Game jams to provide cultural safety training: bridging the health care gap in multicultural settings

Juan Pimentel MD MSc PhD(c)

Lack of cultural safety in health care is linked to stigma and discrimination towards culturally diverse patients. Health professionals without cultural safety skills do not usually recognize or address intercultural tensions in their daily professional practice.

The term cultural safety was described by Irihapeti Ramsden, a Māori nurse in New Zealand who developed the concept as a result of the increasing discontent of Māori people. Their discontent resulted from healthcare that was totally disconnected from their cultural background and traditional practices.

My doctoral project aims to foster cultural safety in Colombian medical education. Cultural safety training allows medical students to examine how their own culture shapes their clinical practice and to respect their patients’ worldviews. This type of education is relevant in multicultural Colombia, where more than 14% of the population belongs to a minority group and more than 40% of the population use traditional and cultural practices to maintain their health.

The key element of cultural safety is the concept of authority, meaning the people who receive the service define culturally safe care. In summer of 2017 and supported by the McGill Global Health Programs, I travelled to Colombia to co-design a curriculum for cultural safety training. Community leaders from the Sabana Centro region of Colombia, cultural safety experts, and last-year medical students participated in focus groups, interviews, and expert panels to define the learning goals and academic content of the curriculum.

My doctoral journey did not end there. We realized that the implementation of the co-designed curriculum involved several challenges. First, the new generation of medical students has strong relationships with technology and information, so our teaching intervention had to take this into consideration. Second, we do not know the most effective, evidence-based way to provide cultural safety training for health professionals. Third, cultural safety training is not only about merely transmitting knowledge; we needed to implement a transformative experience in which learners were able to change their behavior in professional practice. And finally, modern medical curricula are replete, which requires developing transformative interventions within a limited amount of time.

To try to address these challenges, we came up with the idea of using a game jam -an 8-hour collaborative workshop to co-design and play educational games- to train medical students in cultural safety. The reason why collaborative learning connects to cultural safety training is quite interesting. The first step in cultural safety training is to confront ethnocentrism. Mezirow’s transformative learning theory describes ethnocentrism as a habit of mind -a habitual way of thinking and acting-. The way to remodel habits of mind is through education that is collaborative, communicative, problem- and challenge-based. That is how my supervisors - Drs. Neil Andersson and Anne Cockcroft- and I came up with the hypothesis that transformative learning through co-designing educational games could be more effective than standard education for cultural safety training.

In July of 2019 and supported by the Norman Bethune Award for Global Health, I travelled again to Colombia to conduct a full-scale randomized controlled trial to assess the impact of medical students’ participation in a game jam, compared with a standard lesson on cultural safety. 641 students completed the baseline questionnaire and were randomized to the intervention and control arms. Around 400 students received the training, 200 students in each arm.

It was an extremely challenging task, but thanks to the support of the academic staff and students’ body at La Sabana University in Colombia, what was once only an idea is now coming to life. I will travel back to Colombia in January of 2020 to conduct the third and final assessment of the RCT. The medical students will also describe in their own words what the most significant change in their clinical practice was after receiving the training.

The future of cultural safety training is promising. The approach is more popular in New Zealand and Australia, but many universities in Canada – including McGill – have started exploring ways to integrate this training into their medical curricula. The Royal College of Physicians and Surgeons of Canada will soon require all medical residency programs to provide cultural safety training.

I believe Latin-American countries would greatly benefit from cultural safety training given that the region is extremely rich in terms of cultural diversity, and many traditions persist despite the dramatic consequences of colonization and cultural transition. My thesis is a first step towards more inclusive and culturally congruent health services.

About the author

Juan Pimentel is a public health physician with an MSc in Epidemiology. During his last year of medical school, he had the opportunity to immerse himself in the fascinating world of Colombian traditional medicine. Through this experience, he became aware of the consequences of the substantial gap existing between the communities’ needs and expectations, and the physicians’ knowledge and skills. His work as a lecturer and researcher in community health aims to close this gap by providing cultural safety training to medical students and interns in Colombia. He is now pursuing a Ph.D. in family medicine at McGill to foster cultural safety in research and clinical practice through game-based learning in medical education.