Zanting Albertine, Meershoek Agnes, Frambach Janneke M, Krumeich Anja
Department of Health, Ethics and Society, Faculty of Health, Medicine and Life Sciences, School Caphri, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands.
School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands.
Med Teach. 2020 Jul;42(7):791-798. doi: 10.1080/0142159X.2020.1736534. Epub 2020 Mar 11.
Implementation of cultural diversity training in medical education faces challenges, including ambiguity about the interpretation of 'cultural diversity'. This is worrisome as research has demonstrated that the interpretation employed matters greatly to practices and people concerned. This study therefore explored the construction of cultural diversity in medical curricula. Using a constructivist approach we performed a content analysis of course materials of three purposefully selected undergraduate curricula in the Netherlands. Via open coding we looked for text references that identified differences labelled in terms of culture. Iteratively, we developed themes from the text fragments. We identified four mechanisms, showing together that culture is unconsciously constructed as something or someone exotic, deviant from the standard Dutch or Western patient or disease, and therefore problematic. We complemented earlier identified mechanisms of othering and stereotyping by showing how these mechanisms are embedded in educational materials themselves and reinforce each other. We argue that the embedded notion of 'problematic stranger' can lead to a lack of tools for taking appropriate medical action and to insecurity among doctors. This study suggests that integrating more attention to biological and contextual differences in the entire medical curriculum and leaving out static references such as ethnicity and nationality, can enhance quality of medical training and care.
在医学教育中实施文化多样性培训面临诸多挑战，包括对“文化多样性”解释的模糊性。这令人担忧，因为研究表明所采用的解释对相关实践和人员至关重要。因此，本研究探讨了医学课程中文化多样性的构建。我们采用建构主义方法，对荷兰三所经过有目的挑选的本科课程的课程材料进行了内容分析。通过开放式编码，我们寻找那些识别出以文化为标签的差异的文本参考。我们反复从文本片段中提炼出主题。我们识别出四种机制，共同表明文化被无意识地建构为某种或某人异国情调的、偏离荷兰或西方标准患者或疾病的事物，因此是有问题的。我们通过展示这些机制如何嵌入教育材料本身并相互强化，对早期识别出的他者化和刻板印象机制进行了补充。我们认为，“有问题的陌生人”这一内在观念可能导致缺乏采取适当医疗行动的工具，并使医生产生不安全感。本研究表明，在整个医学课程中更加关注生物和背景差异，并摒弃诸如种族和国籍等固定参考，可以提高医学培训和护理的质量。
