Cross-cultural perspectives on the patient-provider relationship: a qualitative study exploring reflections from Ghanaian medical students following a clinical rotation in the United States

BMC Medical Education

Cheryl A. Moyer⁴  Timothy R. B. Johnson⁶  Peter Donkor⁵  Kwabena A. Danso⁵  Joseph C. Kolars¹  Sandra Danso-Bamfo³  Nauzley C. Abedini² 

[1]Department of Internal Medicine and Global REACH, University of Michigan Medical School, Ann Arbor, MI, USA

[2]University of Washington Internal Medicine Residency Program, Seattle, WA, USA

[3]Harvard T.H. Chan School of Public Health, Boston, MA, USA

[4]Departments of Learning Health Sciences and Obstetrics and Gynaecology, University of Michigan Medical School, Ann Arbor, MI, USA

[5]School of Medical Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana

[6]Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, MI, USA

关键词: Medical education;    Clinical electives;    Humanism in medicine;    Global health;    Patient-provider communication;    Patient-provider relationship;    International partnerships;   

Others  :  1228678
DOI  :  10.1186/s12909-015-0444-9

 received in 2015-05-02, accepted in 2015-09-21,  发布年份 2015

【 摘 要 】

Background

In international health experiences, learners are exposed to different culturally-based patient care models. Little is known about student perceptions of patient-provider interactions when they travel from low-to high-resource settings. The purpose of this study was to explore these reflections among a subset of Ghanaian medical students who participated in clinical rotations at the University of Michigan Medical School (UMMS).

Methods

In-depth, semi-structured interviews lasting 60–90 min were conducted with 15 individuals who had participated in 3-to 4-week clinical rotations at UMMS between January 2008 and December 2011. Interviews were conducted from March to August 2012 and transcribed verbatim, then independently coded by three investigators. Investigators compared open codes and reached a consensus regarding major themes.

Results

Participating Ghanaian medical students reported that their perspectives of the patient-provider relationship were significantly affected by participation in a UMMS rotation. Major thematic areas included: (1) observations of patient care during the UMMS rotation, including patient comfort and privacy, physician behavior toward patients, and patient behavior; (2) reflections on the role of humanism and respect within patient care; (3) barriers to respectful care; and (4) transformation of student behaviors and attitudes. Students also reported integrating more patient-centered care into their own medical practice upon return to Ghana

Discussion

Participation in a US-based clinical rotation has the potential to introduce medical students from resource-limited settings to a different paradigm of patient-provider interactions, which may impact their future behavior and perspectives regarding patient care in their home countries.

Conclusions

Students from under-resourced settings can derive tremendous value from participation in clinical electives in more affluent settings, namely through exposure to a different type of medical care.

【 授权许可】

   
2015 Abedini et al.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Ramsey AH, Haq C, Gjerde CL, Rothenberg D. Career influence of an international health experience during medical school. Fam Med. 2004; 36(6):412-6.
• [2]Thompson MJ, Huntington MK, Hunt DD, Pinsky LE, Brodie JJ. Educational effects of international health electives on U.S. and Canadian medical students and residents: a literature review. Acad Med. 2003; 78(3):342-7.
• [3]Mutchnick IS, Moyer CA, Stern DT. Expanding the boundaries of medical education: evidence for cross-cultural exchanges. Acad Med. 2003; 78(10 Suppl):S1-5.
• [4]McKinley DW, Williams SR, Norcini JJ, Anderson MB. International exchange programs and U.S. medical schools. Acad Med. 2008; 83(10 Suppl):S53-7.
• [5]Kolars JC, Cahill K, Donkor P, Kaaya E, Lawson A, Serwadda D et al.. Perspective: partnering for medical education in Sub-Saharan Africa: seeking the evidence for effective collaborations. Acad Med. 2012; 87(2):216-20.
• [6]Izadnegahdar R, Correia S, Ohata B, Kittler A, ter Kuile S, Vaillancourt S et al.. Global health in Canadian medical education: current practices and opportunities. Acad Med. 2008; 83(2):192-8.
• [7]Cooper-Patrick L, Gallo JJ, Gonzales JJ, Vu HT, Powe NR, Nelson C et al.. Race, gender, and partnership in the patient-physician relationship. JAMA. 1999; 282(6):583-9.
• [8]Johnson RL, Saha S, Arbelaez JJ, Beach MC, Cooper LA. Racial and ethnic differences in patient perceptions of bias and cultural competence in health care. J Gen Intern Med. 2004; 19(2):101-10.
• [9]Young M, Klingle RS. Silent partners in medical care: a cross-cultural study of patient participation. Health Commun. 1996; 8(1):29-53.
• [10]Roter D. The enduring and evolving nature of the patient-physician relationship. Patient Educ Couns. 2000; 39(1):5-15.
• [11]Abedini NC, Danso-Bamfo S, Moyer CA, Danso KA, Makiharju H, Donkor P et al.. Perceptions of Ghanaian medical students completing a clinical elective at the University of Michigan Medical School. Acad Med. 2014; 89(7):1014-7.
• [12]Creswell JW. Qualitative inquiry and research design: choosing among five approaches. 2nd ed. Sage Publications, Thousand Oaks, CA; 2007.
• [13]Vivian LM, Naidu CS, Keikelame MJ, Irlam J. Medical students’ experiences of professional lapses and patient rights abuses in a South African health sciences faculty. Acad Med. 2011; 86(10):1282-7.
• [14]Preez RR, Pickworth GE, Van Rooyen M. Teaching professionalism: a South African perspective. Med Teach. 2007; 29(9):e284-91.
• [15]Caldicott CV, Faber-Langendoen K. Deception, discrimination, and fear of reprisal: lessons in ethics from third-year medical students. Acad Med. 2005; 80(9):866-73.
• [16]Ginsburg S, Regehr G, Stern D, Lingard L. The anatomy of the professional lapse: bridging the gap between traditional frameworks and students’ perceptions. Acad Med. 2002; 77(6):516-22.
• [17]Rentmeester CA, Brack AB, Kavan MG. Third and fourth year medical students’ attitudes about and experiences with callousness: the good, the bad and the ambiguous. Med Teach. 2007; 29(4):358-64.
• [18]Hendelman W, Byszewski A. Formation of medical student professional identity: categorizing lapses of professionalism, and the learning environment. BMC Med Educ. 2014; 14:139. BioMed Central Full Text
• [19]Baingana RK, Nakasujja N, Galukande M, Omona K, Mafigiri DK, Sewankambo NK. Learning health professionalism at Makerere University: an exploratory study amongst undergraduate students. BMC Med Educ. 2010; 10:76. BioMed Central Full Text
• [20]Byszewski A, Hendelman W, McGuinty C, Moineau G. Wanted: role models--medical students’ perceptions of professionalism. BMC Med Educ. 2012; 12:115. BioMed Central Full Text
• [21]Morihara SK, Jackson DS, Chun MB. Making the professionalism curriculum for undergraduate medical education more relevant. Med Teach. 2013; 35(11):908-14.
• [22]Kizza IB, Tugumisirize J, Tweheyo R, Mbabali S, Kasangaki A, Nshimye E et al.. Makerere University College of Health Sciences’ role in addressing challenges in health service provision at Mulago National Referral Hospital. BMC Int Health Hum Rights. 2011; 11 Suppl 1:S7. BioMed Central Full Text
• [23]Irabor DO, Omonzejele P. Local attitudes, moral obligation, customary obedience and other cultural practices: their influence on the process of gaining informed consent for surgery in a tertiary institution in a developing country. Dev World Bioeth. 2009; 9(1):34-42.
• [24]Ndebele P, Mfutso-Bengo J, Masiye F. HIV/AIDS reduces the relevance of the principle of individual medical confidentiality among the Bantu people of Southern Africa. Theor Med Bioeth. 2008; 29(5):331-40.
• [25]Matheson D. A right to health: medicine as Western cultural imperialism? Disabil Rehabil. 2009; 31(14):1191-204.
• [26]Abedini NC, Gruppen LD, Kolars JC, Kumagai AK. Understanding the effects of short-term international service-learning trips on medical students. Acad Med. 2012; 87(6):820-8.
• [27]Dharamsi S, Richards M, Louie D, Murray D, Berland A, Whitfield M et al.. Enhancing medical students’ conceptions of the CanMEDS Health Advocate Role through international service-learning and critical reflection: a phenomenological study. Med Teach. 2010; 32(12):977-82.
• [28]Petrosoniak A, McCarthy A, Varpio L. International health electives: thematic results of student and professional interviews. Med Educ. 2010; 44(7):683-9.