with similar symptoms but different cultural back- grounds and thereby to identify personal bias. Correspondence: Paula T Ross, MA, Department of Health Behavior and Health Education, 3858 School of Public Health 1, 1415 Washington Heights, Ann Arbor, Michigan 49109, USA. Tel: 00 1 734 615 2819; Fax: 00 1 615 763 7379; E-mail: paulat@umich.edu doi: 10.1111/j.1365-2923.2010.03638.x Responding to the challenges of teaching cultural competency Paritosh Kaul & Gretchen Guiton Context and setting This study evaluates the effec- tiveness of a 2.5-hour introductory session on culture, health and illness delivered to Year 1 medical students. It examines the effectiveness of this session on students’ attitudes and compares it with that of prior efforts. The primary goal was to introduce the notion of culture and explore the interaction of cultures in a medical encounter. The session attempted to help students understand that both the patient and the doctor have a culture. A second objective was to provide a tool to help students to explore medically relevant aspects of a patient’s culture. Why the idea was necessary The need to include cultural competency education throughout medical school is widely accepted. However, introducing this topic in the context of the basic science curriculum presents many challenges. Student apathy and resis- tance are primary challenges that are gaining wider acknowledgement. This session attempted to over- come such resistance through student leadership and a focus on the clinical encounter. What was done During an interactive session in the Foundations of Doctoring course, upper-level students and a clinician jointly introduced the notion of culture to 156 Year 1 students (in groups of 50+). Each group then viewed a video of a medical situation involving culture and discussed their impressions of the doctor and family portrayed. The students were encouraged to reflect on the situation, the family’s culture, the medical culture and the interactions between the two cultures. Under the upper-level students’ leadership, group members then explored their own individual culture with a peer using structured dyads. Finally, the clinician and an upper-level student demonstrated the use of anthropologically oriented interviewing techniques in a role-play of a medical interview which the students then practised with their peers. Students completed the 15-item Health Beliefs Attitude Survey before and after participating in the session. A paired t-test was conducted for each attitudinal factor documented in the literature: whether the doctor should elicit a patient’s perspec- tive, and whether knowing the patient’s perspective affects the quality of care the doctor provides. Evaluation of results and impact Students’ attitudes increased significantly (P = 0.001) on both factors resulting in large (d = 0.66) and moderate (d = 0.44) effect sizes for care and elicit, respectively. These results are remarkable when compared with those of prior studies with medical students in which attitudes declined or increased only on care. Asked to evaluate whether the session ‘advanced my under- standing of the impact of culture on communication issues’, students rated the session significantly more highly than in the previous prior year (t = 3.4385, P £ 0.0007). We felt that the utilisation of upper-level students along with clinicians as instructors and the provision of opportunities to relate to culture personally and in a medical situation and to practise skills to address culture appeared to reduce resistance and improve students’ attitudes towards addressing cross-cultural communication in medicine. Correspondence: Paritosh Kaul, MD, Director of Culturally Effective Medicine, University of Colorado, Undergraduate Medical Education, 13001 East 17th Place, Building 500, Box F523, Aurora, Colorado 80045, USA. Tel: 00 1 720 724 7740; Fax: 00 1 720 724 7743; E-mail: Paritosh.kaul@ucdenver.edu doi: 10.1111/j.1365-2923.2010.03691.x Actors’ personal stories in case-based multicultural medical education Arno K Kumagai, Mehreen Kakwan, Soud Sediqe & Monica M DiMagno Context and setting Case studies are often used in medical education to provide a health care-related context in which to discuss diversity and social justice. However, there are obstacles to this approach, including the stigmatisation of psychosocial and multicultural concerns, the treatment of ‘culture’ as static and limited to minority groups, and the use of ‘cultural characteristics’ which reinforce existing stereotypes and deprive members of marginalised groups of individuality and autonomy. 506 ª Blackwell Publishing Ltd 2010. MEDICAL EDUCATION 2010; 44: 489–526 really good stuff