Designing and implementing a cultural competence OSCE: lessons learned from interviews with medical students.

PURPOSE: Objective structured clinical examinations (OSCEs) use standardized patients (SPs) to teach and evaluate medical students' skills. Few studies describe using OSCEs for cultural competence education, now a Liaison Committee on Medical Education accreditation standard for medical schools. We designed an OSCE station emphasizing cross-cultural communication skills (ccOSCE) and interviewed students to better understand and improve upon this tool.
METHOD: Two investigators conducted semistructured interviews with 22 second-year Harvard medical students who completed the ccOSCE. Three investigators coded and analyzed the interview transcripts by using qualitative methods to explore students' perspectives on the station and its focus on cultural competence.
RESULTS: Themes that emerged pertinent to design and implementation of the station were grouped into four categories: learning goals, logistical issues, faculty feedback, and SPs. Students were positive about the overall experience. They appreciated the practical focus on nonadherence. Some found the learning goals complex, and others felt the format promoted stereotypes. Logistical issues included concerns about marginalizing cross-cultural care by creating a separate station. Faculty feedback was helpful when specific about sociocultural issues students did or did not explore well. Students found SPs realistic but inconsistent in how easily they revealed information.
CONCLUSION: Designing a ccOSCE experience is challenging but feasible. Students' perspectives highlight a tension between presenting cultural competence in a dedicated station (potentially marginalizing the topic and promoting stereotypes) and spreading it across stations (limiting opportunity for focused teaching). Learning goals should be clear, concise, and effectively communicated to faculty and SPs so their feedback can be standardized and specific.