Sociocultural Aspect of Care is Definitely Part of the “problem”: Developing Preclinical Students’ Cross-Cultural Care Competence Through Problem-Based Learning

Increasing diversity issues have posed challenges on pedagogical strategies of medical education, particularly in the post-pandemic era. Medical students are not only expected to have essential medical skills, but also be equipped with the abilities to stay attuned to the sociocultural needs of diverse patient groups. Providing students safe environments to hone these abilities is essential in helping them prepare for future patient encounters in the clinical setting. This study adopted mixed methods to explore the effectiveness of integrating issues on cross-cultural care competence (CCC) into problem-based learning (PBL) to enhance medical students’ CCC preparedness. With bases in constructivism and social cognitive learning theories, and drawing from Bloom’s taxonomy and the Conscious-Competence model in the development of adaptive expertise, this article included discussions of students’ and tutors’ perceptions of the effectiveness of integrating CCC issues into problem-based learning (PBL) in a Taiwanese medical school. We incorporated into PBL scenarios diversity issues students identified as being less prepared for in a previous study. For quantitative analysis, undergraduate medical students completed pre- and post-PBL questionnaires (pre =124, post = 239) and 24 tutors completed a tutor version of pre-PBL questionnaire. For qualitative analysis, we conducted two student focus groups (n = 8) and 12 individual tutor interviews. Scripts were transcribed, coded, and analyzed using inductive thematic analysis. Quantitative results revealed students generally considered CCC-integrated PBL to be effective in providing them with learning experiences to better understand diversity issues and preparing them for clinical learning. From interviews and focus groups, we further identified four themes: awareness raising- CCC topics in medical training; students’ engagement in CCC-issues- reasons affecting participation; tutors’ concerns- competence in facilitation of CCC learning; and competition in a crowded curriculum. These themes showed that participation in CCC-integrated PBL sessions can raise students’ awareness of sociocultural aspects, biases, stereotypes, diverse cultural groups’ healthcare needs and CCC issues. However, there are still gaps to fill including insufficient student engagement, tutors’ own competence (or capabilities) in addressing CCC, and inadequate time. In conclusion, strategically integrating CCC into PBL provide opportunities that allow students to raise awareness of the impact patients’ diverse backgrounds have on health care. Nevertheless, it is pivotal to address gaps in tutors’ perceptions and students’ learning experiences to design curricular content that can broaden students’ adaptive expertise and sensitivity to diverse patient needs.