Journal of General Internal Medicine

, Volume 25, Supplement 2, pp 119–125

Reflective Practice Enriches Clerkship Students’ Cross-Cultural Experiences

  • Desiree Lie
  • Johanna Shapiro
  • Felicia Cohn
  • Wadie Najm
Innovations in Education

DOI: 10.1007/s11606-009-1205-4

Cite this article as:
Lie, D., Shapiro, J., Cohn, F. et al. J GEN INTERN MED (2010) 25(Suppl 2): 119. doi:10.1007/s11606-009-1205-4



To describe a curriculum incorporating written reflection followed by reflective discussion with the goal of enhancing students’ recognition and handling of cross-cultural and health disparity issues in different healthcare delivery settings.


This required curriculum was implemented within a 4-week family medicine clerkship (n = 188 students, 6 to 12 per rotation) in 23 successive rotations over 2 years. Electronic submission of a written assignment in response to structured questions was followed by in-class discussion in week 4.


Outcomes were students’ session evaluations, thematic analysis of student responses, and analysis of faculty facilitators’ reflections about discussion sessions. Students’ cultural knowledge about their patients’ health beliefs around diabetes was assessed using multiple choice questions at the beginning and end of the clerkship.


One hundred percent of students submitted narratives. Student evaluations demonstrated high acceptance, appreciation of sessions and faculty. Analyses of written assignments and in-class discussions identified recurring themes. Students achieved greater synthesis and more nuanced understanding of cross-cultural encounters after discussion. Self-rating of confidence in addressing cultural issues after the curriculum was high at 3.17 ± SD 0.57 (1–4). Cultural knowledge scores improved significantly. Core components for success were clerkship director support, required participation, experienced faculty facilitators without evaluative roles, a structured assignment and formal forum for trigger question discussion


Written reflection followed by facilitated peer discussion adds value to simple ‘exposure’ to cross-cultural clinical experiences for medical students.


reflection cross-cultural RP curriculum 

Copyright information

© Society of General Internal Medicine 2009

Authors and Affiliations

  • Desiree Lie
    • 1
  • Johanna Shapiro
    • 1
  • Felicia Cohn
    • 2
  • Wadie Najm
    • 1
  1. 1.UCI - Department of Family MedicineUniversity of California, Irvine, School of MedicineOrangeUSA
  2. 2.UCI - Department of Internal MedicineUniversity of California, Irvine, School of MedicineOrangeUSA

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