Cultural sensitivity – a prescription for medical students
by Elizabeth Willoughby
A Nigerian walks into a German doctor's office. The doctor looks at him and says, "How can I help you?" The Nigerian says, "Entschuldigung Sie bitte?" Not the start of a joke, this is an example of cultural stereotyping missteps played out in examining rooms everyday. IMECU has a solution.
Intercultural doctor-patient contact is increasing across the globe in step with emigration patterns. Ethnic sensitivity training for doctors, however, has not developed in unison, relegating the learning of when cultural stereotyping is good and when it's bad to mistakes made on-the-job.
Born in Germany to an Iranian father and Italian mother, third-year medical student Neda Ghotbi says, "Coming from a multicultural background, you think you know how to interact with people from different countries, but I'm surprised how much prejudice there is."
When PROFIN, the program of the German Academic Exchange Office to promote integration of foreign students, called for proposals in 2009, LMU's Prof. Dr. Matthias Siebeck asked Fabian Jacobs to outline an examination of perspectives to broaden medical student sensibilities. PROFIN accepted Jacob's tender for funding, allowing him and fellow project manager Barbara Habermann to create IMECU, the "International Medical Culture" program at LMU.
Considering medical students' study load, Jacobs and Habermann split the voluntary course into three parts. Module one, lasting one semester, is the most time intensive, but at only 10% theory and 90% participatory is a welcome break from lecture. Every other week during a two-hour seminar and two six-hour Saturday sessions, 20 foreign and German students meet to discuss and role play, drawing upon each other's cultural expertise.
It's through role play that most eureka moments occur; like that a German doctor could small talk with her patient, maybe about how he is enjoying his stay in this foreign city, before she tells him he has prostate cancer. And she should not take it personally when the Saudi Arabian insists that she send in a more experienced male doctor to talk to him.
Besides immigrant patients, the number of doctors practicing in foreign lands is growing as well. According to a 2009 survey by the Robert Koch Institute, 12% of doctors practicing in Germany are not from Germany, adding another layer to the intercultural dynamic. The IMECU program addresses each perspective in turn, from that of international students and doctors in German settings to German students and doctors in foreign ones.
Listening to first hand experiences of a physician from Doctors Without Borders setting up a camp in Africa and the challenges his team faced, from determining the hospital structure to whether they would accept patients from outside the camp, becomes particularly meaningful once students are divided into groups and tasked with planning their own fictional camps in Uganda.
The other two legs of the course are without a schedule. To complete module two, a student must design his own event to address difficulties experienced by foreigners, and in module three integrate it into a future module one. It's an astute way to keep IMECU's content current and crucial.
Designs on the future
Although students completing all three modules will receive a certificate outlining what they've covered, they will not receive a credit for it. Nevertheless, student response to the program has been overwhelmingly positive.
"The original plan was to offer the course every other semester," says Habermann, "but then we received e-mails from more students to join the program, so we decided to offer it every term, and it's full. That's pretty good feedback. They are here because they want to be here and they take part actively."
Brazilian LMU medical student Tassia Lau Zinser was shocked by her treatment as a patient in Munich until she realized the issues were her own misunderstandings. She thinks other universities should take a cue from IMECU's course. Ghotbi agrees: "This program shines a light on topics that you wouldn't think about otherwise. You get real advice here, things that you will need professionally. It's not only something that is interesting, but a necessary and valuable program."
Jacobs is even more hopeful. In future, he'd like to see IMECU's topics become part of LMU's medical curriculum.