Several studies have shown that diversity is important in delivery of health care. The understanding of diversity by medical students, who are the medical practitioners of the future, will help to bridge the existing health disparities existing across ethnic or racial cultures. Diversity in the medical field is increasingly being stepped up. This is because studies have shown that there exists a diversity gap between composition of health profession and the general population as it is the case in United States. The groups categorized as minority are increasingly becoming more populous. However this is not reflected in the composition of health profession as the number of minority health professional is not increasing at the same rate. In enhance diversity in medical schools some states have embarked on affirmative action.
Medical students like all other people hail from different cultural background that shapes their beliefs, knowledge set, decisions and their behavior. Many at times it is difficult for the students to appreciate teachers, fellow students and patients of different cultural background or even create trusting relationships with them. Interactions with people of different cultures help to broaden the students' knowledge about other cultures and even appreciate them. When students have an understanding of diversity, communication with people of other cultural backgrounds is enhanced and hence ability to create lasting relationships with them.
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Student body diversity is important for developing a culturally competent medical workforce. Cultural competency goes beyond cultural awareness or sensitivity and may be defined as the ability to utilize cultural knowledge efficiently in cross-cultural situations (Kundhal et al, 2003). Health professionals have their own values by the virtue of their cultural background as mentioned earlier. Sometimes thy may be unable to work with the patients cultural values in the circumstance of use of conventional medical practices. Lack of cultural competence will then lead to taking for granted patients' values which can lead to detrimental effect on the patients' health due to poor adherence. Therefore diverse student body in the medical field enhances the ability of students to provide medical services in culturally diverse societies.
The importance of understanding diversity
Profound demographic change especially in United States continues to accelerate especially due to increasing number of immigrants (Kosoko-Lasaki et al 2009, p.75). The latest census in United States revealed that the so called minority groups presently make up the majority in almost all most populous counties in United States. The census even projects that within 40 years the groups categorized as minority will form the bulk of American citizenry. What is astonishing is that the healthcare professional tapestry remains unrepresentative of the general population. Moreover the diversity gap between health professions and general population continues to widen. Reducing the existing diversity gap would greatly contribute to reduction of health inequalities.
The changing American demographics create a compelling need for medical workforce to practice across culturally and racially diverse society. Some research findings have suggested that attitude of medical students on culture and health issues associated with diversity are shaped by student's medical school experiences. Inclusion of Cross-Cultural Education (CME) can help develop certain cultural competency skills such as inclusion of family and community members in the discourse to understand the dynamics of patient symptoms (Kundhal et al, 2003).
Cross-cultural education for medical students is important in preparing them to meet the health needs of ever growing and diverse population (Smedley et al, 2003). Definition of disease and health differs across different societies. Some diseases may be stigmatized in a community and this affects health seeking behavior regarding the diseases. For example depression is stigmatized in Asian society. As a result patients suffering from depression will tend to leave out symptoms of the diseases and present those that are less stigmatized to the clinician. An understanding of Asian culture would therefore significantly help in delivery of health care to Asians.
Prevalence of diseases varies across cultures. There are also beliefs and practices surrounding every disease and curative approaches in every society. Some may believe in folk healers or prayers as initial steps of obtaining healing. Some diseases may not seem serious enough to elicit need for medical treatment. Often than not the community believes that such diseases are best treated by traditional healers. This calls for coordination of care with traditional healers which can be achieved through cross-cultural education.
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Communication between provider and a patient is very important. This because communication plays a key role in adherence and trustful relationship between the provider and the patient necessary to achieve good health outcomes without which this cannot be achieved. Diversity in the student body creates a good opportunity for the students to interact with other students from different cultural background. This helps to exposes students to a broad range of ideas, experiences, and perspectives, thus better preparing them to meet the needs of a multicultural populace (Soha et al, 2008).
Why students experience difficulties in handling diverse ethnic backgrounds
As earlier mentioned cultural diversity is rapidly rocking many populations and as a result significant challenges face practice of health profession in culturally diverse societies. Defining culture itself is challenging. Culture is so broad that it becomes difficult to design a curriculum for cultural diversity education. Lack of concrete information on cultural diversity has also contributed to difficulties in designing cultural diversity education curriculum. As a result teaching of cultural diversity in medical schools is challenging and hence the full benefits of cultural diversity education are not fully realized. Little research exists to verify that change in altitudes as a result of cultural diversity education actually converts into clinical skills. If cultural diversity education does not translate into clinical skills then the student cannot handle ethnic differences between him and the patient.
Medical students like all other people differ in culture; different language, varying expectations, knowledge sets and habits of mind (Kosoko-Lasaki et al, 2009). Students who are ethnocentric find it difficult to interact and appreciate students, teachers and patients of different cultural backgrounds. Ethnocentrism mainly stems from where an individual grew up. For example if a student grew up in a neighborhood that was predominantly whites, then it will be difficult for such a student to interact and appreciate colored people.
Diversity in the medical school also contributes to a student ability to handle ethnic differences. In America for example some medical schools are predominantly white while others are colored. Studies have shown that students in less diverse college have a flimsy understanding of cultural diversity as compared to those from more diverse medical schools. Students from medical schools that are predominantly white are more likely to choose to work in areas that predominantly occupied by whites and verse versa. This is because the students are not prepared enough to work in other societies. Therefore lack of diversity in medical schools can lead to students having difficulties in handling difference in ethnic background between him/her and the patient.
Lack of cultural diversity in medical schools also makes it difficult for students to accommodate students from different cultural background. Students in less diverse medical schools have been found associate more with students of similar cultural background and look down on students of different cultures. The same case applies to teachers. Students learn to appreciate and interact with teachers of different cultures if the teaching staff is culturally diverse. Students tend to have negative attitude towards teachers of a different cultural background if the teaching staff is not diverse. This in turn impacts negatively on the student performance of the coursework taught by a teacher of different culture.
Identity is closely related to the idea of culture. Even though identity is not shaped from culture per se identity draws from culture (Dogra & Karim, 2005). Students from cultural backgrounds regarded as "minority" may have poor identity of themselves as compared to other students. As a result such students find it difficult to interact with other students of "majority" cultural backgrounds because they see them as being superior. Such students will not want to work in areas that are predominantly occupied by the majority ethnic group even on completion of their studies. They are afraid they will not be appreciated by patients and more so they would not feel adequately prepared to work in areas occupied by other ethnic groups. However this may not be the case for all minority students. Some have a strong personality such that they are able to rise above inferiority complex.
Cultural diversity continues to be an important aspect of health care delivery. Considering the rapidly changing demographics which as seen increase in minority groups, the need for closing existing health profession diversity gap is inevitable. This is important in that composition of health profession becomes representative of the larger public. Despite this need culture is very broad such that there is no universal definition of culture as a result it has become difficult for medical schools to develop a curriculum for cultural-diversity education. Cultural diversity education is important for developing cultural competency such as inclusion of family and community members in the discourse to understand the dynamics of patient symptoms (Kundhal et al, 2003).
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Cultural competency can be defined as the ability to utilize cultural knowledge efficiently in cross-cultural situations (Kundhal et al, 2003). Cultural competency goes beyond cultural awareness or sensitivity. Cultural competency is important for good delivery of health care to minority ethnic groups and hence reducing health disparities existing between minority groups and the general public. Cultural competency helps a health provider to communicate well with patients and build lasting relationship necessary for good health outcomes in the patient.
Diversity in the student body creates a good opportunity for the students to interact with other students from different cultural background. This helps to exposes students to a broad range of ideas, experiences, and perspectives, thus better preparing them to meet the needs of a multicultural populace (Soha et al, 2008). Attitude and perception of students concerning other ethnic groups change as a result. The beneficial effect of diversity in student body has led to many medical schools advocating for it. Some have even embarked on affirmative action in the effort to increase the enrollment of students from minority ethnic groups.
However students sometimes find it difficult to embrace cultural diversity. These difficulties stem from their cultural background and medical schools. Diversity in medical school is important in addressing the difficulties. Understanding of Cultural diversity therefore plays a major role in delivery of health care.