The need for cultural competence in the training for health professionals has been recognised for decades but remains poorly implemented. Covid brought into sharp relief disproportionate negative health outcomes for people of colour in the UK. As data capture has improved and with greater transparency in reporting, we are beginning to see the true extent of health disparities long suspected across all fields of health. Communication is critical to better patient outcomes. Better understanding and responding to patient needs can create greater rapport and positive relationships between patients and practitioners and begin the improvement to disparities in access and treatment.

Simulated patient sessions are a core part of health professional training and rely on actors playing the role of a patient in a prepared scenario. There is little official guidance on these scenarios, and many institutions create their own. These have the potential to be problematic and reinforce stereotypes.  This study will be the first step on a journey to coproducing a culturally competent teaching resource that reflects patient experiences and needs with materials from a range of communities, facilitation guide, and example videos.

What will the project involve? 

This study will bring together a multidisciplinary team of community members, community workers, academics, and dental and medical clinicians, to address this gap by coproducing new materials that can be used in the teaching and post-qualification training of health professionals to improve the experience for all. The aim is to improve the cultural competence of health professionals through coproducing a set of culturally appropriate scenarios that can be used in training and teaching settings.

The researchers intend to:

• Coproduce scenarios with the Bangladeshi community drawing on lived experience of health concerns and attending health services through storytelling workshops.
• Ensure (through the expertise of the academic and health professionals) the scenarios meet the learning outcomes of professional curriculums.
• Produce a resource that can be used by health educators.

The project will use creative approaches which are more inclusive than traditional research methods.  Storytelling is common across all cultures and by foregrounding the stories of community members rather than approaching individuals with a questionnaire, or asking them to participate in an interview, the researchers aim to move away from dominant colonial forms of knowledge making. They will be working with the Bangladeshi community, a significant and well-established minority community in Bristol, to create ‘counterstories’ which amplify the stories, narratives, and experiences of marginalised groups. They will coproduce scenarios that reflect lived experience and the community worker and challenge dominant stereotypes. Through a series of three workshops, they aim to coproduce a teaching resource, and then hold a fourth session to collect feedback on the final resource.

The researchers plan to hold the following workshops:

• First workshop – introductions and storytelling of lived experience of health services.
• Second workshop – compose draft scenarios collaboratively.
• Third workshop – tweak and finalise scenarios – at least two – one medical and one dental.
• Fourth workshop – presentation of the final scenario and the opportunity for community feedback.

The research team will also conduct a storytelling workshop with the Somali Community so that they can collect their experiences of health services. They do not have the time to deliver the full programme of four workshops with the Somali community during this phase of the research, but they will seek further funds to deliver this work, and use the learning from their work with the Bangladeshi community to refine the process.

Who are the team and what do they bring?

• Nilu Ahmed (Dental School, University of Bristol) is a Chartered Psychologist and Senior Lecturer in Social Sciences at the University of Bristol leading on Clinical Communication Skills. Her work is rooted in an intersectional and antiracist framework and she has a background in community work and coproduction.
• Christina Worle (Dental School, University of Bristol) is a Clinical Lecturer in Restorative Dentistry at Bristol Dental School. She is passionate about inclusive dental care and the vital role that communication plays in this. She has a background in providing primary care dentistry to disadvantaged groups in the community and will bring the clinical expertise to the scenarios and will attend the workshops.
• Huzaifa Adamali (Medical Consultant, Southmead Hospital) is a Respiratory Consultant. He worked extensively during COVID to engage communities and improve uptake of the vaccination during the pandemic. He is member of the Bristol City Council COVID19 Local Engagement Board and North Bristol Trust BAME Network Support lead.
• Shahnaz Chowdhury (Health Links) is a member of NHS Health Links working with the Bengali and Sylheti speaking community. Her role is to facilitate access to health services to those who may have difficulties or feel restricted due to cultural and language barriers.
• Fiona Spence (Equalities and Community Development Manager, Sirona)

What is to come?

The researchers intend to produce 4 short scenarios to be used in training and teaching with educational films. These will be divided into two medical and two dental training scenarios. They also hope to produce filmed scenarios using actors and community members.

The project hopes to produce at least two videos, one medical and one dental, ideally with members of the community as patients (if they are happy to do so) and their student researchers as the health professionals.

Dr Ahmed is in a key position as Clinical Communication Skills Lead for the Dental Curriculum to implement these scenarios into the School’s teaching for further evaluation and feedback from students, actors, and colleagues. The medical scenario can be adapted for medical skills communication teaching in the Dental School and also shared with the Medical School. Ethical approval will be sought separately for undertaking this pedagogical research. The researchers will then have evidence-based coproduced teaching materials that can be published in educational journals and made available to other teaching and training institutions.

Based on the learning from this study, the researchers will seek further funding to:

Collect scenarios from other communities: The researchers intend to apply the learning from this study to continue working with the Somali community and expand to other groups including working with Haven for refugee communities.

Develop a facilitation guide: The team believe it is imperative they do not perpetuate stereotypes or create a lack of safety for minoritised students or staff, and that those delivering the training are confident in delivering these sessions. To this end, as part of this work, they will develop guidance on working with minoritised actors, how to manage if you don’t have any non-white actors, creating safe spaces, managing bias, and handling conflict.

Film further videos: they hope to coproduce videos with the communities to illustrate examples of the scenarios in action. They will use the videos to film examples of good practice and bad practice. These are to be filmed either at a health location or at Dental School/Practice if community agree. If possible the team would like the patients to be played by members of the community, however if this is not preferable to the community Dr Ahmed has connections with actors in the community.