Robins L S, White C B, Alexander G L, Gruppen L D, Grum C M
Department of Medical Education, University of Washington School of Medicine, Seattle, Washington 98195-7240, USA.
Acad Med. 2001 Jan;76(1):76-80. doi: 10.1097/00001888-200101000-00020.
To assess students' performances on a health-beliefs communication OSCE station to determine whether there were differences in cultural competence based on the students' ethnic backgrounds.
A total of 71 students completed a health-beliefs communication OSCE station in which they were required to address the health beliefs and cultural concerns of a standardized patient (SP) portraying an African American woman with diabetes. The SPs rated students' performances on a ten-item interview assessment checklist. Scores on the station were standardized within SPs to adjust for differences in their use of the rating scale. A factor analysis was performed to determine conceptual constructs on the interview assessment checklist. Subscale means were computed for each student. T-tests of these subscale scores were conducted to investigate gender and ethnic differences between subgroups of students. The underrepresented minority (URM) students (five African Americans and three Mexican Americans) were compared with all other students, and the white students were compared with all others. To assess the magnitudes of the differences between subgroups, effect sizes (ES(m)) were computed for means comparisons.
Factor analysis formed two factors: Disease Beliefs and Management, and Cultural Concerns. Two remaining items loaded on a third factor that had reliability too low to support further analysis. Meaningful differences were found in cultural sensitivity based on students' ethnic backgrounds. The URM students performed better than did all other students in addressing the patient's concerns about altering culturally-based dietary behaviors for diabetes self-care [URM students' mean standardized score (SD) = 0.42 (0.15); all others = -0.01 (0.67); ES(m) = 1.05]. White students performed better than did all other students in assessing the patient's concerns about using insulin to control her blood sugar levels [white students' mean standardized score (SD) = 0.13 (0.40); all others = -0.10 (0.64); ES(m) = 0.4].
Cultural competency deficits and differences were measurable using a health-beliefs communications station, and these differences were meaningful enough to warrant faculty discussion and research about how to ensure that students master this competency.
评估学生在健康信念沟通客观结构化临床考试（OSCE）站的表现，以确定基于学生种族背景的文化能力是否存在差异。
共有71名学生完成了一个健康信念沟通OSCE站的测试，在该测试中，他们需要应对一名扮演患有糖尿病的非裔美国女性的标准化病人（SP）的健康信念和文化问题。标准化病人根据一份十项访谈评估清单对学生的表现进行评分。站内得分在标准化病人之间进行了标准化处理，以调整他们在使用评分量表方面的差异。进行了因子分析以确定访谈评估清单上的概念结构。计算了每个学生的子量表平均分。对这些子量表分数进行t检验，以调查学生亚组之间的性别和种族差异。将代表性不足的少数族裔（URM）学生（五名非裔美国人和三名墨西哥裔美国人）与所有其他学生进行比较，并将白人学生与所有其他学生进行比较。为了评估亚组之间差异的大小，计算了均值比较的效应量（ES(m)）。
因子分析形成了两个因子：疾病信念与管理以及文化问题。其余两个项目加载到第三个因子上，该因子的信度过低，无法支持进一步分析。基于学生的种族背景，在文化敏感性方面发现了有意义的差异。在解决患者对为糖尿病自我护理改变基于文化的饮食行为的担忧方面，URM学生的表现优于所有其他学生[URM学生的平均标准化分数（标准差）=0.42（0.15）；所有其他学生=-0.01（0.67）；ES(m)=1.05]。在评估患者对使用胰岛素控制血糖水平的担忧方面，白人学生的表现优于所有其他学生[白人学生的平均标准化分数（标准差）=0.13（0.40）；所有其他学生=-0.10（0.64）；ES(m)=0.4]。
使用健康信念沟通站可以测量文化能力缺陷和差异，这些差异具有足够的意义，值得教师进行讨论和研究，以探讨如何确保学生掌握这一能力。
