Long-term effectiveness of patient-centered training in cultural competence: what is retained? What is lost?

Abstract

Purpose: To determine whether the effects of a patient-centered cultural competence curriculum could be sustained for one year.

Method: In 2006, 57 fifth-year medical students at National Taiwan University were randomly assigned either to a group that received training in patient-centered cross-cultural communication skills or one that received no training. Students' scores on objective structured clinical exams (OSCEs) were compared in the realms of exploring (1) patient perspectives and (2) social factors related to illness, immediately after training (OSCE1) and one year after training (OSCE2).

Results: Regarding students' exploration of patient perspectives, the intervention group scored significantly higher than the control group at OSCE1, but there was a significant decrease from OSCE1 to OSCE2 in the intervention group and no significant difference between the intervention and control group at OSCE2. Regarding students' exploration of social factors related to illness, the intervention group scored significantly higher than the control group at OSCE1, with a nonsignificant decrease from OSCE1 to OSCE2 in the two groups, such that the intervention group again scored higher than the control group in OSCE2.

Conclusions: The effect of a patient-centered cultural competence training curriculum on students' exploration of social factors related to illness was sustained to a significant degree after one year, whereas the effects on students' exploration of patient perspectives were not. Further research is needed to determine the extent to which additional training can prevent the loss of student skills.

Figure 1

Change in the mean scores of all students in two domains (patient perspective; social factors related to illness) over time. Higher scores indicate better performance. Scores were from 57 fifth-year medical students who were randomly assigned either to an intervention group that received training in patient-centered cross-cultural communication skills (n = 29) or to a control group that received no training (n = 26). Each group’s scores on objective structured clinical exams (OSCEs) were compared in the realms of exploring (1) patient perspectives and (2) social factors related to illness, immediately after training (OSCE1) and one year after training (OSCE2). Mean scores indicate the mean number of skills.