Mini-ethnography for medical students. Inquiry-based learning to foster transcultural competences

BACKGROUND: Transcultural competences are important for health professionals in plural societies. But if ‘culture’ is addressed in medical curricula, the underlying concepts are often not up to date with constructivist approaches of social sciences. Instead of teaching multiple definitions and complex theory, medical students can be familiarized with the perspective of these sciences through a methodologically structured exposure. OBJECTIVES: An ethnographic field exercise was included in a clinical elective on refugee health care for medical students at a German university between 2016 and 2023. An anthropologist introduced the scientific perspective as well as participant-observation as qualitative method. Evaluations after introducing the task were analysed and a qualitative content analysis after completion was done to discern if learning goals were reached. RESULTS: 130 students participated in the ethnographic exercise. Perceived relevancy for medical education varied (4-p; M = 2,6; SD = 0,7; n = 81); 47% of students regarded written reflection as enhancing competencies (5-p; M = 3,3; SD = 1,2; n = 107). Many considered the exercise as demanding, but interesting. The field protocols show it sharpened perception, ‘culture’ became one of many factors impacting on interactions. Learning to separate description from interpretation, students were able to reflect on own thoughts, evaluations, stereotypes and emotions. Awareness of context-dependency and structural embeddedness of medical encounters, critical assessment of power-dynamics, political issues, service quality and professional ethics in a resource constrained setting were fostered. CONCLUSIONS: An anthropological approach and self-experience as participant observer can provide medical students with the opportunity to cultivate situational awareness and a holistic, multi-layered, structurally sensitive perception that may be more helpful in dealing with the challenges of diversity than presumed knowledge about ‘cultures'. KEY MESSAGES: • Ethnographic exercises linked with exposure to refugee settings help to foster transcultural and structural competences of medical students without the need for an extensive study of culture theory. • Essentialist culture concepts within medical education can be countered by short theoretical updates and inquiry-based learning within contexts characterised by diversity and exclusion.