A Study of Online Discussion as Instructional Method for Teaching Health Literacy and Cultural Humility to Health Professions Students

This educational research examines online discussion as an instructional method for teaching health literacy and cultural humility to health professions students. The ＂Working Across Cultures＂ lesson applies a cultural humility framework that encourages student discussions of implicit bias, which impacts provider-patient relationships and overall health outcome. Student achievement was compared across teaching platforms: asynchronous online, synchronous online, and in-person. Discussion transcript content were analyzed using inductive open coding. The goal of this study is to positively impact the quality of healthcare for increasingly diverse communities. Health literacy and cultural humility knowledge and skills are priority learning objectives for preparing health professions students to work across cultures and languages. Educational research shows discussion, as a teaching method, results in changes in attitudes and knowledge related to cultural competence. Little is known, however, about online discussion as a teaching method for achieving cultural competence and humility among health professions students. Two basic types of online discussion are commonly available when teaching with technology, synchronous and asynchronous. Asynchronous online discussion is generally facilitated using e-mail and discussion boards. A key benefit of online learning is the flexibility asynchronous interactions present. Students may also spend more time on their contributions. Synchronous discussion is often supported using video conferencing. Learners and teachers interact in real time, similar with traditional classroom setup. Both platforms were used to teach ＂Working Across Cultures＂, one of seven lessons taught as part of the Seminar in Health Literacy at Tufts University School of Medicine and is the educational context of this study. Upon completing the lesson, students were expected to: 1) recognize culture, language and health literacy as interrelated factors influencing health communication; 2) identify systems changes to promote health literate, culturally competent health organizations; and 3) practice self-reflection to check implicit bias in public health and healthcare. To complete the content analysis, the research team identified emergent themes on types and topics of discussion from transcripts using an iterative review process. Topics of discussion identified include Culture of Medicine, Empathy, Power, Systems Change, and Trust. Types of discussion codes include Self-reflection and Personal Stories. This research showed that health literacy and cultural humility are essential topics in training healthcare professions students. In today's increasingly diverse communities, soon-to-be professionals and patients will both benefit from the early exposure and open discussion of these difficult topics. Available learning opportunities online will be most effective through purposeful facilitation of these discussions.