Background: International medical graduates (IMGs) are vital members of the United States (US) healthcare landscape, making up 24.7% of physicians nationally.[1] Despite this, IMGs face numerous challenges in matching and transitioning to US residencies. One hurdle is adapting to the Western value of relationship-centered care (RCC), which emphasizes patient autonomy, shared decision-making, and interpersonal communication skills.[2-3]
Purpose: We created an innovative curriculum on RCC and implemented it as part of a 5-day seminar series at an international medical school in Istanbul, Türkiye. Learning objectives included valuing effective communication as important to patient outcomes, discussing common barriers to effective communication and demonstrating RCC by exploring patients’ perspectives. We describe the development and implementation of this curriculum.
Description: The 3-hour workshop was rooted in Constructivism. Constructivism espouses learning occurs when an individual actively creates their understanding through the lens of their lived experience rather than passively acquiring another’s perspective. It is an important theory for US-trained medical educators to use in creating IMG curricula to bridge cultural differences and avoid projecting Western cultural supremacy. Interactive small group exercises situated in Kolb’s experiential learning cycle were used over formal didactics to promote collaboration.To develop the construct of RCC, learners first created a relational map with the patient placed at the center of the actors involved in their care (ie. nurse, custodian, phlebotomy).[4] Through small and large group discussions, learners added more actors, connected actors via communication channels, and evaluated each channel’s directionality and strength. This led to discussions on what contributes and detracts from relationships in healthcare, culminating in self-reflection on how their individually constructed definitions of relationship-centered care differed from that of Beach and Inui.[3]The other section of the workshop practiced RCC via peer-roleplay. Peer role-play in medical education usually involves multiple improvised clinical encounters in which learners move between the roles of physician and patient. It has been shown to be more effective at improving trainees’ empathy by improving their understanding of patients’ perspectives. In small groups learners role-played an outpatient encounter, focusing on setting an agenda and exploring the patient’s perception of their illness followed by peer feedback and large group debrief.The session was attended by approximately 40 students from multiple countries and four faculty.
Conclusions: This innovative curriculum contributes to the ongoing conversation on how best to prepare IMGs to adapt to US residencies. For interpersonal skills training, constructivism is an important tool to avoid ethnocentrism. The positive reception and engaging discussions by faculty and learners during the curriculum underscore how cultural differences were successfully bridged. Further research should focus on outcomes of such interventions to ensure that IMGs are well-prepared for US-based residency training.