Assessing Cultural Competences by Janusz Janczukowic
I am just back from the incredibly interesting meeting “Detoxing Narratives: Telling Other Stories in Different Ways” organised by the Department of Education of the University of Vienna to discuss how stories and tales form a cultural and social background of diverse groups, communities, societies and influence interactions between them.
Working every day with international students of the Medical University of Lodz, coming from all continents and forming an amazingly complex community of diverse religions and cultures, we are infused in constant discourses presenting multiple, often complex and contradictory points of views and perceptions. Cultural diversity brings new challenges to medical schools and the team of Centre for Medical Education cooperating with multiple European experts in this domain aims to create a safe and creative space for teaching and learning cultural and social competence being an element of academic and medical professionalism. The special difficulty of this task is to provide the balance between teaching about our local norms and values remembering at the same time that we are educating future doctors who have to gain trust of their patients around the world.
Special “Declaration to address the urgent need for culturally competent health professionals in an increasingly diverse world” emphasizing the complexities arising from the current refugee crisis had been agreed an published last year in Amsterdam during the meeting of the European project - Culturally competent in medical education consortium where I had the privilege of representing at AMEE.
Now, here comes the problem- how to evaluate the outcomes of teaching cultural and social competence at levels higher than participants’ satisfaction? If we provide participants of educational sessions with the friendly environment, well prepared facilitators and interactive tasks, their evaluation is usually very positive, although, we need to know what have they learned, how their knowledge, skills and attitudes have developed. It was not uncommon during the implementation phase of our courses that when recalling previous meeting students where using adjectives: “interesting”, “interactive”, “creative” and at the same time, when asked “what have you learned?” their answers were very vague and superficial.
Another problem that should be kept in mind is the knowledge, skills and attitudes retention. A recent small research project conducted by Bartczak and Sikorski in the Simulation Centre of our university revealed that while students enjoy the simulated sessions, their immediate educational outcomes are very good, the skills retention after one year is highly unsatisfactory. This brings us to the model of teaching professionalism suggested by Cruess and Cruess. While the cognitive base of professionalism, including cultural and social competence should be taught throughout the entire curriculum, with the increasing ability for the learner’s self-reflection it has to be supplemented with the constant infusion in experiential learning. This task is really complex as it requires clinical teachers capable of professional implementing elements of cultural and social competence into their courses and into the consecutive assessment but it reflects the current perspectives at teaching and learning cultural competence.
While it is impossible to learn all factual knowledge about cultures and such mechanical approach may even push us deeper into applying stereotypes, we should focus on developing intercultural skills based on empathy and self-reflection including the ability to identify own, implicit stereotypes. Again, this is a difficult task requiring thinking outside the box and stepping out of own comfort zone.
There are two quotes from the EBMA experts that perfectly describe the complexities of assessing cultural and social competence. Cees van Der Vleuten wrote: „we have been measuring the measurable and ignoring the (so-called) ‘too difficult to measure’”. This challenge was discussed during the workshop “Assessment of Professionalism in Cultural and Social Competence” presented by me and Charlotte Rees from Monash University during the EBMA Annual Academic Conference in Exeter this October. It is obvious, that teaching particular domains (e.g. technical clinical skills and cultural competence) and assessing only part of them (e.g. technical skills) conveys a subliminal message to the learner: “they don’t assess cultural competence; hence we don’t need to learn it”.
At the same time, we need to admit that assessing cultural competence is really complex and requires special skills of culturally diverse assessors. The second quote, this time from Dame Lesley Southgate states: “…everyone was in favour of quality – but everyone thought it meant something different”. While setting uniform, European standards for assessment of medical procedures or doses of medicines is relatively easy, deciding on similar standards in the domain of professionalism is highly context dependent. We can clearly identify this problem during the extremely interesting EBMA Board discussions on video assessment, when expert-assessors from diverse countries differ in their opinions on students’ performance when it comes to such complex issues as personal comfort zone or the role of touch (e.g. the distance between the doctor and patient during the interview). That’s why “crossing boundaries” being the main theme of the EBMA Annual Academic Conference in Exeter was so important and should be definitely continued in the future.
As apart from my role on the EBMA I am also leading the AMEE diversity–related initiatives including the diversity theme of annual AMEE conferences, I will be very happy to hear from all interested in exchanging experience in teaching, learning and assessing cultural and social competence and professionalism.
Janusz Janczukowicz, MD,PhD, FHEA,
- Head of Centre for Medical Education- Medical University of Lodz
- Member of the AMEE Executive Committee
- Member of the European Board of Medical Assessors
Email: janusz.janczukowicz@umed.lodz.pl
REFERENCES:
Culturally competent in medical education: Declaration to address the urgent need for culturally competent health professionals in an increasingly diverse world. Amsterdam, 2015
Cruess, Cruess and Steinert (2009): Teaching Medical professionalism. Cambridge Medicine
Southgate and van der Vleuten (2014): A conversation about the role of medical regulators. Medical Education, 48: 215–218
Interested in a Masterclass Assessment of Professional Competences by Professor Cees van der Vleuten?
SHE offers the next advanced course in Assessment in Maastricht from 3-7 April, 2017. There are still some places available to register. Registration deadline is 1 March, 2017
Starting point in this course will be the (new) messages from assessment research. The focus will be on the challenge to translate these insights to (your own) assessment practice. Attention will be paid to different approaches to assessment (design), including programmatic assessment.
"Assessment in the health professions is at a crossroads: ongoing and dramatic changes in healthcare and education systems call for new ways of thinking about assessment practices."
Cees van der Vleuten, Scientific Director SHE
More information: https://she.mumc.maastrichtuniversity.nl/masterclass-assessment-professional-competence
International students of the Medical University of Lodz during the workshops on cultural competence in the “ms2” Museum of Art and in the University Didactic Centre.