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Finish the Story – Making Choices in a Culturally Diverse Healthcare Encounter
Exercise #13
Finish the Story – Making Choices in a Culturally Diverse Healthcare Encounter
Authors: Elena Rousou, Panagiota Ellina, Paraskevi Charitou
60–90 minutes
Description
Students read a branching clinical story about Mr. Karim, a 67-year-old refugee patient, and navigate key decision points about communication, interpreter use, and cultural sensitivity. Each decision pathway reveals different outcomes, fostering empathy and critical reflection on intercultural healthcare communication.
Methodological Guide
Objectives
Recognize how different cultural values can influence healthcare decisions.
Explore how communication choices affect patient trust and outcomes.
Reflect on how one's own assumptions may guide professional behaviour.
Develop empathy through perspective-taking and ethical reflection.
Explore how communication choices affect patient trust and outcomes.
Reflect on how one's own assumptions may guide professional behaviour.
Develop empathy through perspective-taking and ethical reflection.
Expected Outcomes
Enhanced ability to identify cultural and ethical challenges in healthcare communication.
Greater empathy for patients from culturally diverse or displaced backgrounds.
Practical understanding of intercultural communication strategies.
Greater empathy for patients from culturally diverse or displaced backgrounds.
Practical understanding of intercultural communication strategies.
Exercise Procedure
Introduction (5 min): Explain purpose and give instructions. Arrange students into small groups of 3–5. Set the ground rule of 'no right or wrong choices — only learning moments.' Explain that they will make decisions as a healthcare team.
Story (5–10 min): Read or display story opening (Mr. Karim's case). Discuss first impressions.
Decision Points (20 min): Teacher presents each story branch (Choice A/B), narrate outcomes. Students discuss and vote on choices; justify decisions.
Discussion (15–20 min): Which ending did your group reach? What contributed to that outcome?
Summary (10 min): This exercise guides students through the complexity of communication with refugee and migrant patients.
Final Reflection (15–20 min): Every patient encounter is shaped by context, culture, and communication.
Story (5–10 min): Read or display story opening (Mr. Karim's case). Discuss first impressions.
Decision Points (20 min): Teacher presents each story branch (Choice A/B), narrate outcomes. Students discuss and vote on choices; justify decisions.
Discussion (15–20 min): Which ending did your group reach? What contributed to that outcome?
Summary (10 min): This exercise guides students through the complexity of communication with refugee and migrant patients.
Final Reflection (15–20 min): Every patient encounter is shaped by context, culture, and communication.
Mode of Implementation
Group work (4–6 students). Optional online version using branching story tools.
Role of the Teacher
Facilitate a safe space for open discussion. Guide the flow of the story and present consequences of each choice. Encourage reflection rather than 'right/wrong' judgment. Help connect story learning to professional practice.
Theoretical Basis
This exercise applies transformative learning by immersing students in a branching narrative where their decisions shape the story outcome. Disorienting Dilemma: Students face ethically and culturally complex situations that do not have one 'correct' answer. Critical Reflection: After each choice, students discuss why they made that decision and how it reflects their cultural assumptions. Dialogue and Action: Groups compare their story paths and analyse how their decisions affected the patient's experience and trust.
Practical Application
Students read a short clinical story about a refugee patient visiting an outpatient clinic. At several key points, they must choose one of two possible actions (A or B). Each decision leads to a different storyline and outcome. At the end, students reflect on how their choices influenced the patient's care experience.
Knowledge Transfer
Students analyse their story outcomes and compare with other groups: How did different choices shape patient outcomes? Which values or assumptions guided decisions? How can these lessons apply to real healthcare settings?
Reinforcement & Reflection
Peer feedback: 'One thing your group did well…' and 'One thing you might consider next time…'. Teacher feedback highlights how each choice demonstrates (or misses) elements of cultural humility and patient-centered communication.
Required Resources
Printed or digital story scenarios. Whiteboard or Padlet for group decision paths. Reflection sheets.
Assessment / Evaluation
Peer assessment: 2 positives + 1 suggestion based on communication and empathy on other groups' selection of story ending (post in forum). Self-assessment checklist: I recognized my own biases. I considered cultural factors in each decision. I communicated with empathy and respect.
Practical Tips
Emphasize that there are no 'perfect' answers — every choice offers learning. Optional: Add sound effects, photos, or brief quotes from real patients to enhance realism.
Discussion Topics
How can we balance efficiency and empathy in intercultural encounters?
What system-level barriers (e.g., time, resources) influence cultural sensitivity?
How can healthcare organizations ensure interpreter services are accessible?
What system-level barriers (e.g., time, resources) influence cultural sensitivity?
How can healthcare organizations ensure interpreter services are accessible?
Further Resources
Link to video: Bridging borders: WHO Global Research Agenda on Health, Migration and Displacement https://youtu.be/A6wY2GSozzQ
Articles:
The Lancet (2022). Migrants' health and persisting barriers to accessing health-care systems http://doi.org/10.1016/j.eclinm.2022.101321
Lebano et al., (2020). Migrants' and refugees' health status and healthcare in Europe: a scoping literature review. BMC public health, 20(1), 1039.
Articles:
The Lancet (2022). Migrants' health and persisting barriers to accessing health-care systems http://doi.org/10.1016/j.eclinm.2022.101321
Lebano et al., (2020). Migrants' and refugees' health status and healthcare in Europe: a scoping literature review. BMC public health, 20(1), 1039.
Additional Remarks
Create a safe space: remind students that the aim is to explore complexity, not find a 'perfect' answer. Encourage all voices. Avoid judgmental language; use open-ended questions. Reinforce that interpreters are a right, not a privilege, in culturally competent care. This exercise works well as both a classroom or e-learning module.