Fostering Cultural Humility in Caring for a Returning Traveler: A Pediatric Resident Simulation

Abstract

Introduction: International travel has become more frequent outside of the current worldwide pandemic. With increased international travel, there is also more opportunity for physicians to encounter illness associated with this travel, including in pediatric patients. Pediatric residents should be well versed in obtaining a detailed travel history, creating a differential diagnosis and launching a treatment plan with the family for management of illness after international travel. Additionally, the concepts of cultural humility and avoiding judgement while caring for families with different cultural backgrounds is an important skill for residents to foster during training. Study Design/Hypothesis: A simulated patient encounter focusing on a pediatric patient with recent international travel was designed as part of a large multi-scenario simulation education event that is held annually for all pediatric residents. We hypothesized that this simulation would increase pediatric resident knowledge in obtaining a travel history as well as improve the residents’ self-perceived cultural humility when caring for international travelers. Methods: We designed a simulation scenario for second year pediatric residents focused on a febrile child who recently returned from international travel. The child’s family originally presented to a local religious leader prior to having the medical assessment. Pre and post simulation, a survey with questions regarding medical knowledge in the preparation of a pediatric patient for international travel as well as assessment of these patients upon return from international travel were included. Additionally, the Multidimensional Cultural Humility Scale (MCHS) was administered to residents to assess their cultural humility pre- and post- simulation. Results: Twenty- seven residents participated in the simulation. Overall, the mean score of the MCHS did not significantly increase after the simulation. After completing the scenario, all participants did agree that they felt more comfortable caring for immigrant children, more prepared to take a travel history, and more comfortable caring for a child who has traveled or will travel internationally. Conclusions: While we did not find statistical significance in overall self- perceived cultural humility after completing the simulation, pediatric residents felt more prepared to care for children after international travel as a result of participating in this educational intervention. Further data is required to determine if statistical significance would be achieved with increased numbers of participants. Based on post-scenario feedback and observations from scenario facilitators, minor adjustments will be made in future iterations of the scenario to better meet the educational objectives outlined for the participating pediatric residents.