Cultural Safety in Medical Education: Notes from Multicultural Colombia

by Juan Pimentel, MD MSc

My PhD project is rooted in a larger community-based research experience that started 30 years ago in Colombia. Following an unexpected encounter between an indigenous traditional healer and a Western family doctor, a group of researchers and professionals from various fields began a respectful approach to traditional medicine. During three decades of work, the Center for Intercultural Medical Studies (CEMI, a Colombian NGO), has sought articulations between Western and traditional medicine in Colombia and Latin America.

During my final year of medical school (2011), I had the opportunity to get involved with CEMI, thus immersing myself in the fascinating world of Colombian traditional medicine. I worked as a volunteer in six projects aimed at strengthening traditional medicine. I visited rural municipalities isolated by the Colombian Civil War and had the opportunity to enter in dialogue with, and learn from, authentic traditional medicine users and providers.

As a result, I discovered a coherent and delicate system of knowledge and practice aimed at promoting health, as well as preventing, diagnosing, and treating disease, especially among minorities, such as indigenous populations, Afro-Colombians, and peasants practicing these ancient bodies of knowledge to maintain their health.

Moreover, I became aware of the substantial gap that exists between the communities’ needs and expectations, which demand traditional medicine, and the physicians’ knowledge and skills, which are deeply based on the Western biomedical model. I understood that these differences between physicians and patients lead to discrimination and social exclusion, thus promoting health disparities in multicultural settings. Just to give an idea of this gap, the World Health Organization estimates that more than 40% of Colombians still use traditional medicine. In some countries of Africa, this figure can be as high as 90% [1].

Motivated by this discovery, I wanted to explore research-based strategies to address this problem. In 2013, I was offered a professorship in community health at La Sabana University, my alma mater. I was interested in developing an exploratory, community-based teaching intervention involving cultural safety in medical education. Cultural safety is a type of medical training that enables medical students to properly work in multicultural settings and requires that the patient’s way of knowing and being is valid.

I organized small, student-driven participatory research projects lasting six months each. The projects were co-designed by traditional medicine users, senior medical students, and community health experts. They were aimed at strengthening traditional medicine knowledge and resources in rural municipalities in Colombia. The experience lasted two years, involved 25 senior medical students, and benefited around 500 traditional medicine users. This fuelled my interest in the cultural safety approach and, upon my supervisor’s request (Dr. Neil Andersson), led to my pursuit of a PhD degree at McGill University. I started the program in Fall 2016.

The feedback and ideas provided by my supervisor and thesis committee took my project to another level. Cultural safety is not necessarily enjoyable to learn for medical students. The strong biomedical mindset they have usually hinders the training in less hospital-centered areas of medicine. In light of this challenge, I am currently interested in implementing game-based learning as a methodology for cultural safety training.

In summer 2017, thanks to the Norman Bethune Award for Global Health, I visited Colombia to conduct fieldwork. The task was to engage stakeholders in co-designing a curriculum on cultural safety training in medical education. Using focus groups, I explored what traditional medicine users would like that medical students knew and respect about Colombian traditional medicine. In a second focus group exercise, I explored what medical students would like to learn about traditional medicine, so that they can provide a culturally safe clinical practice. Based on these results, key cultural safety experts from Colombia participated in an expert panel to decide on the learning goals and academic content of the curriculum. The co-designed curriculum will inform the game learning process in subsequent phases of the project.

The project continues, and the research team now comprises ten traditional medicine users, seven young physicians (former medical students that participated in the project between 2013 and 2016), and eight cultural safety experts from Colombia and Canada. Little by little, this research is contributing to addressing both knowledge and action gaps with the participation of those affected by the problem.

I believe that human beings should have the capacity to chart their own courses and to choose the practices that best reflect their common values and culture. Our societies should seek ways to protect, accept, and celebrate the legitimacy of difference and diversity in human behaviour and social structure, instead of condemning and censuring it. This perspective requires involving peoples’ voices in the health decisions that implicate them.

I thank the Global Health Programs at McGill University for having supported my research project. I strongly believe that the results of my project will have implications for Canada and the global health community.

Juan Pimentel is a Colombian physician and epidemiologist. Currently, he is an assistant professor in family medicine and community health at La Sabana University, a researcher at the Research Group on Traditional Health Systems (El Rosario University, Colombia), and the head of Intercultural Medical Education at the Center for Intercultural Medical Studies (Colombian NGO). He is now pursuing a Ph.D. in Family Medicine to foster cultural safety in research and clinical practice through game-based learning in medical education.

Contact: juan.pimentel@mail.mcgill.ca

References

[1] World Health Organization. WHO Traditional Medicine Strategy 2002–2005. Geneva, Switzerland; 2002.