Competency-Based Cultural Safety Training in Medical Education at La Sabana University, Colombia: A Roadmap of Curricular Modernization.

Issue: Cultural safety enhances equitable communication between health care providers and cultural groups. Most documented cultural safety training initiatives focus on Indigenous populations from high-income countries, and nursing students, with little research activity reported from low- and middle-income countries. Several cultural safety training initiatives have been described, but a modern competency-based cultural safety curriculum is needed. Evidence: In this article, we present the Competency-Based Education and Entrustable Professional Activities frameworks of the Faculty of Medicine at La Sabana University in Colombia, and illustrate how this informed modernization of medical education. We describe our co-designed cultural safety training learning objectives and summarize how we explored its impact on medical education through mixed-methods research. Finally, we propose five cultural safety intended learning outcomes adapted to the updated curriculum, which is based on the Competency-Based Education model. Implications: This article presents five cultural safety intended learning outcomes for undergraduate medical education. These learning outcomes are based on Competency-Based Education and the Entrustable Professional Activities framework and can be used by faculties of medicine interested in including the cultural safety approach in their curriculum.

What facilitates or prevents academic fraud in a Colombian faculty of medicine-Protocol of a study using fuzzy cognitive mapping.

INTRODUCTION: Academic fraud is any behavior that gives a student an undeserved advantage over another student. Few studies have explored the causes of and possible solutions to academic fraud in Latin America. We aim to map the knowledge of stakeholders in a Colombian faculty of medicine about the factors that facilitate and prevent academic fraud. METHODS: Fuzzy cognitive mapping. We will use the approach proposed by Andersson and Silver to generate fuzzy cognitive maps representing stakeholder knowledge. This process consists of ten steps: (1) definition of the research question; (2) identification of participants; (3) generation of ideas; (4) rationalization of ideas; (5) organization and connection of ideas; (6) weighing; (7) pattern grouping; (8) list of links and digitization; (9) combination of maps and network analysis; and (10) deliberative dialogue. To draw the maps, we will invite medical students, interns, resident physicians, master's students, and professors in the faculty of medicine. Four medical students will receive training to facilitate the sessions. Participants will identify the factors contributing to academic fraud and their causal relationships. We will use a combination of network analysis and graph theory to identify the chains of factors with greatest influence on academic fraud. CONCLUSION: The maps will serve to discuss strategies to reduce academic fraud in the Faculty of Medicine and to identify factors that could be addressed in other contexts with similar problems. This research will allow the students who facilitate mapping sessions to learn about research techniques, fuzzy cognitive mapping and academic fraud. Study registration: Registered in OSF Registries on August 2nd, 2022. Registration number: osf.io/v4amz.

Educational games created by medical students in a cultural safety training game jam: a qualitative descriptive study.

BACKGROUND: Cultural safety training, whereby health professionals learn to reflect on their own culture and to respect the cultural identity of patients, could address intercultural tensions in health care. Given the context of their medical education, however, medical students might perceive such training to be dull or even unnecessary. Game jams, collaborative workshops to create and play games, are a potentially engaging learning environment for medical students today. How medical students learn while making games is poorly documented. This study describes the characteristics of educational games created by participants in a cultural safety game jam and the concepts they used to create games. METHODS: As part of a trial, 268 Colombian medical students divided into 48 groups participated in an eight-hour game jam to create a prototype of an educational game on cultural safety. In this qualitative descriptive study, we reviewed the description of the games uploaded by participants, including the name, objective, game narrative, rules, rewards, penalties, and pictures. An inductive thematic analysis collated their descriptions. RESULTS: The game descriptions illustrated the characteristics of the educational games and the aspects of the cultural safety concept that the students used to create games. Medical students situated cultural safety within a continuum with culturally unsafe actions at one end and cultural safety at the other end. Although not familiar with game design, the students designed prototypes of basic educational games including game dynamics, game scenarios, learning objectives, and pedagogical strategies. CONCLUSION: The findings of this study could help researchers and educators to understand how medical students learn from game design and the kind of games that game jam participants can create without previous game design skills.

Overview of traditional medicine in the Muisca Reserve of Cota, Colombia: A cross-sectional study. / Panorama de la medicina tradicional en el Resguardo Muisca de Cota, Colombia: estudio transversal.

Introduction: The Muisca Indigenous people in Cota, Colombia, has committed to reviving and strengthening their traditional culture, including the ancestral knowledge associated with their traditional medicine. Objective: To explore the occurrence of traditional medicine and factors associated with its use among the Muisca people in Cota, Colombia. Methods: A participatory cross-sectional study applied a questionnaire to 471 Muisca mothers who had at least one child over 10 in April 2019. The 44 questions inquired demographic, social, and cultural factors of participants and their knowledge, use and practice of traditional medicine. We used the Mantel-Haenszel procedure to measure the associations using Odds Ratio and 95% confidence intervals. Results: 66.2% (312/471) of the mothers knew at least three cases of traditional diseases; 56.8% (267/470) had and used medicinal plants; 15.8% (73/462) had practiced traditional self-care for flu, menstruation and postpartum; and 11.8% (54/458) reported that they had gone to midwives, bonesetters and healers. Four factors had a significant association (p < 0.05) with traditional medicine: consumption of three traditional foods; having traditional gardens and plants; living within the reservation; and parents born in a municipality of indigenous influence. Conclusions: The study showed that the permanence of traditional medicine is strongly associated with traditional food, agricultural vocation and the possession and use of medicinal plants. The results suggest that the strategy for the recovery of traditional medicine could focus on promoting a stronger link between indigenous identity, territory, food and health.

Introducción: La población del Resguardo Indígena Muisca de Cota, Colombia, se encuentra en un proceso de fortalecimiento cultural. Ahora busca la recuperación de sus saberes ancestrales relacionados con la medicina tradicional. Objetivo: Explorar la ocurrencia de la medicina tradicional y factores asociados con su vigencia en el resguardo indígena Muisca de Cota, Colombia. Métodos: Estudio transversal participativo con los miembros del resguardo. Para este estudio se aplicó en abril de 2019 un instrumento de 44 preguntas a 471 madres de familia que tenían por lo menos un hijo mayor de diez años. A través de él se indagaron algunos factores demográficos, sociales y culturales. Además, se plantearon preguntas relacionadas con conocimiento, uso y práctica de medicina tradicional. Usamos el procedimiento de Mantel-Haenszel para establecer las asociaciones mediante el Odds ratio e intervalos de confianza del 95%. Resultados: El 66,2% (312/471) de las madres conocía al menos tres casos de enfermedades tradicionales, el 56,8% (267/470) tenía y usaba plantas medicinales, el 15,8% (73/462) practicaba cuidados tradicionales de la gripa, la menstruación y el puerperio, y el 11,8% (54/458) reportó que han acudido a parteras, sobanderos y curanderos. El consumo de tres alimentos tradicionales, la tenencia de huertos y plantas tradicionales, tener la vivienda dentro del resguardo y padres nacidos en un municipio de influencia indígena, fueron los principales factores asociados con la prevalencia de la medicina tradicional (p < 0,05). Conclusiones: El estudio mostró que la permanencia de la medicina tradicional está fuertemente asociada a la alimentación tradicional, a la vocación agrícola y a la tenencia y uso de plantas medicinales. Los resultados sugieren que la estrategia de recuperación de la medicina tradicional podría enfocarse en promover un mayor vínculo entre identidad indígena, territorio, alimentación y salud.

Panorama de la medicina tradicional en el Resguardo Muisca de Cota, Colombia: estudio transversal / Overview of traditional medicine in the Muisca Reserve of Cota, Colombia: a cross-sectional study

INTRODUCCIÓN: La población del Resguardo Indígena Muisca de Cota, Colombia, se encuentra en un proceso de fortalecimiento cultural. Ahora busca la recuperación de sus saberes ancestrales relacionados con la medicina tradicional. OBJETIVO: Explorar la ocurrencia de la medicina tradicional y factores asociados con su vigencia en el resguardo indígena Muisca de Cota, Colombia. MÉTODOS: Estudio transversal participativo con los miembros del resguardo. Para este estudio se aplicó en abril de 2019 un instrumento de 44 preguntas a 471 madres de familia que tenían por lo menos un hijo mayor de diez años. A través de él se indagaron algunos factores demográficos, sociales y culturales. Además, se plantearon preguntas relacionadas con conocimiento, uso y práctica de medicina tradicional. Usamos el procedimiento de Mantel-Haenszel para establecer las asociaciones mediante el Odds ratio e intervalos de confianza del 95%. RESULTADOS: El 66,2% (312/471) de las madres conocía al menos tres casos de enfermedades tradicionales, el 56,8% (267/470) tenía y usaba plantas medicinales, el 15,8% (73/462) practicaba cuidados tradicionales de la gripa, la menstruación y el puerperio, y el 11,8% (54/458) reportó que han acudido a parteras, sobanderos y curanderos. El consumo de tres alimentos tradicionales, la tenencia de huertos y plantas tradicionales, tener la vivienda dentro del resguardo y padres nacidos en un municipio de influencia indígena, fueron los principales factores asociados con la prevalencia de la medicina tradicional (p < 0,05). CONCLUSIONES: El estudio mostró que la permanencia de la medicina tradicional está fuertemente asociada a la alimentación tradicional, a la vocación agrícola y a la tenencia y uso de plantas medicinales. Los resultados sugieren que la estrategia de recuperación de la medicina tradicional podría enfocarse en promover un mayor vínculo entre identidad indígena, territorio, alimentación y salud.

INTRODUCTION: The Muisca Indigenous people in Cota, Colombia, has committed to reviving and strengthening their traditional culture, including the ancestral knowledge associated with their traditional medicine. OBJECTIVE: To explore the occurrence of traditional medicine and factors associated with its use among the Muisca people in Cota, Colombia. METHODS: A participatory cross-sectional study applied a questionnaire to 471 Muisca mothers who had at least one child over 10 in April 2019. The 44 questions inquired demographic, social, and cultural factors of participants and their knowledge, use and practice of traditional medicine. We used the Mantel-Haenszel procedure to measure the associations using Odds Ratio and 95% confidence intervals. RESULTS: 66.2% (312/471) of the mothers knew at least three cases of traditional diseases; 56.8% (267/470) had and used medicinal plants; 15.8% (73/462) had practiced traditional self-care for flu, menstruation and postpartum; and 11.8% (54/458) reported that they had gone to midwives, bonesetters and healers. Four factors had a significant association (p < 0.05) with traditional medicine: consumption of three traditional foods; having traditional gardens and plants; living within the reservation; and parents born in a municipality of indigenous influence. CONCLUSIONS: The study showed that the permanence of traditional medicine is strongly associated with traditional food, agricultural vocation and the possession and use of medicinal plants. The results suggest that the strategy for the recovery of traditional medicine could focus on promoting a stronger link between indigenous identity, territory, food and health.

[Cultivation and use of medicinal plants and association with reporting of childhood asthma: A case-control study in the Bogotá savanna]. / Cultivo y uso de plantas medicinales y su asociación con el reporte de asma infantil: estudio de casos y controles en la Sabana de Bogotá.

INTRODUCTION: The prevalence of childhood asthma has increased in recent years. The World Health Organization has called for conducting research exploring the role of traditional medicine and medicinal plants in respiratory disease control. OBJECTIVE: To identify the relationship between the prevalence of childhood asthma and traditional care of the respiratory system, including cultivation and use of medicinal plants. METHODS: We conducted an observational, analytic, case-control study that included children 2 to 14 years old who used official health services in eight municipalities near Bogota between 2014 and 2015. Cases were children diagnosed with asthma. We randomly selected the controls among the remaining patients of the same healthcare facilities. We applied an 18-question survey. The Mantel-Haenszel procedure identified significant associations using 95% confidence intervals. RESULTS: We surveyed the caretakers of 97 cases and 279 controls in eight municipalities. Some 23.4% (88/376) and 37.9% (142/375) reported using traditional remedies for fever control and common cold management, respectively. 8.8% (33/376) reported following traditional care during a common cold, 30.4% (114/375) reported growing medicinal plants at home, and 45% (166/369) reported using medicinal plants for health purposes in their household. Multivariate analysis showed that having and using medicinal plants at home is associated with a lower reporting of asthma (odds ratio 0.49; 95% confidence interval: 0.25 to 0.99). CONCLUSIONS: Cultivating and using medicinal plants at home is associated with a lower reporting of childhood asthma. Researchers should consider the therapeutic, environmental, and cultural properties of medicinal plants to prevent respiratory diseases.

INTRODUCCIÓN: La prevalencia de asma infantil ha aumentado en los últimos años. La Organización Mundial de la Salud invita a buscar evidencia científica en las medicinas tradicionales y el uso de plantas medicinales, como contribución al control de las enfermedades respiratorias. OBJETIVOS: Identificar la relación entre prevalencia de asma infantil y cuidados respiratorios tradicionales, incluyendo el cultivo y uso de plantas medicinales. MÉTODOS: Estudio observacional, analítico con diseño de casos y controles en niños (de 2 a 14 años) atendidos por servicios estatales de salud en ocho municipios vecinos a Bogotá durante 2014 y 2015. Fueron casos quienes recibieron diagnóstico de asma y se seleccionaron los controles aleatoriamente entre los demás usuarios de las mismas instituciones. Aplicamos un cuestionario con 18 preguntas. La prueba de Mantel-Haenszel identificó asociaciones significativas usando el Odds ratio e intervalos de confianza del 95%. RESULTADOS: Encuestamos a los acudientes de 97 casos y 279 controles en ocho municipios. El 23,4% (88/376) reportó el uso de remedios caseros para controlar la fiebre y el 37,9% (142/375) para manejar la gripe. El 8,8% (33/376) reportó cumplir con todos los cuidados del frío durante la gripe; 30,4% (114/375) tiene plantas medicinales sembradas en su vivienda y 45% (166/369) reportó uso de plantas medicinales para el cuidado de la salud en el hogar. El análisis multivariado mostró que la tenencia y uso de plantas medicinales en la vivienda se asoció con menor reporte de asma (Odds ratio: 0,49; intervalo de confianza 95%: 0,25 a 0,99). CONCLUSIONES: Cultivar y usar plantas medicinales en los hogares está asociado con menor reporte de asma infantil. Conviene considerar las propiedades terapéutica, ambiental y cultural de las plantas medicinales para la prevención de enfermedades respiratorias.

The Experience of Colombian Medical Students in a Pilot Cultural Safety Training Program: A Qualitative Study Using the Most Significant Change Technique.

Problem: The Colombian government provides health services grounded in the Western biomedical model, yet 40% of the population use cultural and traditional practices to maintain their health. Adversarial interactions between physicians and patients from other cultures hinder access to quality health services and reinforce health disparities. Cultural safety is an approach to medical training that encourages practitioners to examine how their own culture shapes their clinical practice and how to respect their patients' worldviews. This approach could help bridge the cultural divide in Colombian health services, improving multicultural access to health services and reducing health disparities. Intervention: In 2016, we conducted a pilot cultural safety training program in Cota, Colombia. A five-month training program for medical students included: (a) theoretical training on cultural safety and participatory research, and (b) a community-based intervention, co-designed by community leaders, training supervisors, and the medical students, with the aim of strengthening cultural practices related to health. Evaluation used the Most Significant Change narrative approach, which allows participants to communicate the changes most meaningful to them. Using an inductive thematic analysis, the authors analyzed the stories and discussed these findings in a debriefing session with the medical students. Context: Cota is located only 15 kilometers from Bogota, the national capital and biggest city of Colombia, so the small town has gone through rapid urbanization and cultural change. A few decades ago, inhabitants of Cota were mainly peasants with Indigenous and European traditions. Urbanization displaced agriculture with industrial and commercial occupations. One consequence of this change was loss of cultural health care practices and resources, for example, medicinal plants, that the community had used for centuries. Impact: A group of 13 final-year medical students (ten female and three male, age range 20-24) participated in the study. The medical students listed four areas of change after their experience: increased respect for traditional health practices to provide better healthcare; increased recognition of traditional practices as part of their cultural heritage and identity; a desire to deepen their knowledge about cultural practices; and openness to incorporate cultural practices in healthcare. Lessons Learned: Medical students reported positive perceptions of their patients' cultural practices after participating in this community-based training program. The training preceded a positive shift in perceptions and was accepted by Colombian medical students. To the best of our knowledge, this was the first documented cultural safety training initiative with medical students in Colombia and an early attempt to apply the cultural safety approach outside the Indigenous experience.

Creencias y vivencias de mujeres adultas sobre la menstruación en el municipio de Cota, Colombia / Beliefs and experiences of menstruation on adult women in cota municipality, Colombia / Crenças e vivências de mulheres adultas sobre a menstruação no município de cota na, Colômbia

Objetivo: Conocer y documentar las connotaciones culturales, las prácticas de cuidado y los estilos de vida en torno a la menstruación, en mujeres adultas del municipio de Cota. Métodos. Se llevó a cabo una investigación cualitativa dentro de un contexto individual y sociocultural, caracterizada por un enfoque teórico etnográfico y fenomenológico. Se incluyeron 28 mujeres voluntarias, entre 48 y 97 años, que fueron referenciadas por reconocimiento de la comunidad y seleccionadas por muestreo de tipo “bola de nieve”, a quienes se les hizo una entrevista semiestructurada analizada por edición. Resultados. Existe un cuerpo de conocimientos que cimenta el saber de la medicina tradicional en el municipio de Cota, los cuales incluyen prácticas que han prevalecido a lo largo de los años y que hacen énfasis en cuatro áreas: la dieta, el cuidado del cuerpo con el equilibrio frío-calor, el uso de plantas medicinales y las restricciones sociales. Para ofrecer un cuidado culturalmente congruente, se deben conocer las creencias y prácticas relacionadas con la menstruación, lo cual facilita la interacción en el cuidado y la intervención en la atención de los servicios de salud, con base en sus propias creencias y valores.

Objective: To learn and document life styles, beliefs, practices and therapeutic treatments regarding menstrual care, used by women from the municipality of Cota, Colombia. Methods: A qualitative investigation characterized by a theoretical ethnological and a phenomenological approach was carried out, within an individual and socio-cultural context. Twenty eight voluntary women between 48 and 97 years of age were included, refe- rred through community recognition and selected by snowball sampling. Additionally, semi-structured inter- views were applied to all the participants and analyzed through edition or classification. Results: In the municipality of Cota, Colombia, a body of knowledge exists that supports traditional ancestral medicine and wisdom, within which there are practices and customs that have prevailed through the years and that emphasize or focus on four areas: diet, taking care of the body using heat and cold balancing methods or practices, and social restrictions or taboos. In order to offer culturally congruent medical care, the physician must acknowledge and become familiar with the traditional ancestral practices and beliefs regarding women’s menstrual care, so that in the future he/she can determine which of them are important to preserve, adapt and restructure, facilitating interaction during both the care and the intervention phases accomplished by health service institutions and personnel, by taking into consideration the patient’s beliefs and values.

Objetivo: Documentar as conotações culturais, práticas de cuidado e estilos de vida a respeito da menstruação entre mulheres adultas no município de Cota. Métodos: Pesquisa qualitativa fenomenológica que incluiu entrevistas semiestruturadas, analisadas por edição, a 28 mulheres voluntárias com idades ente 48 e 97 anos, amostra referenciada por Bola de Neve. Resultados: Existe no município de Cota, um saber baseado na medicina tradicional que inclui práticas antigas que se focam em quatro aspectos: dieta, cuidado do corpo (balance frio-calor), uso de plantas medicinais e restrições sociais. Para oferecer e facilitar um cuidado médico culturalmente coerente é importante conhecer as crenças populares sobre este período da mulher.