Contextualizing cultural competence training of residents: results of a formative research study in Geneva, Switzerland.

Medical training programs need to prepare physicians to provide care to increasingly diverse patient populations. While the general concepts and approaches of clinical cultural competence are broadly relevant across contexts, the content of cultural competence training should reflect and respond to the specific needs and challenges of clinicians in their local reality. In order to better understand and respond to the needs and challenges of residents working with diverse patients in Geneva, Switzerland, depth interviews with physicians and professional medical interpreters and direct observations of consultations were combined. Cross-cultural communication difficulties were intertwined with more general difficulties related to primary care in an outpatient context, and physicians' frustrations reflected the expectations and image of medicine that they developed during their hospital-centered training. Study results point to the need to understand how cross-cultural communication challenges articulate with other aspects of the clinical context.