Cultural minority students' experiences with intercultural competency in medical education.

CONTEXT: Medical schools increasingly value and focus on teaching students intercultural competency within present-day multicultural society. Little is known about the experiences of cultural minority students in intercultural competence activities. OBJECTIVES: This article discusses the intercultural competence activities of medical education in a Dutch university from the perspective of cultural minority students. We will formulate recommendations for how to stimulate intercultural competency in, as well as inclusiveness of, medical education. METHODS: A qualitative evaluation was performed within a medical school in the Netherlands. Data were collected through interviews (n = 23), a focus group (six participants) and participant observations (20 hours). Thematic analysis was performed. RESULTS: Cultural minority students experienced a lack of respect and understanding by cultural majority students and teachers. Education activities intended to transfer intercultural knowledge, address personal prejudice and stimulate intercultural sensitivity were perceived as stigmatising and as creating an unsafe climate for cultural minority students. Cultural minority and majority students on campus seemed segregated and the intercultural awareness of minority students was not integrated in intercultural competence activities. CONCLUSIONS: As cultural minority students were confronted with microaggressions, the medical school did not succeed in creating a safe education environment for all students. Contrary to their aims and intentions, intercultural competence activities had limited effect and seemed to support the polarisation of cultural minority and majority students and teachers. This can be seen as pointing towards a hidden curriculum privileging majority over minority students. For structural integration of intercultural competency in medical education, the focus must penetrate beyond curricular activities towards the critical addressing of the culture and structure of medical school. Collective commitment to creating a safe and inclusive education climate is vital. This requires fostering social cohesion between minority and majority students and teachers, raising awareness and the practice by all involved of critical (self-)reflexivity on cultural prejudice and dominant, exclusionary norms in academic medicine.

Standing out and moving up: performance appraisal of cultural minority physicians.

Despite a growing diversity within society and health care, there seems to be a discrepancy between the number of cultural minority physicians graduating and those in training for specialization (residents) or working as a specialist in Dutch academic hospitals. The purpose of this article is to explore how performance appraisal in daily medical practice is experienced and might affect the influx of cultural minority physicians into specialty training. A critical diversity study was completed in one academic hospital using interviews (N = 27) and focus groups (15 participants) with cultural minority physicians and residents, instructing specialists and executives of medical wards. Data were digitally recorded and transcribed verbatim. A thematic and integral content analysis was performed. In addition to explicit norms on high motivation and excellent performance, implicit norms on professionalism are considered crucial in qualifying for specialty training. Stereotyped imaging on the culture and identity of cultural minority physicians and categorical thinking on diversity seem to underlie daily processes of evaluation and performance appraisal. These are experienced as inhibiting the possibilities to successfully profile for selection into residency and specialist positions. Implicit criteria appear to affect selection processes on medical wards and possibly hinder the influx of cultural minority physicians into residency and making academic hospitals more diverse. Minority and majority physicians, together with the hospital management and medical education should target inclusive norms and practices within clinical practice.