Incorporating equity, diversity and inclusion (EDI) into the education and assessment of professionalism for healthcare professionals and trainees: a scoping review.

BACKGROUND: Current definitions of professionalism for healthcare trainees often lack equity, diversity and inclusion (EDI) in the expectations and assessment of professionalism. While professionalism teaching is incorporated in healthcare training, equity-deserving groups still experience discrimination. This scoping review investigates the literature to understand how EDI and associated domains of cultural humility, and advocacy can be incorporated in healthcare trainees' education and assessment of professionalism. METHODS: The Arksey and O'Malley framework was applied to this scoping review. MEDLINE, Embase & PsychINFO were searched up to March 2023, with terms surrounding health professionals, professionalism, EDI, cultural humility, and advocacy. Titles and abstracts (n = 3870) and full-texts (n = 140) were independently screened by two reviewers. Articles were included if they focused on EDI, cultural humility, or advocacy among healthcare students/trainees, and had outcomes related to professionalism. Articles lacking discussion of professionalism as an outcome were excluded. Themes were generated by mutual discussion. Risk of bias was assessed using the Cote et al. and Medical Education Research Study Quality Instrument (MERSQI) tools. RESULTS: 48 articles underwent thematic analysis. Studies investigated the disciplines of medicine, nursing, social work, physiotherapy, and dentistry. Most studies were qualitative in methodology (n = 23). Three themes emerged: (1) EDI-related interventions are associated with improved professionalism of healthcare trainees/workers (n = 21). Interventions employed were either an EDI-associated educational course (n = 8) or an exchange program to promote EDI competencies among trainees (n = 13). (2) Trainee definitions and perceptions of professionalism include themes related to EDI and cultural humility (n = 12). (3) Current standards of professionalism are perceived as non-inclusive towards historically-marginalized populations (n = 15). Literature investigating advocacy as it relates to professionalism is limited. CONCLUSION: This review identified that core EDI principles and its associated domains of cultural humility and advocacy are often viewed as integral to professionalism. These findings create a strong impetus to incorporate EDI principles within professionalism frameworks in healthcare education. Future research should employ standardized tools for professionalism assessment to provide more conclusive evidence. Incorporating patient perspectives of professionalism can inform actionable recommendations for fostering inclusive healthcare environments.

Nursing educators' experiences of cultural competence in the nursing education program: A qualitative descriptive study.

BACKGROUND: To meet the population's increasing diversity and the health system's needs, it is necessary to prepare nursing schools to produce culturally qualified students. PURPOSE: This study aimed to extract the experiences of nursing educators about the cultural competence of nursing students. METHOD: In this qualitative descriptive study, data were collected through in-depth, semi-structured interviews with 15 nursing educators affiliated with three medical sciences universities in southeastern Iran. Purposive data sampling and analysis were performed using Graneheim and Lundman's conventional content analysis methods. RESULTS: One main theme, 5 categories, and 18 subcategories were extracted. The main theme was "cultural equality, the essence of care and education". Categories included "Toward culturally-based caring and education", "Charter of cultural rights", "The need for cultural competence facilitators", "Cultural exposure", and "Modifying the curriculum policies". CONCLUSION: This study shows that nursing educators strive to take into account students' cultural competence, even though cultural competence is not explicitly integrated into nursing curricula. The acquisition of cultural competence requires multifaceted changes in education, in clinical centers, and in the creation of cultural infrastructure.

Culturally Competent Care for Diverse Populations: A Review of Transcultural Nursing Education.

Transcultural nursing is a discipline that emphasizes culturally competent care for diverse populations, recognizing the influence of culture on health beliefs, values, practices, and outcomes. It requires nurses to respect cultural differences and similarities, but faces challenges in curriculum design, faculty development, and student assessment. This paper explores transcultural nursing education's current state and future directions, addressing the American Association of Colleges of Nursing essentials for integrating cultural content into nursing curricula, reviewing Madeleine Leininger's transcultural nursing theory, diversity, equity, and inclusion concepts, and discussing the main challenges of transcultural nursing education, including lack of student diversity, training, and resources. Strategies to overcome these challenges include interprofessional collaboration, cultural immersion, and evidence-based practice. The paper concludes with how emergency department nurses should incorporate this into practice.

Intercultural competence development: A qualitative case study.

AIM: The aim of this study was to explore Bachelor of Science in Nursing (BSN) students' perceptions of the effectiveness of a unique teaching-learning strategy using their results from the Intercultural Development Inventory (IDI), an instrument for the assessment of intercultural competence, with their customized Intercultural Development Plan (IDP) in enhancing their cultural competence development in a nursing senior practicum. The study also examined student insights about how having a plan to develop their intercultural competence will have an impact on their future nursing practice. BACKGROUND: Intercultural competence is vital for providing quality healthcare, yet there is a gap in understanding how educational interventions are designed and implemented to enhance cultural competence among nursing students. This paper describes a strategy for developing intercultural competence. The IDI was administered to Bachelor of Science in Nursing (BSN) students in the fourth semester of a five-semester BSN program. Based on their IDI results, each student received a customized IDP that suggested specific activities and encouraged guided self-reflection to enhance intercultural competence development. In the fifth-semester senior practicum course, the students developed personal intercultural competence development goals based on their IDP. They also kept weekly journals on their intercultural competence development during their practicum. DESIGN: This study used a Qualitative Case Study design. METHODS: This study was conducted from January to July 2021 with 47 senior practicum students in a large BSN program in the Southeastern United States. Data consisted of student written responses to prompts on how the IDI/IDP influenced their intercultural development and its potential effect on their future practice. The data were analyzed through inductive content analysis. RESULTS: Three key themes emerged: self-awareness, recognition of cultural influences and growth goals. Student reflections suggested that they desired to develop intercultural competence so they could provide the best possible nursing care for their patients. Still, most students did not have a plan for how to grow in this area. Many students reported that their IDI/IDP heightened cultural awareness throughout their practicum, guiding their development of intercultural competence and leading to a deeper and broader understanding of culture. Students suggested that this enhanced cultural understanding, along with their IDP, will facilitate their continued development of intercultural competence in their future professional practice. CONCLUSION: This study contributes to existing knowledge about intercultural competence development and effective teaching methods by providing empirical evidence of the positive impact of the IDI/IDP on nursing students' perceived intercultural development. These findings can inform the development and implementation of pedagogical strategies to enhance intercultural competence, which will ultimately improve patient care outcomes in all healthcare settings.

"To be culturally competent is to be willing to learn about the differences and to acknowledge them"- a qualitative study on Polish medical students' attitudes towards cross-cultural competence development.

BACKGROUND: Changes in Polish demographic data with a growing number of culturally and linguistically diverse patients stipulate new directions in medical education to prepare future physicians to work effectively across cultures. However, little is known about Polish medical students' willingness to gain cross-cultural knowledge and skills, desire to get engaged in interactions with patients from diverse cultural backgrounds, expectations and needs concerning cross-cultural training as well as challenges they face in the path to cultural competence. METHODS: Therefore, in this study, we conducted and thematically analysed fifteen semi-structured interviews with medical students to broaden our understanding of medical students' perception of cross-cultural competence enhancement. RESULTS: The conducted thematic analysis allowed for the development of four themes, which showed that Polish medical students perceived skills and knowledge necessary to facilitate culturally congruent care as indispensable to form quality patient-doctor relations, believed that lack of cultural sensitivity may lead to dangerous stereotype formation and insufficient competence may be the source of stress and anxiety resulting in confusion and lack of confidence. Finally, numerous suggestions have been made by participants on how to improve their cross-cultural competence. Students emphasized, however, the role of medical education with active and experiential learning methods, including simulation-based training, in the process of equipping them with the knowledge and skills necessary to provide best quality care to culturally diverse patients. CONCLUSIONS: Our analysis indicated that Polish medical students seem to hold positive attitudes towards cultural competence development and view it as an important component of physician professionalism.

Enhancing nursing students' cultural awareness through Community of Inquiry-guided online 'Internationalization at Home' strategies-An intervention study.

AIM: Internationalization at Home (IaH) strategies play an important role in nursing curricula to enhance nursing students' cultural awareness in the globalized world. The Community of Inquiry (CoI) is a theoretical framework for the optimal design of online learning environments to support critical inquiry and discourse among students and teachers. To optimise nursing students' online cultural awareness learning experiences, it was timely to develop online IaH strategies based on a sound theoretical model. This study aimed to examine the effectiveness of CoI-guided online IaH strategies on enhancing the cultural awareness of nursing undergraduates who enrolled in a community nursing course. DESIGN: This was an interventional pre-test post-test study. METHOD: One hundred and six nursing undergraduates who enrolled in the course participated in the study. The online IaH strategies were developed focusing on the interactions of teaching presence, cognitive presence and social presence of CoI framework and they were integrated into the course. A previously validated Cultural Awareness Scale was adopted for pre-post evaluation. Higher scores indicate greater cultural awareness. RESULTS: The results showed that there was a significantly higher total score of cultural awareness of participating students at post-online IaH strategies. To be effective, aligning CoI-guided online IaH strategies with course content, pedagogy and assessment was shown to be significant. The inclusion of technological elements in related strategies was also critical to engage student learning. The positive change on the total score of cultural awareness suggested the effectiveness of the deployed strategies. In this ever-changing educational landscape, it may provide insights to educators regarding considering online IaH strategies with theoretical underpinning for curriculum planning and design.

Ka Malu a Wa'ahila: Cultivating cultural safety for Native Hawaiian students in university behavioral health.

Ka Malu a Wa'ahila, an Indigenous-centered and student-informed program, was established in 2022 to meet the growing behavioral health needs of Native Hawaiian college students at the University of Hawai'i at Manoa. Utilizing a cultural safety foundation and relying on the wisdom of community voices articulated by the Pilinaha framework, clinicians provide prevention, direct intervention, and outreach services. As the program continues to evolve, future plans include expanding to other Pacific Islanders and developing an additional layer of systemic change through building an Indigenous behavioral health training pathway and training curriculum for clinicians serving Native Hawaiian and Pacific Islander (NHPI) communities.

Cultural competence of undergraduate student nurses: a multicenter study.

OBJECTIVE: to evaluate the level of cultural competence of an undergraduate nursing students' population from four European higher education institutions. METHOD: a total of 168 nursing students from four different countries were included in our study. The study methodology involved a cross-sectional assessment of cultural competence among undergraduate nursing students from four European universities. Data collection included sociodemographic variables, as well as the following validated tools: the Intercultural Sensitivity Scale, the Cultural Competence Assessment Tool (student version) and the Cultural Awareness Scale. RESULTS: our results indicated that students demonstrated a high level of intercultural sensitivity but a moderate level of cultural competence and cultural awareness. Variations existed among students from different countries, suggesting potential differences in educational approaches. Despite expectations that higher-level students would exhibit greater cultural competence, no significant differences were found by year of study, indicating a lack of effective integration of cultural competence into nursing curricula. CONCLUSION: nurse educators should consider the students' cultural competence before designing related study programmes. Training programmes related to cultural competence should include elements which have been associated with enhanced cultural competence, including language skills, cultural encounter, and opportunities for internationalisation.

Immigrant and Refugee Health Curricula in US-Based Medical Training: A Scoping Review to Inform Integration Into Pediatric Residency Programs.

OBJECTIVE: Despite increases in the US foreign-born population, medical education opportunities in immigrant and refugee health (IRH) remain limited. We summarize findings for published IRH curricula and offer recommendations for integrating IRH into pediatric residency programs. METHODS: We performed a literature review of articles describing the design, implementation, or assessment of IRH curricula for US-based undergraduate and graduate medical trainees. RESULTS: The literature review identified 36 articles from 21 institutions describing 37 unique curricula. Three curricula included pediatric residency programs. Commonly taught topics included cultural humility, interpreter use, and immigration status as a social determinant of health. Immigrant-focused training experiences existed at continuity clinics, clinics for refugees or asylum seekers, and dedicated electives/rotations. Curricula were most frequently described as stand-alone electives/rotations. CONCLUSIONS: IRH curricula provide opportunities to develop skills in clinical care, advocacy, and community partnerships with immigrant populations. Pediatric residency programs should align the IRH curriculum with existing learning priorities, support and hire faculty with expertise in IRH, and partner with community organizations with expertise. Programs can also consider how to best support learners interested in careers focusing on immigrant populations. Further work is needed to establish competencies and validated tools measuring trainee satisfaction and clinical competency for IRH curricula.

Culturally Responsive Pedagogy in Physical Therapy Education.

The push for holistic admissions practices in physical therapy education has evoked concerns that learners who are culturally and linguistically diverse might be less qualified than the predominant demographic traditionally admitted into programs. The implications are that culturally and linguistically diverse learners struggle academically and experience challenges passing the National Physical Therapy Examination. However, as the academic preparedness of learners is discussed, rarely does the conversation include the capabilities of faculty to teach these learners. As cohorts continue to include learners from a greater variety of backgrounds and identities, the largely homogenous professorate, with more than 80% identifying as White, might need training in culturally responsive pedagogy to best serve learners from all backgrounds and identities. Educators often use a "one-size-fits-all" approach in which learners are expected to use the same resources and pace for assignments, readings, and assessments, regardless of their learning strengths or academic preparation. That approach fails to empower educators to design curricula and instruction to position all learners to excel in the classroom. This Perspective explores strategies to support all learners through three dimensions of culturally responsive pedagogy: institutional, personal, and instructional. To truly transform society, we must first transform physical therapy education. Culturally responsive pedagogy advances and supports all student achievement by recognizing, fostering, and using their strengths in the learning environment.

Enriching Spiritual Care in Medical Residents Through Cultural Humility and Courage.

Introduction: While many patients desire spiritual care, it is infrequently provided by physicians. When a model of cultural humility and courage is employed, resident physicians can be introduced to the spiritual care of patients. Methods: We developed this 90-minute, onetime session to speak directly to resident physicians about the relationships between medicine and spirituality and the nature of spiritual care. In the session, we facilitated residents in reflecting on their current posture toward spiritual care while addressing its evidence, obstacles, and timing. We also discussed the need for cultural humility and courage as we followed spiritual care to its root: guiding a person in finding meaning in their current circumstances. Results: We presented this interactive session to 35 internal medicine residents from all four training years. All residents responded to an embedded pre- and postsurvey question modeled after four attitudes towards spiritual care: rejecting, guarded, pragmatic, and embracing. Out of 22 residents who did not report embracing spiritual care in the presession survey, 10 (45%) reported a more positive attitude toward spiritual care on their postcourse surveys. Twenty-seven residents in attendance (77%) also provided feedback about presentation quality, with a mean rating of 4.7 out of 5 indicating overall satisfaction. Discussion: A single well-received session on spiritual care for medical residents models the integration of relevant spiritual care curricula into residency training. The resulting module can be modified for physicians of any specialty or seniority and complemented by other skill-based spiritual care curricula.

Considerations for Culturally Congruent Healthcare for Simulation in Bedside Clinical Practice.

This article provides practical recommendations for creating and implementing culturally appropriate and culturally congruent healthcare simulation applications for bedside providers that adhere to best practices and reporting standards. Framed within the 11 criteria for simulation design outlined in the Healthcare Simulation Standards of Best Practice, the article provides a summary of these criteria, highlighting the lessons learned from their application in a Health Resources and Services Administration-sponsored public health grant 6 U4EHP46217-01-01, Public Health Simulation-Infused Program.

Comparison of global nursing education and necessary supports for nurse educators between Japan and four English-speaking countries: An international cross-sectional study.

AIM: This study aimed to compare characteristics of nurse educators, factors related to teaching global nursing, contents of global education and support and the level of burden of global education and factors related to the burden between nurse educators among top nursing universities in Japan and four English-speaking countries. BACKGROUND: Intercultural sensitivity is the active desire to motivate oneself to understand, appreciate and accept different cultures. Nurse educators need to be culturally sensitive to teach cultural care to nursing students. DESIGN: This is a cross-sectional exploratory international comparative study using an online survey. METHODS: Participants were nurse educators with a nurse license in the top 20 in Japan and the top 10 universitiesin the United States, Canada, United Kingdom and Australia (hereafter "English-speaking countries"), respectively. The questions in Google form selected participants by the inclusion criteria. Intercultural sensitivity was measured by the Intercultural Sensitivity Scale. Chi-square test, Fisher's exact test, t-test, Mann-Whitney U test and Spearman's correlation coefficients were used for the analyses. Data were collected from October 2023 to January 2024. RESULTS: A total of 144 in Japan (response rate=29.0 %) and 106 educators in English-speaking countries (response rate=2.4 %) were included in the analysis. Nurse educators in Japan had less work experience in foreign countries, had fewer opportunities to take part in cross-cultural interactions and had significantly lower intercultural sensitivity. In both groups, those who had more experience in foreign countries with higher intercultural sensitivity taught global nursing. While in Japan nurse educators who had higher proficiency in non-native languages and those who had more frequently taken part in cross-cultural interactions taught global nursing, in English-speaking countries full-time workers who had attended international academic conferences taught. In Japan, global nursing was a more optional course and the number of contents taught was lower. While participants in Japan had international seminars at universities as support for global nursing education, those in English-speaking countries had faculty members with different cultural backgrounds. Participants in Japan felt more burden for global nursing education. In Japan, more proficient non-native language, more frequent cross-cultural interaction and higher intercultural sensitivities were associated with a lower burden, while teaching other than in their native language, contents taught and performance evaluation were associated with a higher burden in English-speaking countries. CONCLUSIONS: Higher intercultural sensitivity, performance evaluation and proficiency in non-native language may be important for nurse educators to teach global nursing and support is necessary to enhance them.

Toward Culturally Responsive Mentoring of Muslim Research Mentees in the Sciences.

Research experiences are an integral part of training future scientists and fostering diversity in science. Providing culturally responsive research mentorship, defined as mentorship that incorporates cultural knowledge to improve learning experiences for a particular group, is a critical step in this endeavor. While culturally responsive mentoring is most commonly associated with mentoring students with underrepresented races and ethnicities in the sciences, it can also be helpful for mentees with a diversity of abilities, sexualities, economic backgrounds, and religions. In this essay, we discuss how mentors can provide more culturally responsive mentoring of Muslim research mentees in the sciences. Muslims are a stigmatized minority group in the United States who participate in a religious culture that often differs from the secular culture of science. Notably, there are few resources for how to engage in culturally responsive mentoring of Muslim research mentees. To address this gap, we drew from the extant literature on the challenges that Muslims encounter in the United States, which likely extends to the context of scientific research, and identified potential culturally responsive accommodations in research.

Examining where to go: pediatric psychology trainees' perception of their graduate training in culture and diversity.

OBJECTIVE: Culture and diversity-related training is critical to the development of competent pediatric psychologists. Evaluation of training efforts have been conducted at the program level, yet evaluation of trainee experiences in culture and diversity-related training remains unassessed. This trainee-led study was the first formal assessment of pediatric psychology trainee experiences of culture and diversity-related training and the impact of training on their own cultural humility. METHODS: Study overview and a survey link was distributed across 2 listservs associated with the American Psychological Association (Division 53, Division 54) and sent directly to directors of graduate, internship, and fellowship training programs with a request to share with trainees. Surveys assessing integration of cultural training and trainee cultural humility were completed. Trainees also provided qualitative feedback regarding their multicultural training and development. RESULTS: Pediatric psychology trainees (N = 90) reported inconsistent integration of culture and diversity topics into their training. Of the 34 training areas assessed, 10 were perceived as thoroughly integrated into formal training by at least half of the respondents. Trainees often sought independent cultural training outside of their programs, and no relationship was detected between perceived integration of cultural training and trainee cultural competence. DISCUSSION: Results indicate room for improvement regarding integration of cultural training and a need to better understand driving forces behind trainees independently seeking training outside of their formal training programs. Moreover, understanding the aspects of training that are most contributory to trainee development is needed given that no relationship between training and development emerged in the current study.

Race-Conscious Learning and Sociocultural Competence in an Academic Surgery Program: Diversity, Equity, and All-Inclusion Program.

INTRODUCTION: Race-based associations in medicine are often taught and learned early in medical education. Students and residents enter training with implicit and explicit biases from their educational environments, further propagating biases in their practice of medicine. Health disparities described out of context can lead trainees to develop harmful stereotypes. Surgery leadership created a model to implement educational opportunities, resources, and outcomes in an academic Department of Surgery. METHODS: An ad hoc committee of surgical faculty, residents, and medical students was assembled. Educational goals and objectives were established via Diversity, Equity & Inclusion (DEI) committee: 1) incorporate race-conscious awareness and learning into the academic surgery curriculum for residents and medical students, 2) cooperatively learn about race in clinical and surgical decision-making, 3) incorporate learning about social determinants of health that lead to racial and ethnic inequities, and 4) develop tailored learning in order to recognize and lessen health inequities. PHASE I: DEI Committee formed of surgery faculty, residents, medical students, and support staff. Activities of the committee, goal development, a DEI mission statement, training, and education overview were formulated by committee members. PHASE II: A strengths, weaknesses, opportunities, and threats analysis was created for assessment of diversity and inclusion, and race-conscious learning in the surgery clerkship and residency curriculum. Phase III: Baseline assessment to: 1) understand opinions on DEI in the Department of Surgery, 2) assess current representation within the department workforce, and 3) correlate workforce to the make-up of patient population served. Development and restructuring of the surgery education curriculum for medical students and residency created jointly with the Racism and Bias Task Force. RESULTS: Educational programs have been implemented and delivered for: 1) appropriate inclusion of race-conscious learning such as image diversity, as well as race-based association, 2) social determinants of health in the care of patients, 3) racial disparities in surgical outcomes, 4) introduction of concepts on implicit bias, 5) opportunities for health equity rounds, and 6) inclusion in committees and leadership positions. CONCLUSIONS: Awareness of clinical faculty and learners to race-conscious and antibias care is paramount to recognizing and addressing biases. Knowledge of sociocultural context may allow learners to develop a socioculturally sensitive approach for patient education, and to more broadly measure surgical outcomes. Race-conscious education should be implemented into teaching curriculum as well as professional development in attempts to close the gap in health-care equity.

Operating on A Bias: A Review of Cultural Competency Curricula in Surgical Residencies and a Call for Systemic Change.

BACKGROUND: Several factors contribute to surgical outcome disparities, including structural racism and implicit bias. Research into how surgical residency programs intervene on Cultural Complications via education remains sparse. We review the literature for how surgical residency programs use education to combat staff and patient exposure to Cultural Complications. METHODS: We searched PubMed, SCOPUS, and Google Scholar for curricula aimed at improving cultural competency in surgical residencies. OBGYN curricula were included. Non-US studies were excluded. RESULTS: Studies were organized by intervention type: Didactic, Grand Rounds, and M&M. The most common interventions were Didactics, with Grand Rounds being the least common. Target measures improved anywhere from 20-88%. CONCLUSIONS: The common types of cultural competency curricula are clear, and certain interventions show improvement in trainees' education. Scarcity of data on these curricula does not necessarily indicate their lack of existence but does suggest additional research is needed into curricular interventions and how they may address cultural complications.

Factors influencing intercultural competences of hospital workers for multicultural patients in South Korea.

Objectives: This study aims to assess the intercultural competence of general hospital workers in South Korea by examining their understanding of cultural diversity in healthcare and to identify factors influencing their intercultural competence. Methods: A cross-institutional survey was conducted with 439 participants from four South Korean general hospitals, employing inferential statistics such as one-way Analysis of Variance, Mann-Whitney U, and Kruskal-Wallis test followed by post-hoc, and multiple linear regression analyses. Results: While 85% (n = 362) of participants acknowledged the significance of multiculturalism in Korean society, only 11% (n = 49) felt competent in treating multicultural patients. Additionally, 72% (n = 315) experienced significant linguistic difficulties in medical communication. Multiple regression analysis identified advanced English competency, multicultural training experiences, and peer support with organizational awareness of multicultural importance as significant positive contributors to intercultural competence. Conclusions: Despite recognizing the importance of multiculturalism, general hospital workers face significant language barriers and low self-efficacy in providing care to multicultural patients. To address these challenges, hospitals should designate resident translators for culturally appropriate communication. Furthermore, a tri-tiered training approach is proposed to enhance the five domains of intercultural competence among general hospital workers in Korea, including overarching multicultural training, occupation-specific courses, and long-term managerial programs aimed at managing cultural diversity effectively in healthcare settings.

Brochure: Diálogos de saberes

Los diálogos de saberes, también llamados diálogos interculturales, son procesos de comunicación e intercambio entre personas, grupos o comunidades que provienen de diferentes orígenes o culturas. En el caso del sector de la salud, los intercambios se realizan entre determinados grupos o personas y personal de salud capacitado. Su objetivo es, entre otros, mejorar el acceso a los servicios de salud y construir una salud intercultural, con énfasis en la resolución de problemas previamente planteados y sus causas, la comprensión mutua y la creación de vínculos sólidos. Este brochure describe de manera general el proceso que tienen los diálogos de saberes.