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Reflective Practice Enriches Clerkship Students’ Cross-Cultural Experiences

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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.

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This project was supported by a grant from the National Institutes of Health (NIH), National Heart, Lung and Blood Institute, award# K07 HL079256-01 “An Integrative, Evidence-based Model of Cultural Competency Training in Latino Health across the Continuum of Medical Education” (2004–9) and from the Association of American Medical Colleges (AAMC) grant initiative “Enhancing Cultural Competence in Medical Schools” (2005–8) supported by the California Endowment. The contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH or AAMC. The authors gratefully acknowledge the invaluable contributions of Loretta Garcia and Jennifer Encinas for data collection and management, and the support of clerkship director David Morohashi, MD.

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Correspondence to Desiree Lie MD, MSED.

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Lie, D., Shapiro, J., Cohn, F. et al. Reflective Practice Enriches Clerkship Students’ Cross-Cultural Experiences. J GEN INTERN MED 25 (Suppl 2), 119–125 (2010).

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