Open Access Open Badges Research article

Cultural diversity: blind spot in medical curriculum documents, a document analysis

Emma Paternotte1*, Joanne PI Fokkema1, Karsten A van Loon1, Sandra van Dulmen234 and Fedde Scheele15

Author Affiliations

1 Department of Medical Education, Sint Lucas Andreas Hospital, Jan Tooropstraat 164, P.O. Box 9243, 1061 AE Amsterdam, The Netherlands

2 Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, The Netherlands

3 NIVEL (Netherlands Institute for health services research), Utrecht, The Netherlands

4 Department of Health Sciences, Buskerud and Vestfold University College, Drammen, Norway

5 Department of Medical Education, VU University Medical Centre, Amsterdam, The Netherlands

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BMC Medical Education 2014, 14:176  doi:10.1186/1472-6920-14-176

Published: 22 August 2014



Cultural diversity among patients presents specific challenges to physicians. Therefore, cultural diversity training is needed in medical education. In cases where strategic curriculum documents form the basis of medical training it is expected that the topic of cultural diversity is included in these documents, especially if these have been recently updated. The aim of this study was to assess the current formal status of cultural diversity training in the Netherlands, which is a multi-ethnic country with recently updated medical curriculum documents.


In February and March 2013, a document analysis was performed of strategic curriculum documents for undergraduate and postgraduate medical education in the Netherlands. All text phrases that referred to cultural diversity were extracted from these documents. Subsequently, these phrases were sorted into objectives, training methods or evaluation tools to assess how they contributed to adequate curriculum design.


Of a total of 52 documents, 33 documents contained phrases with information about cultural diversity training. Cultural diversity aspects were more prominently described in the curriculum documents for undergraduate education than in those for postgraduate education. The most specific information about cultural diversity was found in the blueprint for undergraduate medical education. In the postgraduate curriculum documents, attention to cultural diversity differed among specialties and was mainly superficial.


Cultural diversity is an underrepresented topic in the Dutch documents that form the basis for actual medical training, although the documents have been updated recently. Attention to the topic is thus unwarranted. This situation does not fit the demand of a multi-ethnic society for doctors with cultural diversity competences. Multi-ethnic countries should be critical on the content of the bases for their medical educational curricula.