The aim of this thesis is to identify and analyse the origins, organisation, contents, delivery and outcomes of the learning and teaching of 'cultural diversity' within undergraduate medical education in the UK. Literature reviews of the history of medical education and relevant educational theory were conducted. Two ideal type models of 'cultural diversity' teaching programmes, designated as the 'cultural expertise' model and the 'cultural sensibility' model, were devised. Comparisons were made between the educational philosophy, educational process, educational content and outcomes of the two models. The models were then utilised as benchmarks against which to analyse and compare approaches and programmes to the teaching of 'cultural diversity'. The main research objective was to identify perceptions and evaluations of the teaching and learning of 'cultural diversity' held by a range of stakeholders in medical education including policymakers, school heads, teaching staff, researchers, students and users. Qualitative interviews of 61 respondents and documentary analysis were undertaken. The key findings are that the origins of 'cultural diversity' education have been driven more by political than educational agendas. As a result, the development of 'cultural diversity' teaching has not been systematic and has been inadequately informed by available theory or evidence. Programmes have evolved through the advocacy of individuals, many of who have not been involved in the development of education strategy. Contents and assessment processes are driven largely by ideas that are consistent with the 'cultural expertise' ideal type but the desired outcomes in clinical practice and for students are more in line with the 'cultural sensibility' model. Ambivalence towards assessment in this area, and the management of students who demonstrate inappropriate attitudes needs resolution since the current position undermines the development of the subject. Specific recommendations for each stakeholder group are included and the thesis concludes with ideas for future research.

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This study aimed to explore the construct of Masters level clinical practice. A mixed methods approach converging quantitative and qualitative data was undertaken. Consensus of behaviours indicative of the construct was explored through a quantitative Delphi study. Participants represented a total population sample of Masters course tutors in healthcare (n = 48). Round 1 requested behaviours indicative of the construct. Quantitative content analysis informed the behaviours explored in round 2, where participants rated their relative importance. Round 3 asked participants to rank the behaviours in order of importance. Descriptive and inferential analysis enabled interpretation of consensus. The construct was also explored through an in-depth qualitative case study, using semi-structured interviews and participant observation. Purposive sampling selected the `case' of a manipulative physiotherapy course and the participants for the study. Analytic categories were derived from the data using a constant comparative process until saturation of the data were achieved. Theoretical propositions to identify the components of the construct were developed. The response rate for the Delphi study was very good (79.1%, 77.1% and 70.8% for rounds 1-3 respectively). Rounds 1 and 2 achieved good consensus enabling 21 agreed 'important' behaviours to be taken into round 3. The ranking process in round 3 afforded consensus overall, but also highlighted some differences between professions regarding the prioritisation of components of the construct. There was good convergence of the data with the case study, with clinical reasoning and knowledge identified as the most important components of the construct. The study has identified generic components of the construct of Masters level clinical practice. In addition specific components and their prioritisation for the speciality of manipulative physiotherapy are identified. Development of this work by exploring several case studies to enable further consideration of professions and specialities through analytic generalisation would be beneficial.