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.

Training the next generation of community-engaged physicians: a mixed-methods evaluation of a novel course for medical service learning in the COVID-19 era.

BACKGROUND: Medical school curricula strive to train community-engaged and culturally competent physicians, and many use service learning to instill these values in students. The current standards for medical service learning frameworks have opportunities for improvement, such as encouraging students to have more sustainable and reciprocal impact and to ingrain service learning as a value to carry throughout their careers rather than a one-time experience. PEDS 220: A COVID-19 Elective is a Stanford University course on the frontlines of this shift; it provides timely education on the COVID-19 pandemic, integrating community-oriented public health work to help mitigate its impact. METHODS: To analyze our medical service learning curriculum, we combined qualitative and quantitative methods to understand our students' experiences. Participants completed the Course Experience Questionnaire via Qualtrics, and were invited to complete an additional interview via Zoom. Interview transcripts were analyzed using an interactive, inductive, and team-based codebook development process, where recurring themes were identified across participant interviews. RESULTS: We demonstrate through self-determination theory that our novel curriculum gives students valuable leadership and project management experience, awards strong academic and community-based connections, and motivates them to pursue future community-engaged work. CONCLUSIONS: This educational framework, revolving around students, communities, and diversity, can be used beyond the COVID-19 pandemic at other educational institutions to teach students how to solve other emergent global health problems. Using proven strategies that empower future physicians to view interdisciplinary, community-engaged work as a core pillar of their responsibility to their patients and communities ensures long-term, sustainable positive impact. TRIAL REGISTRATION: N/A.

Intercultural sensitivity in Chilean healthcare profession students.

Each culture has unique health care related values, habits, perceptions, expectations, norms, etc., that makes cultural competence an important attribute to be developed by healthcare professionals, to ensure they provide effective treatment. Intercultural sensitivity (IS) is the affective dimension of cultural competence. The objective of this study is to explore the self-perceived level of IS in first and last year students of three health sciences professions (i.e., Dentistry, Medicine, and Nursing) at the Universidad de la Frontera, Temuco, Chile. This study adopted a cross-sectional design and a group comparison (e.g., year of study). 312 students completed the Intercultural Sensitivity Scale (ISS). Findings showed that overall ISS scores ranged from 1.83 to 4.94, with a mean score of 4.11 (s.d. 0.43). Group comparison between first and final year students showed statistically significant differences (4.18 vs. 4.00; p < 0.001). Medical and nursing students had a significantly higher overall mean IS score compared to dental students (4.21 and 4.16, respectively vs. 4.02; p < 0.01). There were also significant differences between three factors (interaction engagement; interaction confidence; and interaction enjoyment) by healthcare profession. These findings allow for discussion of the need for explicit incorporation and development of cultural competence in on health care professional curricula. Longitudinal research is needed to explore how IS changes over time, along with generating qualitative data from the student populations IS experiences and exposure.

Effects of Standardized Patient Simulation and Mobile Applications on Nursing Students' Clinical Competence, Self-Efficacy, and Cultural Competence: A Quasi-Experimental Study.

BACKGROUND: Simulation-based education has emerged as an effective approach in nursing education worldwide. We aimed to evaluate the effectiveness of a surgical nursing education program based on a simulation using standardized patients and mobile applications among nursing students. METHODS: A mixed-methods design with a quasi-experimental longitudinal approach and focus group interviews was employed. The data were collected from 130 third-year nursing students at three different time points who were equally divided into experimental and control groups. This study measured the level of clinical surgical nursing competence, self-efficacy in clinical performance, cultural competence, and satisfaction with simulation experience. Four focus group interviews were conducted using open-ended questions to explore the participants' perspectives on the course's efficacy and satisfaction. RESULTS: There were statistically significant differences in clinical surgical nursing competence (F = 8.68, p < 0.001), self-efficacy in clinical performance (F = 13.56, p < 0.001), and cultural competence (F = 10.35, p < 0.001) across time between the intervention and control groups. Student satisfaction with the simulation-based training was high, particularly regarding debriefing and reflection, with an overall mean satisfaction level of 4.25 (0.40). Students' perspectives regarding integrated hybrid training are categorized into three themes: educational achievement, dynamic learning experiences, and satisfaction and suggestion. CONCLUSION: Simulation-based learning provides a dynamic and immersive educational experience that enables undergraduate nursing students to develop and refine essential clinical skills while also fostering confidence and cultural competence.

Perceptions of and preparedness for cross-cultural care: a survey of final-year medical students in Ireland.

BACKGROUND: Migration is increasing globally, and societies are becoming more diverse and multi-ethnic. Medical school curricula should prepare students to provide high-quality care to all individuals in the communities they serve. Previous research from North America and Asia has assessed the effectiveness of medical cultural competency training, and student preparedness for delivery of cross-cultural care. However, student preparedness has not been explored in the European context. The aim of this study was to investigate how prepared final-year medical students in the Republic of Ireland (ROI) feel to provide care to patients from other countries, cultures, and ethnicities. In addition, this study aims to explore students' experiences and perceptions of cross-cultural care. METHODS: Final-year medical students attending all six medical schools within the ROI were invited to participate in this study. A modified version of the Harvard Cross-Cultural Care Survey (CCCS) was used to assess their preparedness, skill, training/education, and attitudes. The data were analysed using IBM SPSS Statistics 28.0, and Fisher's Exact Test was employed to compare differences within self-identified ethnicity groups and gender. RESULTS: Whilst most respondents felt prepared to care for patients in general (80.5%), many felt unprepared to care for specific ethnic patient cohorts, including patients from a minority ethnic background (50.7%) and the Irish Traveller Community (46.8%). Only 20.8% of final-year students felt they had received training in cross-cultural care during their time in medical school. Most respondents agreed that they should be assessed specifically on skills in cultural competence whilst in medical school (83.2%). CONCLUSIONS: A large proportion of final-year medical students surveyed in Ireland feel inadequately prepared to care for ethnically diverse patients. Similarly, they report feeling unskilled in core areas of cross-cultural care, and a majority agree that they should be assessed on aspects of cultural competency. This study explores shortcomings in cultural competency training and confidence amongst Irish medical students. These findings have implications for future research and curricular change, with opportunities for the development of relevant educational initiatives in Irish medical schools.

Evaluating Effectiveness of an Online LGBTQIA+ Health Course for Medical Students.

BACKGROUND AND OBJECTIVES: Despite the increasing number of sexual and gender minority (SGM) patients in the United States and designation by the National Institutes of Health as a population with health disparities, available tools are lacking to train medical students on appropriate care for this population. Therefore, we developed and implemented a novel, self-directed, 2-week online elective for undergraduate medical students. The objective of our study was to evaluate the effectiveness of this course in increasing medical students' competency and confidence in caring for SGM patients. METHODS: We developed the curriculum using Kern's six-step model for curriculum development. We created anonymous pre- and postcourse surveys using the standardized Lesbian, Gay, Bisexual, Transgender Development of Clinical Skills Survey (LGBT-DOCSS) questionnaire to assess cultural competence, as well as a 5-point Likert-scored survey to assess self-perceived confidence in the care of SGM patients. We tested the statistical significance in pre- and postsurvey scores via paired sample t tests in R (R Project for Statistical Computing). RESULTS: We found statistically significant increases in the LGBT-DOCSS categories of clinical preparedness (P<.001), basic knowledge (P<.001), overall competency (P<.001), and self-perceived confidence in caring for SGM patients (P<.001, N=33). CONCLUSIONS: The course represents an effective solution for increasing medical students' self-perceived competence and confidence in caring for SGM patients. The flexibility and ease of the online format may be appealing to both students and institutions, and ultimately can serve to increase access to crucial content that is largely absent from current undergraduate medical education. Future evaluation efforts will be required to determine whether the course impacts long-term behavioral changes and outcomes.

[Developing cultural competence in nursing schools]. / Le développement de la compétence culturelle en institut de formation en soins infirmiers.

Cultural competence is not mentioned as such in the training standards for future nurses, but it is essential for appropriate, personalized and effective care. Learning about and reflecting on one's own history and culture enable an open relationship with patients from other cultures.

Project Building Bridges: A Framework for Preparing Highly Qualified Speech-Language Pathologists to Serve Culturally and Linguistically Diverse Students With Augmentative and Alternative Communication Needs.

PURPOSE: Project Building Bridges was funded by the U.S. Department of Education Office of Special Education Programs to address the shortage of speech-language pathologists qualified to serve students with complex communication needs who benefit from augmentative and alternative communication (AAC) and are culturally and linguistically diverse. The purpose was to train future speech-language pathologists in culturally responsive AAC practices through coursework and fieldwork in AAC integrated into the Master of Science degree in Speech, Language and Hearing Sciences. METHOD: Fifty-seven graduate students completed the project. The scholars' curriculum consisted of two AAC courses, both on-campus and externship AAC clinical practicum experiences to provide services to multicultural and linguistically diverse students, a U.S. or international service-learning opportunity, and cumulative portfolio presentations. RESULTS: Mixed-methods outcome measures consisted of four sets of pre- and postsurveys and qualitative feedback from exit interviews to assess changes in graduate student competencies. Significant differences were demonstrated between scholars' pre- and post-assessments of confidence ratings. Significant differences were also demonstrated in both scholars' and school mentors' pre- and post-assessments of competency ratings. No significant differences were found between evaluations of AAC preparation by Clinical Fellowship (CF) candidates and their CF mentors at 1 year postgraduation. CONCLUSIONS: Project Building Bridges provides a framework for preparing highly qualified speech-language pathologists to serve culturally and linguistically diverse students who benefit from AAC as evidenced by pre- and postsurvey results. The project can serve as a model for other university programs in the development of preservice preparation programs focusing on culturally and linguistically diverse students with AAC needs.

Culture, Cultural Competence, and Clinical Care.

Culture competence is a concept that can be traced back to health care considerations in the 1960s and 1970s, and in particular to nursing education. Critics of the concept have argued that this was not simple a listing of cultural facts, behaviors, and practices, but instead follow a more ethnographic understanding of culture. In this article, I recognize that culture is not simply about the other, but something we all possess, and is also always changing throughout our lives. Understanding and respecting diversity and culture is key to improving services, including lactation support.

Nursing students' internationalization: Virtual exchange and clinical simulation impact cultural intelligence.

BACKGROUND: There is a need for globally competent nurses; however, some cannot train abroad. Internationalization at home strategies seek to teach intercultural and international competencies to all students, regardless of location. PURPOSE: This study evaluated the impact of a virtual exchange and clinical simulation program on nursing students' cultural intelligence. METHODS: The Global Nursing Care (GNC) program was designed to improve nursing students' global competencies, particularly cultural intelligence. It was implemented in two universities in Spain and the USA. A quasi-experimental, analytic, and longitudinal study involved 261 nursing students, 57 from the GNC program and 204 in the control group. Sociodemographic data were collected, and the Cultural Intelligence Scale was used to measure cultural intelligence. DISCUSSION: All cultural intelligence dimensions were augmented following program participation. Moreover, students who participated in the program presented higher cultural intelligence than the control group. CONCLUSION: The results suggest that program participation was associated with a statistically significant gain in nursing students' cultural intelligence.

Cultural competency in dental education: developing a tool for assessment and inclusion.

PURPOSE/OBJECTIVES: This study aimed to assess the cultural competency content in selected Doctor of Dental Surgery (DDS) courses and to explore the use of an assessment tool that may be used to standardize the integration of cultural competency in the dental school curriculum. METHODS: A survey was sent to course directors to determine the inclusion of four topics related to cultural competence, the mechanisms of inclusion, and their comfort level in teaching the topics in their courses.  A scan of the same courses was conducted with the use of a tool developed from an Expert Panel's recommendations for knowledge, skills, and attitudes (KSA) to be included in curricula for teaching cultural competence. RESULTS: Twenty-one course directors responded.  Fifteen reported they include social determinants of health and twelve include health inequities in their courses. Faculty reported an average of 8.67 comfort level in teaching these topics but there was less comfort level in teaching cultural humility and implicit bias.  Course directors used assignments, case studies, lectures, quizzes, and patient care (clinical courses) to include the topics. The scan of courses showed that the use of the Competencies for General Dentists in course syllabi covered the recommended knowledge, skills, and attitudes for cultural competence. CONCLUSIONS: The rubric was suitable for assessing cultural competency content.  The Competencies for General Dentists in course syllabi will allow the integration of the recommended KSA in dental courses to teach cultural competence.  However, dental faculty may need training in the integration of KSA items in course objectives and content.

Examining Cultural Comfort and Knowledge in Undergraduate Nursing Students After the Implementation of an Online Educational Animation on Providing Care for Muslim Patients.

INTRODUCTION: With rapidly growing members of the Islamic faith, health care providers should expect to care for Muslim patients regardless of their chosen specialty. The quality of care provided hinges on their knowledge and understanding of Islam. This study aimed to analyze the influence of an educational animation on undergraduate nursing students' cultural comfort and knowledge concerning the health care needs of Muslims. METHODS: An educational animation was created addressing the unique health care needs of Muslim patients. Surveys (pre, post, 6 weeks) (n = 658) assessed cultural comfort and knowledge on covered topics. RESULTS: Student knowledge (pre: 12.4 ± 0.1; post: 14.4 ± 0.2; p < .01) and cultural comfort (pre: 4.0 ± 0.03; post: 4.1 ± 0.03; p < .05) increased after viewing the online educational animation. The increase in knowledge was sustained at 6 weeks. Students recommended additional topics for the future. DISCUSSION: This study highlights how an innovative educational animation can enhance students' understanding of providing care for Muslim patients, positively impacting patient outcomes.

Effectiveness of Cultural Sensitivity Training on Undergraduate Students' Knowledge, Self-Efficacy, and Ethnocultural Empathy.

ABSTRACT: Institutional racism and systemic bias must be addressed in health care education with embedded cultural sensitivity training. We report the results of remote training on culturally sensitive care to increase knowledge, self-efficacy, and empathy in undergraduate nursing students ( n = 16). The training included four weekly remote sessions (~90 minutes). A pre-post survey indicated knowledge and self-efficacy increased ( p < .01); empathy increased but not significantly, likely because of ceiling effects ( p > .11). Compliance (94%) and satisfaction were excellent. This pilot study demonstrates a flexible, effective training model for nurse educators to implement within or alongside undergraduate nursing curricula.

Development of Cultural Competence: The Effects of a Virtual Exchange Between US and Omani Nursing Students.

ABSTRACT: Development of cultural competence is essential for nurses to meet the needs of patients, families, and communities. Immersion experiences abroad have been shown to facilitate the development of cultural competence in nursing students; not all students are able to participate in these experiences. Virtual exchange is an alternative type of immersion experience that requires no travel and few resources. The purpose of this study was to examine the effects of a virtual exchange between bachelor of science in nursing students in the United States and the Sultanate of Oman on the development of cultural competence.

Embedding cultural competency and cultural humility in undergraduate pharmacist initial education and training: a qualitative exploration of pharmacy student perspectives.

BACKGROUND: Emphasis has been placed upon embedding equity, diversity and inclusion within the initial education and training of healthcare professionals, like pharmacists. Yet, there remains limited understanding of how best to integrate cultural competency and cultural humility into undergraduate pharmacy student training. AIM: This qualitative study explored the views of pharmacy students to understand perspectives on, and identify recommendations for, embedding cultural competency and cultural humility within pharmacy education and training. METHOD: Undergraduate pharmacy students from one UK-based School of Pharmacy were invited to participate in an in-person, semi-structured interview to discuss cultural competency in the pharmacy curriculum. Interviews were conducted between November 2022 and February 2023 and were audio-recorded and transcribed verbatim. Reflexive thematic analysis enabled the development of themes. QSR NVivo (Version 12) facilitated data management. Ethical approval was obtained from the Newcastle University Ethics Committee. RESULTS: Twelve undergraduate pharmacist students, across all years of undergraduate training, were interviewed. Three themes were developed from the data, centring on: (1) recognising and reflecting on cultural competency and cultural humility; (2) gaining exposure and growing in confidence; and (3) thinking forward as a culturally competent pharmacist of the future. CONCLUSION: These findings offer actionable recommendations to align with the updated Initial Education and Training standards from the United Kingdom (UK) pharmacy regulator, the General Pharmaceutical Council; specifically, how and when cultural competency teaching should be embedded within the undergraduate pharmacy curriculum. Future research should further explore teaching content, learning environments, and methods of assessing cultural competency.

Revision and Psychometric Testing of the Intercultural Competence Scale.

Background and Purpose: Given the broad availability of instruments developed to assess cultural competence, there is a need to develop psychometric properties of existing instruments so they might be adapted accordingly. The purpose of this study was to conduct a psychometric evaluation of the Intercultural Competence Scale (ICS) to ensure its validity and reliability of measurement. Methods: The psychometric evaluation included scale selection and construction, psychometric testing, and instrument validation. Data analysis methods included item analysis, internal consistency reliability, and exploratory factor analysis. Results: Participants in this longitudinal study included 215 nursing students from a selected university. The ICS adopted three instruments modified into a 21-item tool. Conclusion: This study provides a foundation for future research to develop a modified instrument for measuring cultural competence.

How cultural competence is conceptualised, developed and delivered in pharmacy education: a systematic review.

BACKGROUND: It is important to have a pharmacy workforce that is culturally competent to recognise a patient's health beliefs to improve medication adherence and reduce poor treatment outcomes. AIM: This systematic review aimed to identify, critically appraise and summarise how cultural competency is conceptualised, developed and embedded in pre-qualification pharmacy education. METHOD: Medline, Scopus, PsychInfo, Web of Knowledge, CINAHL, and Embase databases were searched for relevant papers published in English between January 2012 and December 2021, following PRISMA guidelines. Data from included papers were thematically analysed. Educational quality of papers was appraised using the GREET criteria. This systematic review was registered on PROSPERO, CRD42021295875. RESULTS: The review included 47 papers (46 studies) with 18 papers meeting ≥ 9 points on the GREET criteria thus considered of good educational quality. Forty papers focused on educational interventions implemented to pharmacy students only, the remaining included students from different health disciplines. Half of the educational interventions focused on cultural competence in general. Most educational interventions lasted over a week and 21 were compulsory. Cultural competence conceptualisation varied; a focus on knowledge about different cultures or on culturally competent behaviours or a continuum with knowledge at one end and behaviour at the other. CONCLUSION: There is variation in how cultural competence is embedded in pharmacy programmes, which could be a reflection of the differences in how educators conceptualised cultural competence. Further research is needed to develop a unified understanding of the meaning of cultural competence and how it can be embedded in pharmacy education.

Veteran Cultural Competence Training: Initial Effectiveness and National-Level Implementation.

OBJECTIVE: Because service professionals often lack cultural competence in working with veterans, veterans often perceive such professionals as "not understanding." The authors developed, evaluated, and implemented Veteran Cultural Competence Training (VCCT), combining educational and experiential components in an in-person training focused on building awareness, knowledge, and skills to better work with veterans. METHODS: Study 1 was a type 1 effectiveness-implementation hybrid trial examining VCCT effectiveness in a sample of social service professionals (N=41) compared with a matched comparison group (N=41) via the Multicultural Counseling Self-Efficacy Scale-Veteran Form (MCSE-V) instrument. In study 2, the authors used the reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) framework to conduct a type 2 effectiveness-implementation hybrid trial and implemented VCCT with an expanded population (N=312) during eight training sessions in three U.S. states. RESULTS: Results from study 1 indicated that VCCT significantly increased self-efficacy of trainees in veteran cultural competence compared with the matched group (p<0.001). In study 2, the RE-AIM framework highlighted the importance of building coalitions and utilizing implementation facilitation to maintain fidelity. The within-group effectiveness of VCCT was statistically significant and maintained across settings and professions (p<0.001), and trainees were satisfied with VCCT. Maintenance analysis revealed expansion of VCCT after implementation in terms of the number of training sessions (N=9), regions hosting the training (N=5), staff hired (N=13), and trainee applications (N=1,018). CONCLUSIONS: VCCT effectively increases self-efficacy in veteran cultural competence. Gains appeared across different professions, demographic characteristics, and locations. Participation in VCCT may increase professionals' competence in understanding veteran culture, thereby potentially improving veteran services.

Measuring the longitudinal impact of a transgender and gender diverse curriculum on nurse practitioner students' and nurse practitioners' cultural competence, knowledge, skills, and attitudes.

ABSTRACT: Nurse practitioners (NPs) are well positioned to provide inclusive, person-centered care to patients who are transgender and gender diverse (TGD); however, few NPs have been trained on how to do so. This study demonstrates the longitudinal effect of an educational intervention that used readings, lecture, a patient panel, and a standardized patient encounter on NPs' and nurse practitioner students' cultural competency, knowledge, skills, and attitudes toward patients who are TGD. The study followed participants for 3 months and used the Sexual Orientation Counselor Competency Scale version 3 tool to measure changes across three data points. Significant improvements were demonstrated in cultural competency and clinical skills, with knowledge and attitude increases that did not reach significances. The findings from this study have implications for the inclusion of TGD content in graduate nursing curriculum and continuing education activities and provide educators with best practices to integrate this content into learning activities.