Observational Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 14, 2015; 21(6): 1887-1892
Published online Feb 14, 2015. doi: 10.3748/wjg.v21.i6.1887
Assessing cultural competency skills in gastroenterology fellowship training
Sophie Balzora, Benjamin Abiri, Xiao-Jing Wang, James McKeever, Michael Poles, Sondra Zabar, Colleen Gillespie, Elizabeth Weinshel
Sophie Balzora, Michael Poles, Elizabeth Weinshel, Division of Gastroenterology, Department of Medicine, NYU School of Medicine, New York, NY 10019, United States
Benjamin Abiri, Xiao-Jing Wang, James McKeever, NYU School of Medicine, New York, NY 10019, United States
Sondra Zabar, Colleen Gillespie, Division of General Internal Medicine, Department of Medicine, NYU School of Medicine, New York, NY 10019, United States
Author contributions: Balzora S contributed to study concept and design, acquisition of data, analysis/interpretation of data, drafting manuscript and critical revision of manuscript, administrative support; Abiri B contributed to study concept and design, acquisition of data, analysis/interpretation of data; Wang XJ and McKeever J contributed to analysis/interpretation of data; Poles M contributed to acquisition of data, critical revision of manuscript, administrative and technical support, study supervision; Zabar S contributed to study concept and design, analysis/interpretation of data, critical revision of manuscript, administrative and technical support; Gillespie C contributed to study concept and design, analysis/interpretation of data, statistical analysis, technical support; and Weinshel E contributed to study concept and design, acquisition of data, critical revision of manuscript, analysis/interpretation of data, administrative and technical support, study supervision.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Sophie Balzora, MD, Assistant Professor of Medicine, Division of Gastroenterology, Department of Medicine, NYU School of Medicine, NYU Langone Medical Center - Ambulatory Care West Side, 355 W. 52nd Street, 6th Floor, New York, NY 10019, United States. sophie.balzora@nyumc.org
Telephone: +1-646-7542144 Fax: +1-646-7542151
Received: April 23, 2014
Peer-review started: May 28, 2014
First decision: July 9, 2014
Revised: August 12, 2014
Accepted: October 14, 2014
Article in press: October 15, 2014
Published online: February 14, 2015
Abstract

AIM: 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.

CONCLUSION: 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.

Keywords: Patient care, Physician-patient relations, Gastroenterology, Cultural competency, Education, Patient care, Health literacy, Health care, Graduate, Objective structured clinical examination, Trainees

Core tip: Cultural competency is an integral skill set vital to a fruitful physician-patient relationship. However, we lack tools necessary to assess and teach such skills, especially at the fellowship level. We designed an objective structured clinical examination (OSCE) on specific criteria essential to the delivery of culturally-competent care. Our findings suggest that although the participating trainees’ can adequately provide some aspects of culturally-competent care, their ability to wholly execute such care is subpar. The current fellowship program curricula may not adequately prepare its trainees to successfully employ culturally-competent care, and OSCEs provide a means to assess and teach this complex skill set.