In a room of 300 medical students, how many have considered what it’s like to be a non-English speaking patient trying to access NHS services?
In a country of 120,000 doctors, how many have unintentionally discriminated against a patient due to a cultural implication they did not understand?
Have you ever considered any of these things?
The UK has diversified massively in the last 60 years, but we are still in the process of adjusting to this increased diversity. This has had a particular impact on healthcare, where we see stark disparities in healthcare outcomes amongst different population groups.
As two Black medical students, it often feels like we are the only ones in the room considering these things. The lack of inclusion we see in medical school curriculums across the UK is often overlooked, and we believe this may contribute to the shocking healthcare disparities we see. The ongoing COVID-19 pandemic was a wakeup call to many of us about how deeply this problem runs in society.
Together, we must move beyond speculating why certain members of society have poor healthcare outcomes and seek to develop concrete solutions that can change lives and have real impact.
One solution we wholeheartedly believe in is the need for us to train more culturally competent clinicians. The term ‘cultural competency’ was first used by American researcher Terry L. Cross in 1989, where he explored effective psychiatric services for “minority children”. From here, the world saw the emergence of cultural competency as a concept. Another term you may see used is ‘cultural safety’, which emphasises how cultural assumptions of the majority group can disadvantage minority groups, leading to “unsafe” care.
Our use of the term ‘culturally competent clinician’ refers to a clinician who not only considers their patient’s physical symptoms, but also their beliefs and values. However, how can one consider these things if they have never been taught to consider them? And how can one consider these things in a world where we are taught to overlook our differences?
A common quote we’ve heard from childhood is that ‘we are all the same on the inside’ - but we all have different internal beliefs and cultures which affect our health behaviours. However, this cannot be paralleled with supposed interracial differences in areas like pharmacokinetics, which are currently being deconstructed.
In this same stead, it is important to be wary of perpetuating stereotypes. What we don’t want is for the curriculum to be embellished with facts and figures that dehumanise patients; instead, we want open dialogues that explore issues some patients may face and ways we can help them as clinicians.
This is something we did as President and Vice-President of the African Caribbean Medical Association (ACMA) Cardiff last year. We organised a public health event, where we mobilised students to speak with residents of a historically multicultural part of Cardiff. The event focussed on vitamin D deficiency, which is prevalent in the UK, but particularly affects those with darker skin. Students set up stands to dispel vitamin D myths, distribute free vitamin D supplements, and show models of prosthetic limbs depicting the harmful effects of too much sun. For some students, it was the first time they had discussed healthcare needs with a non-English speaker, and they were able to reflect on how they could better support minority groups in their practice.
ACMA Cardiff’s webinar series, titled ‘The Cultural Curriculum’, highlighted several intersections between healthcare and culture. One interesting example was the intersection between culture and pharmacology, where we explored the need to review a Muslim patient’s diabetes treatment regimen should they choose to fast during Ramadan. As students, we often wonder how many other important details like this are we ignorant of.
What we do know is that the only cure for ignorance is education. We owe it to ourselves, and generations to come, to understand the role of culture in healthcare. By putting a greater emphasis on cultural competency and safety in the curriculum, we can breed a new generation of forward-thinking clinicians that produce the solutions the world needs.
Now, imagine a room of 300 medical students whose curriculum equips them to provide equitable care to a diverse, 21st century population.
Imagine yourself being a part of this change.
In the words of Barack Obama, “change will not come if we wait for some other person or some other time. We are the ones we’ve been waiting for. We are the change that we seek.”
So be a changemaker.
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