CSA troubleshooting: 4 - Culture and ethnicity

The CSA exam reflects diversity in general practice. By Dr MeiLing Denney

Make sure you have a good understanding of transcultural medicine (Photograph: SPL)
Make sure you have a good understanding of transcultural medicine (Photograph: SPL)

A GP's patient population often includes patients from a wide variety of ethnic, religious, cultural and socio-economic backgrounds.A GP would therefore be expected to appreciate and respect these differences, and manage them appropriately in the clinical setting

How it is covered in the CSA exam

All CSA exam days will contain at least one case that features an element of diversity - please note that cases on patients with a disability are covered in a separate article.

CSA role players are drawn from a pool of people from different ethnicities, class backgrounds and religious or cultural beliefs, so they can be used appropriately for the CSA cases. However, there may also be CSA cases that use role players from different ethnic of cultural backgrouds who are playing a straightforward case of otitis media, for example.

What to do in the exam

It is important to treat every patient as an individual. Avoid jumping to inappropriate conclusions; just because an Afro-Caribbean patient is in front of you it does not mean you are expected to demonstrate your knowledge of hypertension guidelines that take into account different ethnicities.

Listen to what the patient is saying, and if you are not sure about the implications of a patient's particular religion or culture, you can ask the patient to help you out. The CSA tries to reflect different social calsses, so you may find yourself with a patient from a high area of deprivation, or someone from an area of relatively high affluence - either or both may present challenges to you.

Understanding their health beliefs and expectations will enable you to take this into account in your management, and tailor your explanation to the patient appropriately. In the interpersonal skills domain you are expected to demonstrate sensitivity and the ability to be non-judgemental.

How to prepare

It may be that your practice does not cover certain social classes to any great extent, or has a narrow range of patients of particular ethnicities or from certain religious backgrounds.

If this is so, ask your trainer if you can spend some time outside the practice to gain this experience. Some training practices have short-term exchange arrangements through which registrars can spend a day or two at a practice that is inner-city, rural, high social class, diverse ethnic mix and so on.

It is also worthwhile reading up on transcultural medicine so you are aware of beliefs that may impact on health-seeking behaviour, patient expectations or compliance.

Make sure you know about religious festivals such as Ramadan, for example, and feel confident in giving advice to a patient with diabetes intending to embark on Hajj.

Another suggestion would be to think through how to give appropriate contraceptive advice to those with a variety of strong religious beliefs. With your trainer's help, you should be able to think of plenty more examples.

Learning Points
  • Each CSA exam day will include at least one case where diversity is an important element.
  • Avoid jumping to any conclusions and use the patient as a resource if you do not understand a patient’s health beliefs and expectations - this will help you with management.
  • Read up on transcultural medicine.
    • Dr Denney is an MRCGP examiner and a GP in Edinburgh

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