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Table 2 Themes and subthemes with representative quotes

From: US medical student perspectives on Asian American patient inclusion in medical education: a qualitative study

Theme Explanation Exemplary Quotes
Motivation Reasons that explain why students are driven to learn more about topics related to AsAm culture  
•Identity Students share personal characteristics (e.g., race/ethnicity, culture, language, nation of origin) with AsAm patients “I have had zero lecture time dedicated to discussing the culture and approach to taking care of Asian/Asian American patients. Being Asian American myself, this is very disappointing..”
"I wish when we talk about cultural discrepancies in med school it's not just Black and Hispanic patients but also Asian patients. Somehow we are always left out of the conversation.”
•Service Students hope to provide care for Asian/AsAm patients in their local community that meets their healthcare needs. They also feel that increased knowledge will have a positive impact on health outcomes “There is a strong Hmong population where I attend medical school and we have not received adequate education as to their culture and general practices/preferences. This education would have been beneficial in many of my clinical rotations.”
“Would like to learn about religious and traditional beliefs that may compliment or interfere with medical treatment.”
•Personal enrichment Students want to learn more about AsAm culture because they want to increase their skills and knowledge in this area “I think that in order to be a competent doctor, it is super important to understand my patients' culture-specific and individual-specific belief systems, cultural understanding, etc. Learning about this for any culture (including for Asian patients), could only help me to better serve the needs of my patients.”
“I would love to learn to better communicate beyond my level of conversational Chinese.”
•Dissenting Students disagree that increased knowledge or training related to AsAm culture would be beneficial to them “In cities like my own, in which there is not a large Asian community, [training on these health disparities] probably would not make as much sense as it would for areas with a different population makeup.”
“Have not had patient experience where their culture beliefs (apparent to me) impacted care, so a brief session would suffice.”
Topics of interest Topics related to AsAm culture and healthcare disparities that students would be interested in learning more about  
•Cultural preferences regarding health and healthcare Topics within AsAm culture that would allow students to better understand AsAm patients’ preferences or perspectives on Western medicine and healthcare (e.g. traditional medicine, ideas surrounding death and reincarnation) “Stronger knowledge base of medical things that conflict with traditional beliefs would be helpful…”
“Would be helpful to learn East and Southeast Asian thoughts on illness and death.”
•Healthcare delivery How to best deliver culturally sensitive healthcare to this group (e.g. translation services, interviewing strategies) “I would be interested to learn more about evaluating language proficiency in order to better utilize translation services.”
•Health outcomes/issues How culturally sensitive care and other social factors affect clinical outcomes “I would like to know about disparities fared by Asian Americans when socioeconomic status is taken into account.”
•Interest in learning more about diverse groups Students reported interest in increasing knowledge about culture and preferences of minority patients in general “I see patients from all different cultural backgrounds and I'd be interested in gaining more cultural competence across the board so I can be a better provider for all of my patients.”
Reported sources of knowledge Experiences and/or events by which students have or want to learn more about AsAm culture  
•Personal Personal experiences, background/identity, social/family network, and/or previous undergraduate classes or activities “I’m only prepared so far as that I am drawing from my own individual Asian American identity and experience.”
“The most valuable interactions were with the [local] Hmong population and also talking with my own family. I think having a Global Health background has certainly helped.”
“I have learned a great deal more about Asian culture from making friends with classmates from China and India than I have in 3 years of medical school.”
•Pre-clinical exposures Medical school classes and/or extracurricular activities “We took an online course on health disparities in different cultures, including among different Asian cultures.”
“Our education about AsAm health issues was limited to talks from APAMSA (a student organization).”
“…assigned reading of ‘A Spirit Catches You and You Fall Down’ before the first year of medical school.”
•Clinical exposures Patient and/or clinical staff interactions during clinical rotations “Attendings that are able to divulge that information to students are some of the best.”
“I study in an area with a much higher proportion of Asians than most areas of the country.”
Challenges Challenges to learning about AsAm health topics and patient populations in medical school  
•Lack of exposure Lack of exposure in both medical school curriculum and clinical experiences “Asian/Asian Americans make up such a tiny proportion of the population we serve which I feel, unfortunately, contributes to my lack of knowledge or specific training regarding Asian and Asian American health.”
“I feel that traditional medical school curricula, textbooks, and resources in general rarely address the Asian/Asian American population.”
•Other challenges Other limiting factors “I think it can be hard to become well-versed in various cultural differences, especially given different patient populations in different areas of the country.”
“I also find myself tending to avoid picking up [AsAm] patients that require the use of an interpreter mainly because I do not know how to use the [interpreting] system”
Suggestions/strategies Participant suggestions on how to incorporate AsAm-health related topics and cultural humility into medical education  
•Pre-clinical Lectures, intersession courses, etc. during the pre-clinical curriculum “Giving a crash course on some of these perspectives and then mainly teaching skills and strategies for making sure we appropriately address these concerns in our patients would be very helpful.”
“Pre-clinical lectures that address this topic would be helpful before clinical years.”
•Clinical Clinical sessions and educational resources “I would like at least a couple of practice cases demonstrating cultural or religious issues that may arise while treating Asian patients.”
“I would also like to have some hands-on practice with collaborating with a translator.”
“I would love to see 'one page memos' with hyperlinks and short summaries that link to longer pieces of information.”
•Other suggestions for format Longitudinal integration, mandatory, catering content to different institutions based on patient population “At the very least, there should be seminars or similar sessions 1–2 times a year discussing the importance of cultural competency and specific health disparities for Asians and Asian Americans… The stress on cultural competency seems to have faded in third year and has not been a part of our non-clerkship didactics.”
“Trainees should learn about the patients that they are likely to treat, so it may make more sense to have different curricula at different institutions.”
Disaggregation AsAm are treated as a monolith in medical education, despite the heterogeneity that exists and should be addressed “Asian American health disparities are highly variable and depend on which Asian country and how long they have been in the US. It is not a good idea to bin all Asians together.”