Integrating Theory, Content, and Method to Foster Critical Consciousness in Medical Students: A Comprehensive Model for Cultural Competence Training.
Many efforts to design introductory "cultural competence" courses for medical students rely on an information delivery (competence) paradigm, which can exoticize patients while obscuring social context, medical culture, and power structures. Other approaches foster a general open-minded orientation, which can remain nebulous without clear grounding principles. Medical educators are increasingly recognizing the limitations of both approaches and calling for strategies that reenvision cultural competence training. Successfully realizing such alternative strategies requires the development of comprehensive models that specify and integrate theoretical frameworks, content, and teaching principles.In this article, the authors present one such model: Introduction to Medicine and Society (IMS), a required cultural competence course launched in 2013 for first-year medical students at the Perelman School of Medicine at the University of Pennsylvania. Building on critical pedagogy, IMS is centered on a novel specification of "critical consciousness" in clinical practice as an orientation to understanding and pragmatic action in three relational domains: internal, interpersonal, and structural. Instead of transmitting discrete "facts" about patient "types," IMS content provokes students to engage with complex questions bridging the three domains. Learning takes place in a small-group space specifically designed to spur transformation toward critical consciousness. After discussing the three key components of the course design and describing a representative session, the authors discuss the IMS model's implications, reception by students and faculty, and potential for expansion. Their early experience suggests the IMS model successfully engages students and prepares future physicians to critically examine experiences, manage interpersonal dynamics, and structurally contextualize patient encounters.
D.K. Dao is a fourth-year MD/MPH student, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. A.L. Goss is a fourth-year medical student, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. A.S. Hoekzema is a fourth-year medical student, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. L.A. Kelly is a fourth-year MD/MPH student, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. A.A. Logan is a fourth-year medical student, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. S.D. Mehta is a fourth-year MD/MBE student, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. U.N. Sandesara is a seventh-year MD/PhD student, Perelman School of Medicine and Department of Anthropology, University of Pennsylvania, Philadelphia, Pennsylvania. M.R. Munyikwa is a fifth-year MD/PhD student, Perelman School of Medicine and Department of Anthropology, University of Pennsylvania, Philadelphia, Pennsylvania. H.M. DeLisser is associate professor of medicine and associate dean for diversity and inclusion, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
Diane K
DK
Dao
Adeline L
AL
Goss
Andrew S
AS
Hoekzema
Lauren A
LA
Kelly
Alexander A
AA
Logan
Sanjiv D
SD
Mehta
Utpal N
UN
Sandesara
Michelle R
MR
Munyikwa
Horace M
HM
DeLisser
D003243:Consciousness; D054521:Cultural Competency / Q000193:education*; D003479:Curriculum; D004504:Education, Medical, Undergraduate / Q000458:organization & administration*; D006801:Humans; D010414:Pennsylvania; D013337:Students, Medical / Q000523:psychology*