Understanding what residents want and what residents need: the challenge of cultural training in pediatrics.

BACKGROUND: There is increasing recognition of the need for sophistication in the way culture is understood and taught in medicine.
METHOD: A two-phase study designed to understand how best to approach cultural training with pediatric residents was conducted. A needs assessment, consisting of resident and faculty focus groups, was carried out from which a workshop was developed for pediatric residents. The aims were to increase knowledge of local cultures and resources as well as to encourage self-reflection and awareness of cultural issues.
RESULTS: Focus group participants were consistent in identifying needs for training in: (1) a specific knowledge base of local cultural groups; (2) skills to better negotiate cultural encounters; (3) reconciling general cultural knowledge with an understanding of individual patient/family beliefs and practices. Analysis of focus group and workshop data suggests that culture is seen as both an obstacle and challenge. Cultural training in medicine uncovers a clash of epistemologies: the promotion of culturally-centered medicine is 'strange' to learners situated within a pedagogical tradition based on a 'familiar' reductionistic view of health.
CONCLUSION: Reconciling these divergent epistemologies requires a paradigm shift in how medicine understands culture and cultural training. These findings raise questions for consideration in other residency programs.