There is more than what you think--cultural competence development in clinical placements through the eyes of ethnography

Research output: Contribution to conference typesPosterpeer-review


The UK General Medical Council stipulates that medical graduates should be able to
provide culturally sensitive care to patients of all backgrounds, including those whose
first language is not English. Cultural competence and diversity education is offered in
UK medical schools. However, little is known how students develop their cultural
competence specially in clinical placements.
Ethnography allows researchers to develop rich descriptions and an in-depth
understanding of the studied population’s lived experience through collecting naturally
occurring data. Participant observation was combined with interviews and focus groups
to triangulate analysis and generate more reliable accounts. We shadowed five medical
students on placements in a central London hospital, interviewed 25 students, and
conducted a focus group with five students.
We found that students developed their cultural competence via immersion,
observation, and interaction. Immersion in a working environment, where diversity was
manifested through interior design, diverse workforces and patient populations was
shown to raise students’ cultural awareness. Observation of culturally (in)appropriate
practices allowed students to develop their practical skills, including clinical
communication. Interaction with other professionals, peers, and patients, allowed
students to integrate attitudes, knowledge and skills into real-time care provision.
Students’ learning varied, depending on luck, individual personalities, the length of
exposure, available support, and the institutional culture of hospitals.
This study provides a rare view of how medical students develop cultural competence
in clinical placements, which may inform future pedagogic development. Some findings
may shed light on the learning of other values-based medical subjects, such as clinical
communication, professionalism, teamworking and ethics.
Original languageEnglish
Publication statusPublished - Jun 2019


  • Medical education
  • Cultural competence
  • Ethnography
  • undergraduate healthcare professional education


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