Integrating cultural awareness into busy residency training-What could work?

Introduction: Provision of culturally sensitive healthcare improves patient-clinician relationships and health outcomes. However, traditional cultural competence training may inadvertently reinforce racial and ethnic biases and can be challenging to implement into busy residency programs. This study aimed to contribute evidence-based recommendations for cultural awareness training to be integrated into existing residency programs, to promote holistic and longitudinal learning of cultural awareness. Methodology: This was a qualitative study of healthcare staff and patient experiences within a culturally diverse population and cultural awareness issues that arise in a tertiary academic paediatric hospital. Nineteen participants (six residents, four faculty, four nurses and five caregivers) were purposefully sampled and underwent semi-structured individual interviews. Transcribed interviews were analysed for emerging themes. Results: From a multi-faceted perspective, cultural awareness issues that emerged included: 1) addressing the tension between residents’ instrumental and expressive behaviour in patient care, 2) cultural and ethnic bias of caregivers towards doctors, 3) residents’ concerns about difficult patients, 4) understanding patients' perspectives and 5) bias within inter-professional relationships. As expected, residents’ learning experiences about cultural awareness occurred through on-the-job learning rather than formal curricula. Discussion: Resource-intensive cultural competency curricula may not always be feasibly integrated into busy residency programs. However, some practical methods to facilitate longitudinal workplace-based learning of cultural awareness include: 1) firm and transparent hospital policies against discrimination and engaging residents into developing such policies, 2) faculty development and leadership training on cultural sensitivity and supporting victims of discrimination, 3) incorporating cultural sensitive communication into assessment methods, 4) utilising patients as educators and 5) ensuring inter-professional team diversity.