Cross-cultural care in medical education: Students’ perceptions, challenges, and the path forward

Cross-cultural care competence (CCC) is vital for patient-centered care and reducing health disparities. This study explored medical trainees' perceptions of CCC education, highlighting gaps, attitudes, preparedness, skills, and challenges in curriculum integration. Extending from a more extensive, mixed methods study that assessed Taiwanese medical students' preparedness for diverse patient groups, we invited 89 medical trainees across different training years from two medical schools to participate in 19 in-depth interviews and 14 focus groups, respectively. We conducted a deductive thematic analysis to collate codes into sub-themes and themes. Ten sub-themes that were categorized into three main themes, including (1) attitudes and awareness of CCC: knowledge, attitude toward different health beliefs, biases, and stereotypes; (2) preparedness for diverse groups, including LGBT, Indigenous, immigrant, alternative medicine users, and those with language barriers; and (3) perceptions of CCC educational environment: exposure and experiential learning, and suggestions for improvement. Trainees valued learning about diverse groups and health beliefs, but still aimed to treat all patients equally, sometimes relying on stereotypes as memory aids for disease associations. Concerns included biased teaching and role-modeling that may reinforce stereotypes. While most struggled to recall explicit CCC training, they agreed it deserved more attention despite a packed curriculum. Trainees favored integrating CCC into general education, valuing experiential learning and community engagement, though they found clinical training provided more opportunities to develop the skills. Our study amplifies medical trainees' voices and provides insights into their attitudes, preparedness, and CCC learning environment in an increasingly diverse society. The findings highlight the need to develop structural competence and implement targeted interventions in faculty development, as well as to design explicit, implicit, and longitudinal CCC curricula.