2014, 36: 743–745
COMMENTARY
Tomorrow’s Doctors and diversity issues in medical education MARGOT A. TURNER1, MOIRA KELLY2, PETE LEFTWICK3 & NISHA DOGRA4 1
St Georges University of London, UK, 2Queen Mary University of London, UK, 3The University of Liverpool, UK, and University of Leicester, UK
4
Med Teach Downloaded from informahealthcare.com by Nyu Medical Center on 05/08/15 For personal use only.
Introduction Teaching ‘cultural diversity’ to medical students in the UK became a priority following the publication of Tomorrow’s Doctors (General Medical Council, [GMC] 1993). This was in the context of increasing recognition in the UK and North America of the need to acknowledge variation in patient needs related to their ethnic background and the influence that cultural perspectives have on health as well as increasing diversity within society and changing expectations of doctors (Dogra et al. 2010). Previously, medical schools included ethnicity more in the context of teaching about health inequalities rather than about how health practitioners, including doctors, could meet the needs of a diverse range of patients including those with different ethnicities (for example: University of Leicester 1993). Tomorrow’s Doctors (GMC 1993) contained the recommendations for undergraduate medical education issued by the Education Committee of the GMC. In developing their recommendations, the Education Committee concluded that the time for change had come and medical schools needed to ensure that future doctors treated patients from all backgrounds equitably (GMC 1993). In this commentary we critique each of the three iterations of Tomorrow’s Doctors (1993, 2003, 2009) with respect to diversity education and discuss how these documents may have both helped and hindered this. We conclude with some recommendations.
Tomorrow’s Doctors 1993 The publication of Tomorrow’s Doctors with the inclusion of the issue of ‘‘diversity’’ implies that the GMC viewed this as an important issue. In response to this, medical schools devised programmes to meet these needs (e.g. Conning et al. 2001; Dogra 2001). Tomorrow’s Doctors laid out a clear agenda for change. There was no emphasis on the value of diversity teaching which should augment the ‘‘basics’’ to enhance the skills of the practitioner in applying their knowledge to their individual patients. The challenges of meeting individual patient needs while also considering population needs appear not to have been noted.
Tomorrows’ Doctors (1993) appeared to have little conceptual clarity about how the intended diversity education was to be implemented in practice. Diversity was mentioned in various sections of the document but with little linkage. Laudable and well-intentioned statements were made about student attitudes and respect for patients and colleagues without prejudice. It is arguable that these broad overarching statements may have overwhelmed teachers and led to paralysis regarding diversity issues for some educators. Dogra & Williams (2006) reported that there was little evidence to suggest that Tomorrow’s Doctors influenced the development of diversity education at UK medical schools or that the GMC’s intentions were meaningfully implemented. The authors concluded that the GMC or other key medical educational policymakers needed to provide stronger leadership.
Tomorrow’s Doctors 2003 The next version of Tomorrows Doctors 2003 linked diversity issues in medical education to the clinical communication curriculum, but again there was little indication of how overarching themes such as ‘‘age, social, cultural or ethnic background’’ could be explored. While this version went beyond just considering ethnicity, the statement still limited the meaning of diversity and related it to group characteristics rather than recognizing that it could be applicable to every clinical encounter. Informal networks of diversity teachers found anecdotal evidence that at least in the UK, it seemed that areas that were easiest to define and least contentious were seized upon without considering diversity as a whole. This for example led to an emphasis on communicating with people with a hearing impairment, working with people with intellectual disabilities, and working with interpreters. We recognize that these are important areas but focusing on just these has led to a piecemeal approach to diversity issues rather than a holistic and strategic approach which can coherently ensure embedding of diversity issues across the curriculum. Additionally, writers such as Rivett (2003) argued that the 2003 version reinforced the ‘‘touchyfeely qualities’’ of the previous version. This raises the issue of
Correspondence: Margot A. Turner, Lecturer in Community Medical Education, Population, Health Sciences and Education, St Georges University of London, Cranmer Terrace, London SW17 ORE, UK. Tel: +208 725 5169; E-mail: [email protected] ISSN 0142-159X print/ISSN 1466-187X online/14/90743–3 ß 2014 Informa UK Ltd. DOI: 10.3109/0142159X.2014.909586
743
Med Teach Downloaded from informahealthcare.com by Nyu Medical Center on 05/08/15 For personal use only.
M. A. Turner et al.
whether or not the principles of Tomorrow’s Doctors were widely supported as a whole. Practical suggestions were made about visits students could make to interact with people from different backgrounds. While useful, it is naive to assume that simply by ‘‘meeting’’ people who may be different from you, will enable you to understand the complexity of some of the issues related to diversity. Such activities need to be contextualized and integral to learning objectives on diversity that could challenge attitudes and stereotypes. There is also the issue that the educational activities need to be assessable and be assessed. Such activities may also be viewed as ‘‘cultural immersion’’ which imply that learning about one ethnic family in depth somehow is a generalizable experience when encountering others from the same ethnic group (e.g. Loudon et al. 1999; Godkin & Weinreb 2001). There is evidence that many medical students struggle with uncertainty and if given some facts about specific groups will latch on to those rather than reflect on how they can explore patient perspectives instead of relying on their own assumptions (e.g. Dogra et al. 2007).
Tomorrow’s Doctors 2009 This version of Tomorrow’s Doctors appears not to have utilized the increasing evidence regarding the teaching of diversity. Although there was evidence that little, if any, progress was being made in the development of a diversity curriculum in medical education, Tomorrow’s Doctors 2009 did not add much to improve the situation. There was still a lack of guidance for medical schools on how to create a culturally sensitive curriculum, or how the GMC in their quality assurance role, would assess whether a medical school was successfully addressing diversity issues in their curriculum. The tick box approach to diversity still exists, with students being asked to respect seventeen diverse criteria that may impact on their interactions with colleagues and patients. There is no suggestion about how to teach this and highlights the need for an educational strategy to help both students and faculty to address and work on the impact of their attitudes. This implies that the GMC is mirroring wider societal positions without evaluating or critiquing them as they relate to medical education. Diversity needs to be taught and learned in a way that engages students and ensures that they are clear that recognizing diversity is not about being ‘‘politically correct’’ but about helping them to work collaboratively with their patients to attain the best clinical outcomes and experience of health care. It is arguable that the GMC itself is assuming a position of ‘‘political correctness’’ but not tackling the need to challenge some cultural values. (An obvious example is the issue of female genital mutilation. Here, the doctor must challenge the culturally held belief that this is acceptable, as by not doing so, they are not applying the same legal standards to these potential patients as they are to others.) There is also a greater focus on the equality agenda rather than the diversity agenda, perhaps because the former is superficially easier to measure. For example, the ethnicity of students entered to medical school is relatively straightforward to collect. It is more challenging to show that staff or students 744
demonstrate some of the attitudes mentioned in the document. We would argue that both the equality and diversity agendas are important and that there is some overlap. However, equality cannot be used as a proxy for diversity. It is also true that an organization that truly embraces the equality agenda will have robust policies and recognize the value of diversity across all its activities. Alongside Tomorrow’s Doctors 2009, the GMC published four supplementary advisory documents on assessment, clinical placements, developing and training teachers and patient and public involvement in undergraduate medical education (GMC 2011a, 2011b, 2011c, 2011d, respectively). In each of these documents, they mention the need to be aware of how aspects of diversity are relevant to the topic. Importantly, statements on diversity issues are embedded into two of these documents, modelling effectively that diversity needs to be considered in all aspects of medical education and that it is not a standalone topic. However, this is then not followed through. While some teaching examples are provided, there is little evidence that these are integrated across the curriculum. The diversity statement on staff training (GMC 2011c) shows a bias towards equality training, which is very much part of the Human Resources agenda and does not address diversity curriculum and teaching issues. While on line training is suggested, there is no comment on how the effectiveness of this or any other training in diversity will be assessed by the GMC. It is also unclear how the GMC will monitor if faculty have been effectively trained to teach diversity. The assessment guidance (GMC 2011a) does appear to consider diversity. There is little mention of the specifics of diversity in the delivery of curriculum sections but then almost out of the blue they write: Also (medical) schools should seriously consider including OSCE stations where cultural or linguistic differences are a major focus and equality and diversity training will be a core component of any assessor/examiner training programme. This statement suggests that there is a lack of clarity about diversity issues as it is difficult to generate OSCES on culture in isolation especially if diversity issues are not embedded in the curriculum or an integral part of all learning. There also appears to be confusion between diversity and equality issues in the way that the statement is written. The statement may relate to the GMC’s awareness of concerns identified through their regulatory role and complaints about doctors who lack an understanding of appropriate professional behaviour. There is also the interpretation that this recommendation ensures that examiners behave appropriately towards examination candidates and treat them fairly, irrespective of their backgrounds.
The way forward We understand it is not the role of the GMC to devise specific curricula but we would argue that in its quality assurance role it cannot disassociate itself from the lack of progress that has been made to date. Dogra et al. (2005) reported that 75% of UK
Med Teach Downloaded from informahealthcare.com by Nyu Medical Center on 05/08/15 For personal use only.
Tomorrow’s Doctors and diversity issues in medical education
medical schools stated that they undertook some diversity teaching, but that teaching was fragmented and there was uncertainty about content. Five years later disappointingly little had changed (Bentley et al. 2008; Dogra 2012). Unsurprisingly, the UK is not alone in struggling with these issues. The US and Canada have faced similar challenges (e.g. Dogra et al. 2010) as have many European countries (e.g. Seeleman et al. 2009; Knipper et al. 2010). The European Union has recently funded a project to consider how medical teachers across the curriculum can be trained to ensure that they integrate cultural diversity across the curriculum to better address the health care needs of diverse groups (AMC 2014). Given that diversity can be a potentially sensitive issue and that the UK including the GMC have been wrestling with how to progress these issues, we would suggest that the GMC needs to be leading this debate and giving guidance on more specific learning objectives. It should also support the training of staff on how to create and deliver material that will avoid reinforcing stereotypes. Only then can the quality assurance of diversity education and assessment be undertaken. To help universities and academics move forward, there appears to be an excellent opportunity for the GMC to produce evidence based supplementary advice on ‘‘Addressing diversity in the medical undergraduate curriculum’’. The GMC could engage more actively with teachers working in this area and with projects such as the one being managed by the AMC. It is important that the GMC is transparent in how they are evaluating effective diversity teaching if the situation is to change.
Notes on contributors MARGOT TURNER, MA, FHEA, is a Lecturer in Community Medical Education and lead on diversity issues in the curriculum at St George’s University of London. MOIRA KELLY, PhD, is a Senior Lecturer in Medical Sociology at Queen Mary University of London. PETE LEFTWICK, MBBS, is a General Practioner and University Community Clinical Teacher at the University of Liverpool. NISHA DOGRA, BM, DCH, FRPsych, MA, PhD, is a Professor of Psychiatry Education and Honorary Consultant in Child and Adolescent Psychiatry, University of Leicester.
Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article.
References AMC. 2014. Cultural competence in medical education. [Accessed 16 January 2014] Available from http://www.amc.nl/web/Research/Major-
projects-and-collaborations/Overview/Culturally-Competent-in-MedicalEducation/Culturally-Competent-in-Medical-Education/Project-C2ME.htm. Bentley P, Jovanovic A, Sharma P. 2008. Cultural diversity training for UK healthcare professionals: A comprehensive nationwide cross-sectional survey. Clin Med 8(5):493–497. Conning S, Hooper A, Turner M. 2001. Reports of new ideas in medical education: Educating tomorrow’s doctors for today’s world: Introducing a new diversity course for year 2 medical students in a communitybased setting. Med Educ 35(11):1071–1090. Dogra N. 2001. The development and evaluation of a programme to teach cultural diversity to medical undergraduate students. Med Educ 35(3):232–241. Dogra N. 2012. Cultural diversity teaching in the UK – update and ways forward. Learning in teaching medicine, dentistry and veterinary medicine. Spring 01.23:4–6. Dogra N, Conning S, Gill PS, Spencer J, Turner M. 2005. Teaching of cultural diversity in Medical schools in the United Kingdom and Republic of Ireland: Cross sectional questionnaire survey. Br Med J 19, 330(7488):403–404. Dogra N, Giordano J, France N. 2007. Cultural diversity teaching and issues of uncertainty: The findings of a qualitative study. BMC Med Educ 7:8. Dogra N, Reitmanova S, Carter-Pokras O. 2010. Teaching cultural diversity: Current status in U.K., U.S., and Canadian medical schools. J Gen Intern Med 25(Suppl 2):164–168. Dogra N, Williams R. 2006. Applying policy and evidence in developing cultural diversity teaching in undergraduate medical education in the UK. Evid Policy 2, 4:463–477. General Medical Council. 1993. Tomorrow’s Doctors. London: General Medical Council. General Medical Council. 2003. Tomorrow’s Doctors. London: General Medical Council. General Medical Council. 2009. Tomorrow’s Doctors. London: General Medical Council. General Medical Council. 2011a. Assessment in undergraduate medical education: Advice supplementary to Tomorrow’s Doctors (2009). London: General Medical Council. General Medical Council. 2011b. Clinical placements for medical students: Advice supplementary to Tomorrow’s Doctors (2009). London: General Medical Council. General Medical Council. 2011c. Developing teachers and trainers in undergraduate medical education: Advice supplementary to Tomorrow’s Doctors (2009). London: General Medical Council. General Medical Council. 2011d. Patient and public involvement in undergraduate medical education: Advice supplementary to Tomorrow’s Doctors (2009). London: General Medical Council. Godkin M, Weinreb L. 2001. A pathway on serving multicultural and underserved populations. Acad Med 76:513–514. Knipper M, Akinci S, Soydan N. 2010. Culture and healthcare in medical education: Migrants’ health and beyond. GMS Z Med Ausbild 27(3):Doc 4. Loudon RF, Anderson PM, Gill PS, Greenfield SM. 1999. Educating medical students for work in culturally diverse societies. J Am Med Assoc 282(9):875–880. Rivett G. 2003. Medical schools and medical education [online]. [Accessed 11 June 2003] Available from www.nhshistory.co.uk/ medical_eductaion_and_staffing.htm. Seeleman C, Suurmond J, Stronks K. 2009. Cultural competence: A conceptual framework for teaching and learning. Med Educ 43(3):229–237.
745
COMMENTARY
Tomorrow’s Doctors and diversity issues in medical education MARGOT A. TURNER1, MOIRA KELLY2, PETE LEFTWICK3 & NISHA DOGRA4 1
St Georges University of London, UK, 2Queen Mary University of London, UK, 3The University of Liverpool, UK, and University of Leicester, UK
4
Med Teach Downloaded from informahealthcare.com by Nyu Medical Center on 05/08/15 For personal use only.
Introduction Teaching ‘cultural diversity’ to medical students in the UK became a priority following the publication of Tomorrow’s Doctors (General Medical Council, [GMC] 1993). This was in the context of increasing recognition in the UK and North America of the need to acknowledge variation in patient needs related to their ethnic background and the influence that cultural perspectives have on health as well as increasing diversity within society and changing expectations of doctors (Dogra et al. 2010). Previously, medical schools included ethnicity more in the context of teaching about health inequalities rather than about how health practitioners, including doctors, could meet the needs of a diverse range of patients including those with different ethnicities (for example: University of Leicester 1993). Tomorrow’s Doctors (GMC 1993) contained the recommendations for undergraduate medical education issued by the Education Committee of the GMC. In developing their recommendations, the Education Committee concluded that the time for change had come and medical schools needed to ensure that future doctors treated patients from all backgrounds equitably (GMC 1993). In this commentary we critique each of the three iterations of Tomorrow’s Doctors (1993, 2003, 2009) with respect to diversity education and discuss how these documents may have both helped and hindered this. We conclude with some recommendations.
Tomorrow’s Doctors 1993 The publication of Tomorrow’s Doctors with the inclusion of the issue of ‘‘diversity’’ implies that the GMC viewed this as an important issue. In response to this, medical schools devised programmes to meet these needs (e.g. Conning et al. 2001; Dogra 2001). Tomorrow’s Doctors laid out a clear agenda for change. There was no emphasis on the value of diversity teaching which should augment the ‘‘basics’’ to enhance the skills of the practitioner in applying their knowledge to their individual patients. The challenges of meeting individual patient needs while also considering population needs appear not to have been noted.
Tomorrows’ Doctors (1993) appeared to have little conceptual clarity about how the intended diversity education was to be implemented in practice. Diversity was mentioned in various sections of the document but with little linkage. Laudable and well-intentioned statements were made about student attitudes and respect for patients and colleagues without prejudice. It is arguable that these broad overarching statements may have overwhelmed teachers and led to paralysis regarding diversity issues for some educators. Dogra & Williams (2006) reported that there was little evidence to suggest that Tomorrow’s Doctors influenced the development of diversity education at UK medical schools or that the GMC’s intentions were meaningfully implemented. The authors concluded that the GMC or other key medical educational policymakers needed to provide stronger leadership.
Tomorrow’s Doctors 2003 The next version of Tomorrows Doctors 2003 linked diversity issues in medical education to the clinical communication curriculum, but again there was little indication of how overarching themes such as ‘‘age, social, cultural or ethnic background’’ could be explored. While this version went beyond just considering ethnicity, the statement still limited the meaning of diversity and related it to group characteristics rather than recognizing that it could be applicable to every clinical encounter. Informal networks of diversity teachers found anecdotal evidence that at least in the UK, it seemed that areas that were easiest to define and least contentious were seized upon without considering diversity as a whole. This for example led to an emphasis on communicating with people with a hearing impairment, working with people with intellectual disabilities, and working with interpreters. We recognize that these are important areas but focusing on just these has led to a piecemeal approach to diversity issues rather than a holistic and strategic approach which can coherently ensure embedding of diversity issues across the curriculum. Additionally, writers such as Rivett (2003) argued that the 2003 version reinforced the ‘‘touchyfeely qualities’’ of the previous version. This raises the issue of
Correspondence: Margot A. Turner, Lecturer in Community Medical Education, Population, Health Sciences and Education, St Georges University of London, Cranmer Terrace, London SW17 ORE, UK. Tel: +208 725 5169; E-mail: [email protected] ISSN 0142-159X print/ISSN 1466-187X online/14/90743–3 ß 2014 Informa UK Ltd. DOI: 10.3109/0142159X.2014.909586
743
Med Teach Downloaded from informahealthcare.com by Nyu Medical Center on 05/08/15 For personal use only.
M. A. Turner et al.
whether or not the principles of Tomorrow’s Doctors were widely supported as a whole. Practical suggestions were made about visits students could make to interact with people from different backgrounds. While useful, it is naive to assume that simply by ‘‘meeting’’ people who may be different from you, will enable you to understand the complexity of some of the issues related to diversity. Such activities need to be contextualized and integral to learning objectives on diversity that could challenge attitudes and stereotypes. There is also the issue that the educational activities need to be assessable and be assessed. Such activities may also be viewed as ‘‘cultural immersion’’ which imply that learning about one ethnic family in depth somehow is a generalizable experience when encountering others from the same ethnic group (e.g. Loudon et al. 1999; Godkin & Weinreb 2001). There is evidence that many medical students struggle with uncertainty and if given some facts about specific groups will latch on to those rather than reflect on how they can explore patient perspectives instead of relying on their own assumptions (e.g. Dogra et al. 2007).
Tomorrow’s Doctors 2009 This version of Tomorrow’s Doctors appears not to have utilized the increasing evidence regarding the teaching of diversity. Although there was evidence that little, if any, progress was being made in the development of a diversity curriculum in medical education, Tomorrow’s Doctors 2009 did not add much to improve the situation. There was still a lack of guidance for medical schools on how to create a culturally sensitive curriculum, or how the GMC in their quality assurance role, would assess whether a medical school was successfully addressing diversity issues in their curriculum. The tick box approach to diversity still exists, with students being asked to respect seventeen diverse criteria that may impact on their interactions with colleagues and patients. There is no suggestion about how to teach this and highlights the need for an educational strategy to help both students and faculty to address and work on the impact of their attitudes. This implies that the GMC is mirroring wider societal positions without evaluating or critiquing them as they relate to medical education. Diversity needs to be taught and learned in a way that engages students and ensures that they are clear that recognizing diversity is not about being ‘‘politically correct’’ but about helping them to work collaboratively with their patients to attain the best clinical outcomes and experience of health care. It is arguable that the GMC itself is assuming a position of ‘‘political correctness’’ but not tackling the need to challenge some cultural values. (An obvious example is the issue of female genital mutilation. Here, the doctor must challenge the culturally held belief that this is acceptable, as by not doing so, they are not applying the same legal standards to these potential patients as they are to others.) There is also a greater focus on the equality agenda rather than the diversity agenda, perhaps because the former is superficially easier to measure. For example, the ethnicity of students entered to medical school is relatively straightforward to collect. It is more challenging to show that staff or students 744
demonstrate some of the attitudes mentioned in the document. We would argue that both the equality and diversity agendas are important and that there is some overlap. However, equality cannot be used as a proxy for diversity. It is also true that an organization that truly embraces the equality agenda will have robust policies and recognize the value of diversity across all its activities. Alongside Tomorrow’s Doctors 2009, the GMC published four supplementary advisory documents on assessment, clinical placements, developing and training teachers and patient and public involvement in undergraduate medical education (GMC 2011a, 2011b, 2011c, 2011d, respectively). In each of these documents, they mention the need to be aware of how aspects of diversity are relevant to the topic. Importantly, statements on diversity issues are embedded into two of these documents, modelling effectively that diversity needs to be considered in all aspects of medical education and that it is not a standalone topic. However, this is then not followed through. While some teaching examples are provided, there is little evidence that these are integrated across the curriculum. The diversity statement on staff training (GMC 2011c) shows a bias towards equality training, which is very much part of the Human Resources agenda and does not address diversity curriculum and teaching issues. While on line training is suggested, there is no comment on how the effectiveness of this or any other training in diversity will be assessed by the GMC. It is also unclear how the GMC will monitor if faculty have been effectively trained to teach diversity. The assessment guidance (GMC 2011a) does appear to consider diversity. There is little mention of the specifics of diversity in the delivery of curriculum sections but then almost out of the blue they write: Also (medical) schools should seriously consider including OSCE stations where cultural or linguistic differences are a major focus and equality and diversity training will be a core component of any assessor/examiner training programme. This statement suggests that there is a lack of clarity about diversity issues as it is difficult to generate OSCES on culture in isolation especially if diversity issues are not embedded in the curriculum or an integral part of all learning. There also appears to be confusion between diversity and equality issues in the way that the statement is written. The statement may relate to the GMC’s awareness of concerns identified through their regulatory role and complaints about doctors who lack an understanding of appropriate professional behaviour. There is also the interpretation that this recommendation ensures that examiners behave appropriately towards examination candidates and treat them fairly, irrespective of their backgrounds.
The way forward We understand it is not the role of the GMC to devise specific curricula but we would argue that in its quality assurance role it cannot disassociate itself from the lack of progress that has been made to date. Dogra et al. (2005) reported that 75% of UK
Med Teach Downloaded from informahealthcare.com by Nyu Medical Center on 05/08/15 For personal use only.
Tomorrow’s Doctors and diversity issues in medical education
medical schools stated that they undertook some diversity teaching, but that teaching was fragmented and there was uncertainty about content. Five years later disappointingly little had changed (Bentley et al. 2008; Dogra 2012). Unsurprisingly, the UK is not alone in struggling with these issues. The US and Canada have faced similar challenges (e.g. Dogra et al. 2010) as have many European countries (e.g. Seeleman et al. 2009; Knipper et al. 2010). The European Union has recently funded a project to consider how medical teachers across the curriculum can be trained to ensure that they integrate cultural diversity across the curriculum to better address the health care needs of diverse groups (AMC 2014). Given that diversity can be a potentially sensitive issue and that the UK including the GMC have been wrestling with how to progress these issues, we would suggest that the GMC needs to be leading this debate and giving guidance on more specific learning objectives. It should also support the training of staff on how to create and deliver material that will avoid reinforcing stereotypes. Only then can the quality assurance of diversity education and assessment be undertaken. To help universities and academics move forward, there appears to be an excellent opportunity for the GMC to produce evidence based supplementary advice on ‘‘Addressing diversity in the medical undergraduate curriculum’’. The GMC could engage more actively with teachers working in this area and with projects such as the one being managed by the AMC. It is important that the GMC is transparent in how they are evaluating effective diversity teaching if the situation is to change.
Notes on contributors MARGOT TURNER, MA, FHEA, is a Lecturer in Community Medical Education and lead on diversity issues in the curriculum at St George’s University of London. MOIRA KELLY, PhD, is a Senior Lecturer in Medical Sociology at Queen Mary University of London. PETE LEFTWICK, MBBS, is a General Practioner and University Community Clinical Teacher at the University of Liverpool. NISHA DOGRA, BM, DCH, FRPsych, MA, PhD, is a Professor of Psychiatry Education and Honorary Consultant in Child and Adolescent Psychiatry, University of Leicester.
Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article.
References AMC. 2014. Cultural competence in medical education. [Accessed 16 January 2014] Available from http://www.amc.nl/web/Research/Major-
projects-and-collaborations/Overview/Culturally-Competent-in-MedicalEducation/Culturally-Competent-in-Medical-Education/Project-C2ME.htm. Bentley P, Jovanovic A, Sharma P. 2008. Cultural diversity training for UK healthcare professionals: A comprehensive nationwide cross-sectional survey. Clin Med 8(5):493–497. Conning S, Hooper A, Turner M. 2001. Reports of new ideas in medical education: Educating tomorrow’s doctors for today’s world: Introducing a new diversity course for year 2 medical students in a communitybased setting. Med Educ 35(11):1071–1090. Dogra N. 2001. The development and evaluation of a programme to teach cultural diversity to medical undergraduate students. Med Educ 35(3):232–241. Dogra N. 2012. Cultural diversity teaching in the UK – update and ways forward. Learning in teaching medicine, dentistry and veterinary medicine. Spring 01.23:4–6. Dogra N, Conning S, Gill PS, Spencer J, Turner M. 2005. Teaching of cultural diversity in Medical schools in the United Kingdom and Republic of Ireland: Cross sectional questionnaire survey. Br Med J 19, 330(7488):403–404. Dogra N, Giordano J, France N. 2007. Cultural diversity teaching and issues of uncertainty: The findings of a qualitative study. BMC Med Educ 7:8. Dogra N, Reitmanova S, Carter-Pokras O. 2010. Teaching cultural diversity: Current status in U.K., U.S., and Canadian medical schools. J Gen Intern Med 25(Suppl 2):164–168. Dogra N, Williams R. 2006. Applying policy and evidence in developing cultural diversity teaching in undergraduate medical education in the UK. Evid Policy 2, 4:463–477. General Medical Council. 1993. Tomorrow’s Doctors. London: General Medical Council. General Medical Council. 2003. Tomorrow’s Doctors. London: General Medical Council. General Medical Council. 2009. Tomorrow’s Doctors. London: General Medical Council. General Medical Council. 2011a. Assessment in undergraduate medical education: Advice supplementary to Tomorrow’s Doctors (2009). London: General Medical Council. General Medical Council. 2011b. Clinical placements for medical students: Advice supplementary to Tomorrow’s Doctors (2009). London: General Medical Council. General Medical Council. 2011c. Developing teachers and trainers in undergraduate medical education: Advice supplementary to Tomorrow’s Doctors (2009). London: General Medical Council. General Medical Council. 2011d. Patient and public involvement in undergraduate medical education: Advice supplementary to Tomorrow’s Doctors (2009). London: General Medical Council. Godkin M, Weinreb L. 2001. A pathway on serving multicultural and underserved populations. Acad Med 76:513–514. Knipper M, Akinci S, Soydan N. 2010. Culture and healthcare in medical education: Migrants’ health and beyond. GMS Z Med Ausbild 27(3):Doc 4. Loudon RF, Anderson PM, Gill PS, Greenfield SM. 1999. Educating medical students for work in culturally diverse societies. J Am Med Assoc 282(9):875–880. Rivett G. 2003. Medical schools and medical education [online]. [Accessed 11 June 2003] Available from www.nhshistory.co.uk/ medical_eductaion_and_staffing.htm. Seeleman C, Suurmond J, Stronks K. 2009. Cultural competence: A conceptual framework for teaching and learning. Med Educ 43(3):229–237.
745
