Medical residents' feedback on needs and acquired skills following a short course on cross-cultural competence

Objectives The purpose of this study is to assess short and long term changes in knowledge, attitudes, and skills among medical residents following a short course on cultural competency and to explore their perspectives on the experience. Methods Eighteen medical residents went through a short training programme comprised of two seminars lasting 30' and 60' respectively over two days. Three months later, we conducted three focus groups, with 17 residents to explore their thoughts, perspectives and feedback about the course. To measure changes over time, we carried out a quantitative sequential survey before the seminars, three days after, and three months later using the Multicultural Assessment Questionnaire. Results Residents expressed a wide variety of perspectives on the main themes related to the content of the training - culture, trialogue, stereotypes, status, epidemiology, history and geopolitics - and related to its organization - relevance, volume, timing, target audience, training tools, and working material. Using the MAQ, we observed a higher global performance score (n=16) at three days (median=38) compared to results before the training (median=33) revealing a median difference of 5.5 points (z=2.4, p=0.015). This difference was still present at three months (∆=4.5, z=2.4, p=0.018), mainly due to knowledge acquisition (∆=3) rather than attitudes (∆=0) or skills (∆=1). Conclusions Cross-cultural competence training not only brings awareness of multicultural issues but also helps participants understand their own cultures, perception of others and preconceived ideas. Physicians' education should however also focus on improving implementation of acquired knowledge in cross-cultural competence.

Cross-cultural clinical competence and post-graduate teaching: any impact(s) on doctors?

Context: Cross-cultural clinical competence (CCC) requires a mixtureof "knowledge" (K), "attitude" (A) and "skills" (S), in order to develop theability to give quality care to patients of different cultures. Theseattributes allow, while providing medical care, consideration of thepatient's medical, social, cultural and language needs. The LausanneUniversity Medical Policlinic (PMU) provides approximately 30000consultations per year to migrant patients and over the past five yearshas implemented a training course on CCC that focuses on trialogue,stereotypes and administrative procedures for the healthcare ofmigrants.Method: A quantitative survey of 18 new residents, was carried outusing a validated questionnaire, the "Multicultural AssessmentQuestionnaire" (the MAQ, 16 questions on K, A and S) to evaluate theimpact of CCC training. The questionnaire was distributed before theCCC course (J-1), three days after (J+3) and three months later (J+90).A descriptive univariate analysis of the difference in MAQ scoresbetween the times J-1 - J+3 and J-1 - J+90 was made. Three FocusGroups were conducted, at three months, to explore residents' thoughtsabout the course.Results: A significant increase was observed in global performancedeclared by residents. Following the intervention, the score of the MAQincreased from 31.4 points to 38.0 points at three days (p = 0.004) andto 37.7 points at three months (p = 0.003). This increase was mostnoticeable in the field of acquiring K: total score J-1: 118, J+3: 189,J+90: 190 (difference J-1 - J+3 and J-1 - J+90: p <0.005). There was nosignificant difference in acquiring A (J-1: 222, J+3: 228, J+90: 229), andS increases in a significant way at first (J-1: 222, J+3: 265, J-1 - J+3:p = 0.035), then comes back to the start value (J+90: 217). The residentswere interested by the course which they felt provides useful informationfor clinical practice. They had a great number of expectations in varyingfields (medical anthropology, cultural differences, epidemiology, etc.),hoping a "ready-made" solution for the approach of migrant patients.Conclusions: A unique training of CCC at the post-graduate level,upgraded K, and to a lesser extent A and S, for these 18 residents. Theywere interest and they had many expectations. Subsequent coursesshould consolidate these acquisitions. Future study should demonstratethe impact on patients' clinical outcome.

The Influence of Chronic and Situational Social Status on Stereotype Susceptibility

We tested whether stereotypical situations would affect low-status group members' performance more strongly than high-status group members'. Experiment 1 and 2 tested this hypothesis using gender as a proxy of chronic social status and a gender-neutral task thathas been randomly presented to favor boys (men superiority condition), favor girls (women superiority condition), or show no gender preference (control condition). Both experiments found that women's (Experiment 1) and girls' performance (Experiment 2) suffered more from the evoked stereotypes than did men's and boys' ones. This result was replicated in Experiment 3, indicating that short men (low-status group) were more affected compared to tallmen (high-status group). Additionally, men were more affected compared to women when they perceived height as a threat. Hence, individuals are more or less vulnerable to identity threats as a function of the chronic social status at play; enjoying a high status provides protection and endorsing a low one weakens individual performance in stereotypical situations.

Aspects de la représentation de l'autre dans les romans grecs et "Les Métamorphoses" d'Apulée

Les romans grecs et les Métamorphoses d'Apulée - même si les modalités sont différentes pour ce dernier - sont des fictions en prose qui fonctionnent autour de topoi auxquels la figure de l'Autre n'échappe pas. Bien que le monde grec soit alors radicalement différent de ce qu'il était au Ve siècle avant J.-C, période à laquelle l'identité grecque est construite par opposition à la figure du barbare, les romanciers qui prennent la plume à partir du 1er siècle avant notre ère utilisent un certain nombre de stéréotypes hérités de l'époque classique, alors mise à l'honneur par le mouvement de la Seconde Sophistique. Il s'agit d'étudier dans le détail certains éléments de la représentation de l'Autre pour déterminer qui il est, comment il se comporte, ce qui le constitue en Autre. Puis, à partir de cette esquisse, nécessairement incomplète, d'évaluer ce que cette représentation peut induire sur l'image de l'identité grecque à l'époque impériale, par le jeu de miroir que F. Hartog a décelé dans l'oeuvre d'Hérodote. Une première partie est consacrée aux rapports entre l'homme et l'animal ainsi qu'à l'image de la sauvagerie, ce qui permet d'explorer les bornes romanesques de l'humanité. La seconde partie s'attache à des éléments que l'époque classique a plus particulièrement mis en avant pour distinguer les Grecs des non-Grecs : le critère de la langue, l'art de faire la guerre et le discours politique qui est tenu sur les institutions barbares. La troisième partie étudie la place des dieux et des pratiques religieuses dans la définition de l'Autre. J'espère ainsi contribuer à la compréhension du genre romanesque et des représentations culturelles de l'empire « gréco-romain ». -- The Greek novels and The Metamorphoses of Apuleius, even if it is in different terms for the last, are prose fictions which are based on topoi, and the figure of the Other is one of them. Although the Greek world was radically different of what it was in the fifth century BC, time during which Greek identity is contructed as opposed to the figure of the barbaros, the authors of novels, who wrote from the first century BC onward, used some stereotypes inherited from classical period, which was celebrated by the Second Sophistic movement. The aim of this thesis is to study in detail some elements of the representation of the Other to determine who it is, how he behaves, what makes him other. Then, from this sketch, necessarily incomplete, to evaluate what this representation says about the image of Greek identity in the imperial age, according to the play of the mirror detected by F. Hartog in the text of Herodotus. The first part of the thesis is dedicated to the relationship between man and animal and to the image of savagery, in order to explore the novelistic limits of humanity. The second part concentrates on elements that classical period had particularly insisted on to promote the distinction between Greeks and non-Greeks : the linguistic criterion, the way to make war, and the politic discourse on the barbaric institutions. The third part study the place of the gods and of religious practices in the definition of the Other. I hope to contribute to the understanding of novel genre and of cultural representations of the « greco- roman- empire ».