case emphasizing shared decision-making will be described elsewhere. Four stations were completed by fellows and observed live by four faculty members, and the fellows' performance was assessed.
  
  
  RESULTS
  Eleven fellows from four programs participated in the four OSCE. In the "Poor Health Literacy" case, 18% (2/11) of participants recognized that the standardized patient (SP) had below-basic health literacy. None successfully evaluated the SP's reading skills in a culturally-sensitive manner. In "Disclosing/Apologizing for a Complication", 4/11 (36%) personally apologized for the complication. 1/11 recognized the SP's mistrust of the medical system. With "Breaking Bad News", 27% (3/11) explored the patient's values to identify her fatalistic beliefs.
  
  
  CONCLUSIONS
  OSCEs can be used to assess deficiencies in culturally-competent care at the fellowship level. OSCEs also afford fellowships the opportunity to inform future training curricula.
authors: Sophie Balzora, Michael Poles, Elizabeth Weinshel, Division of Gastroenterology, Department of Medicine, NYU School of Medicine, New York, NY 10019, United States.
authors: Sophie
authors: S
authors: Balzora
authors: Sophie Balzora, Michael Poles, Elizabeth Weinshel, Division of Gastroenterology, Department of Medicine, NYU School of Medicine, New York, NY 10019, United States.
authors: Benjamin
authors: B
authors: Abiri
authors: Sophie Balzora, Michael Poles, Elizabeth Weinshel, Division of Gastroenterology, Department of Medicine, NYU School of Medicine, New York, NY 10019, United States.
authors: Xiao-Jing
authors: XJ
authors: Wang
authors: Sophie Balzora, Michael Poles, Elizabeth Weinshel, Division of Gastroenterology, Department of Medicine, NYU School of Medicine, New York, NY 10019, United States.
authors: James
authors: J
authors: McKeever
authors: Sophie Balzora, Michael Poles, Elizabeth Weinshel, Division of Gastroenterology, Department of Medicine, NYU School of Medicine, New York, NY 10019, United States.
authors: Michael
authors: M
authors: Poles
authors: Sophie Balzora, Michael Poles, Elizabeth Weinshel, Division of Gastroenterology, Department of Medicine, NYU School of Medicine, New York, NY 10019, United States.
authors: Sondra
authors: S
authors: Zabar
authors: Sophie Balzora, Michael Poles, Elizabeth Weinshel, Division of Gastroenterology, Department of Medicine, NYU School of Medicine, New York, NY 10019, United States.
authors: Colleen
authors: C
authors: Gillespie
authors: Sophie Balzora, Michael Poles, Elizabeth Weinshel, Division of Gastroenterology, Department of Medicine, NYU School of Medicine, New York, NY 10019, United States.
authors: Elizabeth
authors: E
authors: Weinshel
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D057189:Checklist; D003142:Communication; D003466:Cultural Characteristics; D054521:Cultural Competency; D003479:Curriculum; D004503:Education, Medical, Graduate / Q000379:methods*; D005257:Fellowships and Scholarships; D005260:Female; D005762:Gastroenterology / Q000193:education*; D007722:Health Knowledge, Attitudes, Practice; D057220:Health Literacy; D006801:Humans; D007396:Internship and Residency; D008297:Male; D008875:Middle Aged; D009519:New York City; D010342:Patient Acceptance of Health Care; D010353:Patient Education as Topic; D010817:Physician-Patient Relations; D012068:Religion and Medicine; D011795:Surveys and Questionnaires; D013647:Task Performance and Analysis; D013663:Teaching / Q000379:methods; D014741:Video Recording
keywords: Cultural competency; Education; Gastroenterology; Graduate; Health care; Health literacy; Objective structured clinical examination; Patient care; Physician-patient relations; Trainees