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William Stallings Data and Computer Communications 7th Edition

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CENG 3331 Introduction to Telecommunications and Networks.

Eighth Edition by William Stallings

Data and Computer Communications. Data Communications, Data Networks, and the Internet “The fundamental problem of communication is that of reproducing.

Chapter 1 Data Communications and Networks - Overview Data Communications deals with the transmission of signals in a reliable and effective manner. Topics.

ECEN “Mobile Wireless Networking”

Chapter 1: Data Communications & Networking: Overview COE 341: Data and Computer Communications (3-0-3)

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EE 4272Spring, 2003 EE4272: Computer Networks Instructor: Tricia Chigan Dept.: Elec. & Comp. Eng. Spring, 2003.

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ECS 152A 1. Introduction. A Communications Model Source —generates data to be transmitted Transmitter —Converts data into transmittable signals Transmission.

1 K. Salah Module 1.0: Introduction Definition Communication Model Type of networks –WAN –MAN –LAN, WLAN –PAN, WPAN Networking Technologies Network Switching.

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How to Edit a PDF [For Accountants]

Navigating the intricate landscape of financial documents as an accountant often necessitates precise modifications to meet evolving industry standards. As a seasoned writer well-versed in the nuances of financial analysis and reporting, I've encountered the challenges of editing PDFs firsthand. Join me on a journey to uncover simple yet effective strategies to overcome these obstacles and elevate your accounting practices.

How Editing PDFs Can Help You with your Accounting 

The world of accounting revolves around meticulous record-keeping and clear communication of financial data. Thankfully, editing PDFs has become an essential tool for accountants, offering a versatile and efficient way to manage financial documents and reports. Here's a closer look at how editing PDFs can significantly benefit accountants in various aspects of their work:

1. Financial Reporting and Analysis :

Edit financial reports with ease.

Ensure accuracy by adding annotations and updates.

2. Tax Filing :

Quickly update tax documents and forms.

Ensure compliance with tax regulations.

3. Client Communication and Presentations :

Customize presentations for clients.

Add charts and graphs to convey information effectively.

4. Collaboration and Document Sharing :

Securely share financial documents with colleagues and clients.

Maintain confidentiality during document exchange.

5. Data Extraction and Analysis :

Extract data from PDFs for thorough analysis.

Convert PDFs into editable spreadsheets for easy manipulation.

While advanced features often come with a hefty price tag, WPS PDF offers a cost-effective solution. With prices starting at just $2.33 per month and a seven-day trial, it's a budget-friendly option for accountants. Overall, editing PDFs is essential for streamlining accounting tasks and improving efficiency.

How to Edit a PDF  [For Financial Reporting and Analysis]

In Part 1, we explored how editing PDFs can revolutionize your accounting workflow. Now, let's dive into specific editing features and see them in action using a sample financial report.

Imagine this: You received the latest revenue figures for your client. Here's how PDF editing helps you update the report in a flash:

Change Numbers on the Fly : Simply click on the editable text field (like "Revenue: $10,000") and update it with the new figure (e.g., "$12,500"). No need to start from scratch!

Highlight Key Points : Use the highlighter tool to emphasize important financial ratios or trends within the report.

Add Explanations : Need to clarify a specific number or calculation? Use the comment tool to add a note directly next to it.

Find & Replace Errors : Spotted a typo in "Net Income" throughout the report? The "Find & Replace" function lets you fix it all at once!

Experience in Financial Reporting and Analysis:

In the context of financial reporting and analysis, these editing features are invaluable for accountants:

Text Editing : Allows for the correction of errors, updating of financial data, and customization of reports to meet specific requirements.

Annotation and Comments : Facilitates collaboration among team members by providing a platform for feedback, discussion, and analysis of financial information.

Find & Replace : Streamlines the process of updating standardized terminology, correcting errors, and making global changes to financial data across the report.

Editing a PDF for financial reporting and analysis enhances the accuracy, clarity, and effectiveness of financial documents, supporting informed decision-making and strategic planning within organizations.

How to Edit a PDF  [For Tax Filing]

Tax filing often involves handling various forms and documents, which may require editing for accuracy and completeness. Here's how to effectively edit a PDF for tax filing purposes:

Imagine this: You're working on a client's tax return and need to fill out a complex form. Here's how PDF editing helps:

Skip the Paperwork : Many tax forms are fillable PDFs! Click on designated fields and type in your client's information directly (like "Total Income"). No more printing, filling out, and scanning!

Attach Documents with Ease : Need to include receipts or bank statements? Use the "Insert Pages" function to add them directly within the PDF. No more separate attachments – everything stays organized in one place.

Data to the Rescue (Optional) : Did your client give you financial data in a PDF (like an income statement)? Convert it to Excel with the "Convert to Spreadsheet" function. Now you can easily manipulate the data, create charts, and generate summaries for tax filing.

Long Image Advantage (Optional) : Sharing complex tax forms or multi-page statements electronically? Convert them into a long image format (like PNG). This preserves the layout while allowing easy scrolling on any device.

Experience in Tax Filing :

In the context of tax filing, these PDF editing features offer significant benefits for accountants:

Form Filling : Simplifies the process of completing tax forms by allowing for direct input of information into interactive form fields.

Inserting and Deleting Pages : Enables accountants to organize tax documents efficiently by adding necessary pages or removing irrelevant ones.

Converting PDFs to Spreadsheets : Facilitates data extraction from tax documents for analysis and reporting purposes within spreadsheet software.

Converting PDFs to Long Images : Provides an alternative format for presenting complex tax forms or multi-page documents in a visually accessible manner.

Overall, editing a PDF for tax filing purposes streamlines the document management process, enhances accuracy, and ensures compliance with regulatory requirements, contributing to a smooth and efficient tax filing experience.

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How to Edit a PDF  [For Client Communication and Presentations]

Forget boring reports! PDF editing lets you create presentations that impress your clients. Here's how:

Add Hyperlinks : Link key phrases to other parts of the report or even external websites for deeper dives. (Imagine clicking "Market Trends" to jump to a relevant section or open a web page with market data)

Smart Bookmarks : Create a clickable "mini-index" within the PDF. Clients can instantly jump to sections like "Financials" or "Action Plan" with ease. (Imagine a list on the side with clickable titles like "Executive Summary" or "Investment Recommendations")

Digital Signatures : Securely finalize presentations with digital signatures. It's like a virtual handshake ensuring everyone agrees on the final version. (Imagine a designated area for you and your client to sign electronically)

Experience in Client Presentations:

These PDF editing tricks offer valuable benefits for accountants during client presentations:

Hyperlinks and Navigation : Enhance client interaction by providing easy access to relevant information.

Bookmarking : Simplify navigation, allowing clients to find what they need quickly.

Digital Signatures : Ensure document integrity and security, especially for legally binding materials.

By mastering these PDF tricks, you can transform presentations into engaging tools that grab clients' attention and leave a lasting impression.

How to Edit a PDF  [For Collaboration and Document Sharing]

In accounting, effective collaboration and secure document sharing are crucial for smooth workflows. Let's explore how PDF editing can improve these processes:

Imagine this: You finalized a client report and need your team's feedback. Here's how PDF editing helps:

Password Protection : Encrypt the report with a password. This ensures only authorized individuals can access the sensitive data. (Think "adding a lock" to the document)

Watermarks : Add a "Draft" or "Confidential" watermark to the report. This clarifies its status and protects ownership. (Imagine a faint "Draft" stamp across the document)

Easy Sharing : Save the edited and secure report. Simply attach it to an email and send it to your colleagues! (Just like attaching any file to an email)

These features are great for:

Keeping sensitive financial data secure.

Preventing unauthorized access to the report.

Clearly marking the document's status (draft, confidential).

Streamlining document sharing with your team.

Encouraging secure collaboration and feedback.

By using these collaboration features, you can share documents securely and foster a productive, secure work environment for your accounting team.

How to Edit a PDF  [For Data Extraction and Analysis]

Let's explore how accountants can leverage PDF editing tools for data extraction and analysis, enhancing their efficiency and accuracy in handling financial information:

Imagine this: You received a client's scanned receipts (yuck!). You need that data for analysis, not a paper trail. Here's how PDF editing helps:

Magic Text Trick (OCR) : Some PDFs are like images (scanned receipts). Use the "OCR" function to turn them into editable text. (Think of it like a decoder ring for PDFs!)

Extract the Good Stuff : Now that the PDF talks, highlight and copy the data you need (dates, amounts).

Data to the Rescue (Optional) : Paste the extracted data into Excel for analysis. Create charts, do calculations, and unlock hidden financial insights!

Keep it Confidential (Optional) : Use "Redact" to remove any sensitive info before sharing (like client names or social security numbers).

Enhance Your Accounting Process with AI PDF

Integrating AI into PDFs can transform how you handle financial documents and collaborate within your accounting team. Let's explore how AI PDF tools can elevate your accounting practices:

Auto-Magic Data Grab : Say goodbye to manual data entry! AI can automatically suck data (dates, amounts) right out of invoices and receipts. No more typos, just pure efficiency.

Data Detective : AI doesn't just grab data, it analyzes it too. It can spot trends, uncover hidden insights, and even identify potential risks in your financial documents.

Teamwork Makes the Dream Work : AI PDF tools let your team collaborate seamlessly. You can share documents, edit them together, and ensure everyone's on the same page – all within the PDF itself!

The benefits?

Faster Data Entry : No more tedious typing, letting you focus on bigger tasks.

Smarter Analysis : Uncover hidden insights and potential risks in your finances.

Smoother Collaboration : Work together on documents easily, ensuring accuracy and efficiency.

By leveraging AI PDF tools, you can revolutionize your accounting processes, enhance productivity, and drive better financial outcomes for your organization. With streamlined data extraction, automated analysis, and enhanced collaboration capabilities, AI PDF tools empower accountants to tackle complex challenges with confidence and efficiency.

Advanced Features of WPS Office: For Accountants!

We've explored how PDF editing tools can revolutionize your accounting workflow. But what if there was a suite designed specifically for your needs? WPS Office offers a powerful solution packed with features to make your life easier. Let's dive into some of the highlights:

Smart Form :

Imagine creating custom digital forms for expense reports, client information, or any other data you collect regularly.

Smart Forms let you define data formats, set validation rules, and even include automatic calculations.

This means less manual entry for you and fewer errors for everyone!

Split & Merge :

Juggling massive financial reports? Split & Merge has you covered.

Effortlessly break down large PDFs into smaller, more manageable documents.

Need to combine multiple invoices or statements? Simply merge them into a single, organized file.

Split & Merge makes document management a breeze.

Picture to PDF :

Say goodbye to lost receipts or messy expense reports.

Picture to PDF lets you convert any image – a receipt, a chart, even a handwritten note – into a clean, searchable PDF.

This streamlines your workflow, simplifies document management, and ensures all your financial data is organized and accessible.

By leveraging these advanced features and the overall power of WPS Office , you can transform your accounting practice into a model of efficiency and accuracy.

FAQs about Editing a PDF  

Q1. how can i edit pdf files without watermarks.

Editing PDFs without watermarks can be tricky. Here are your two main options:

Free online editing tools : These are convenient but might add their own watermark unless you pay.

Desktop PDF editing software : This is more powerful and watermark-free, but you'll need to buy the software.

Q2. How can I edit a PDF document on my laptop?

Free online editing tools : Edit from your web browser, but watch out for watermarks.

Desktop PDF editing software : Powerful editing features, but requires purchase.

Basic editing in some PDF viewers : Limited editing options, but free and already on your laptop (might be pre-installed).

In summary, mastering the art of editing PDFs is paramount for accountants seeking to streamline their financial management processes. With practical strategies and advanced tools offered by WPS Office , you can elevate your accounting practices, enhance efficiency, and drive success in your professional endeavors.

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Data Communication and Networking

Sep 27, 2014

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Data Communication and Networking. For more such slides visit bcc2000.com. Data Communication.

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• data transmission
• data communication
• packet switching
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Data Communication and Networking For more such slides visit bcc2000.com

Data Communication • Data communications are the exchange of data between two devices via some form of transmission medium such as a wire cable. Or Data Communication technologies deal with means and methods of data transfer from one location to another. • Basic Elements of Communication System • A SENDER(source) that creates and sends a message. • A MEDIUM that carries the message. • A RECEIVER that receives the message.

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Data Transmission Modes • Simplex, half-Duplex and Full- Duplex

Various Transmission Media • Twisted-Pair Wire • Coaxial Cable • Microwave System • Communication Satellite • Optical Fibers Bajaj Coaching Center, Rohtak

Digital and Analog Data Transmission • Data is transmitted from one point to another point by means of electrical signals that may be in digital and analog form. • In Analog signal the transmission power varies over a continuous range with respect to sound, light and radio waves.  • A Digital signal may assume only discrete set of values within a given range.

Analog signal is measured in Volts and its frequency in Hertz (Hz). A digital signal is a sequence of voltage represented in binary form. • When digital data are to be sent over an analog form the digital signal must be converted to analog form. So the technique by which a digital signal is converted to analog form is known as modulation. And the reverse process, that is the conversion of analog signal to its digital form, is known as demodulation. • The device, which converts digital signal into analog, and the reverse, is known as modem.

Analog Signal Digital signal

Switching Techniques • In large networks there might be multiple paths linking sender and receiver. Information may be switched as it travels through various communication channels. There are three typical switching techniques available for digital traffic. • Circuit Switching • Message Switching • Packet Switching Bajaj Coaching Center, Rohtak

Circuit Switching • Circuit switching is a technique that directly connects the sender and the receiver in an unbroken path. • Telephone switching equipment, for example, establishes a path that connects the caller's telephone to the receiver's telephone by making a physical connection. • With this type of switching technique, once a connection is established, a dedicated path exists between both ends until the connection is terminated. Bajaj Coaching Center, Rohtak

Circuit switching • Advantages: • The communication channel (once established) is dedicated. • Disadvantages: • Possible long wait to establish a connection, (10 seconds, • more on long- distance or international calls.) during which • no data can be transmitted. • More expensive than any other switching techniques, • because a dedicated path is required for each connection. • Inefficient use of the communication channel, because the • channel is not used when the connected systems are not • using it.

Message Switching • With message switching there is no need to establish a dedicated path between two stations. • When a station sends a message, the destination address is appended to the message. • The message is then transmitted through the network, in its entirety, from node to node. • Each node receives the entire message, stores it in its entirety on disk, and then transmits the message to the next node. • This type of network is called a store-and-forward network.

Message Switching • Advantages: • Channel efficiency can be greater compared to circuit- • switched systems, because more devices are sharing the channel. • Traffic congestion can be reduced, because messages may be temporarily stored in route. • Message priorities can be established due to store-and-forward technique.

Message Switching • Disadvantages • Message switching is not compatible with interactive • applications. • Store-and-forward devices are expensive, because they • must have large disks to hold potentially long messages.

Packet Switching • In packet switching methods, a message is broken into • small parts, called packets. • Each packet is tagged with appropriate source and destination • addresses. • Since packets have a strictly defined maximum length, they • can be stored in main memory instead of disk, therefore access delay and cost are minimized. • With current technology, packets are generally accepted onto • the network on a first-come, first-served basis. If the network • becomes overloaded, packets are delayed or discarded • (``dropped''). Bajaj Coaching Center, Rohtak

Packet Switching • Advantages: • Packet switching is cost effective, because switching • devices do not need massive amount of secondary • storage. • Packet switching offers improved delay characteristics, • because there are no long messages in the queue • (maximum packet size is fixed). • Packet can be rerouted if there is any problem, such as, • busy or disabled links. • The advantage of packet switching is that many • network users can share the same channel at the same • time.

Disadvantages of packet switching • It can add some initial costs in implementation. • If packet is lost, sender needs to retransmit the data. • There is no guarantee of how long it takes to travel from its source node to its destination node, because time taken for each packet depends on route chosen for that packet. Bajaj Coaching Center, Rohtak

Communication Protocols • How do the computers send and receive data across communication links? The answer is data communication software. • It is this software that enables us to communicate with other systems. The data communication software instructs computer systems and devices as to how exactly data is to be transferred from one place to another. The procedure of data transformation in the form of software is commonly called protocol. Bajaj Coaching Center, Rohtak

The data transmission software or protocols perform the following functions- Data sequencing: A long message to be transmitted is broken into smaller packets of fixed size for error free data transmission. Data Routing: It is the process of finding the most efficient route between source and destination before sending the data. Flow control: All machines are not equally efficient in terms of speed. Hence the flow control regulates the process of sending data between fast sender and slow receiver. Error Control: It ensures that data are transmitted without any error.

What is a Network? • A network consists of 2 or more computers connected together, and they can communicate and share resources (e.g. information). Bajaj Coaching Center, Rohtak

Why Networking? • Sharing information — i.e. data communication • Sharing hardware or software • E.g. print document • Centralize administration and support • E.g. Internet-based, so everyone can access the same administrative or support application from their PCs Bajaj Coaching Center, Rohtak

The Disadvantages (Costs) of Networking • Network Hardware, Software and Setup Costs • Hardware and Software Management and Administration Costs • Undesirable Sharing • Illegal or Undesirable Behavior • Data Security Concerns

Fundamental NetworkClassifications • LAN- Networks used to interconnect computers in a single room, rooms within a building or buildings on one site are called Local Area Network (LAN). LAN transmits data with a speed of several megabits per second (106 bits per second). The transmission medium is normally coaxial cables. • LAN links computers, i.e., software and hardware, in the same area for the purpose of sharing information. Usually LAN links computers within a limited geographical area because they must be connected by a cable, which is quite expensive. Bajaj Coaching Center, Rohtak

Major Characteristics of LAN • Every computer has the potential to communicate with any other computers of the network. • High degree of interconnection between computers. • Easy physical connection of computers in a network. • Inexpensive medium of data transmission. • High data transmission rate.

Advantages • The reliability of network is high because the failure of one computer in the network does not effect the functioning for other computers. • Addition of new computer to network is easy. • High rate of data transmission is possible. • Disadvantages • If the communication line fails, the entire network system breaks down. Bajaj Coaching Center, Rohtak

Metropolitan Area Network (MAN): • A metropolitan area network (MAN) is a network that interconnects users with computer resources in a geographic area or region larger than that covered by even a large local area network (LAN) but smaller than the area covered by a wide area network (WAN). The term is applied to the interconnection of networks in a city into a single larger network (which may then also offer efficient connection to a wide area network). Bajaj Coaching Center, Rohtak

Wide Area Networks (WANs): • The term Wide Area Network (WAN) is used to describe a computer network spanning a regional, national or global area. For example, for a large company the head quarters might be at Delhi and regional branches at Bombay, Madras, Bangalore and Calcutta. Here regional centers are connected to head quarters through WAN. The distance between computers connected to WAN is larger. Therefore the transmission medium used are normally telephone lines, microwaves and satellite links. • The largest and most well-known example of a WAN is the Internet

Characteristics of WAN • Communication Facility: For a big company spanning over different parts of the country the employees can save long distance phone calls and it overcomes the time lag in overseas communications. Computer conferencing is another use of WAN where users communicate with each other through their computer system. • Remote Data Entry: Remote data entry is possible in WAN. It means sitting at any location you can enter data, update data and query other information of any computer attached to the WAN but located in other cities. For example, suppose you are sitting at Madras and want to see some data of a computer located at Delhi, you can do it through WAN. Bajaj Coaching Center, Rohtak

Characteristics of WAN Cont… • Centralised Information: In modern computerised environment you will find that big organisations go for centralised data storage. This means if the organisation is spread over many cities, they keep their important business data in a single place. As the data are generated at different sites, WAN permits collection of this data from different sites and save at a single site.

NETWORK TOPOLOGY • The term topology in the context of communication network refers to the way the computers or workstations in the network are linked together. According to the physical arrangements of workstations and nature of work, there are four major types of network topology. • Star • Ring • Bus • Hybrid

Star topology • In star topology a number of workstations (or nodes) are directly linked to a central node Any communication between stations on a star LAN must pass through the central node.

Advantages of Star Topology • It offers flexibility of adding or deleting of workstations from the network. • Breakdown of one station does not affect any other device on the network. • Disadvantage • Failure of the central node disables communication throughout the whole network.

Ring Topology • In ring topology each station is attached nearby stations on a point to point basis so that the entire system is in the form of a ring. In this topology data is transmitted in one direction only. Thus the data packets circulate along the ring in either clockwise or anti-clockwise direction.

Advantages Of Ring Network • Ring Network works Well where there is no central node for making routing decisions. • It is more reliable than a star network because communication is not dependent on a single central node. If a link between any two nodes fails, or if one of the nodes fails, alternate routing is possible.

Disadvantage • The ring makes it difficult to add new computers. • The disadvantage of ring network is that the breakdown of any one station on the ring can disable the entire system.

Bus Topology • In bus topology all workstations are connected to a single communication line called bus. In this type of network topology there is no central node as in star topology. Transmission from any station travels the length of the bus in both directions and can be received by all workstations.

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Hybrid Network • It is a combination of two or more different network topologies.

Mesh Topology • Mesh topology is where all nodes are connected directly to all other nodes. If N is the number of nodes, then N(N-1)/2 links are required to provide a full mesh.  Bajaj Coaching Center, Rohtak

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• Open access
• Published: 21 May 2024

Effectively teaching cultural competence in a pre-professional healthcare curriculum

• Karen R. Bottenfield 1 ,
• Maura A. Kelley 2 ,
• Shelby Ferebee 3 ,
• Andrew N. Best 1 ,
• David Flynn 2 &
• Theresa A. Davies 1 , 2  

BMC Medical Education volume  24 , Article number:  553 ( 2024 ) Cite this article

208 Accesses

Metrics details

There has been research documenting the rising numbers of racial and ethnic minority groups in the United States. With this rise, there is increasing concern over the health disparities that often affect these populations. Attention has turned to how clinicians can improve health outcomes and how the need exists to educate healthcare professionals on the practice of cultural competence. Here we present one successful approach for teaching cultural competence in the healthcare curriculum with the development of an educational session on cultural competence consisting of case-based, role-play exercises, class group discussions, online discussion boards, and a lecture PowerPoint presentation.

Cultural competence sessions were delivered in a pre-dental master’s program to 178 students between 2017 and 2020. From 2017 to 2019, the sessions were implemented as in-person, case-based, role-play exercises. In 2020, due to in-person limitations caused by the COVID-19 pandemic, students were asked to read the role-play cases and provide a reflection response using the online Blackboard Learn discussion board platform. Evaluation of each session was performed using post-session survey data.

Self-reported results from 2017 to 2020 revealed that the role-play exercises improved participant’s understanding of components of cultural competence such as communication in patient encounters (95%), building rapport with patients (94%), improving patient interview skills (95%), and recognition of students own cultural biases when working with patients (93%).

Conclusions

Students were able to expand their cultural awareness and humility after completion of both iterations of the course session from 2017 to 2019 and 2020. This session can be an effective method for training healthcare professionals on cultural competence.

Peer Review reports

It is projected that by the year 2050, racial and ethnic minority groups will make up over 50% of the United States population [ 1 ]. With a more multicultural society, growing concern has emerged over how to address the health disparities that effect these populations and the ways in which healthcare professionals can increase positive health outcomes. Continuing evidence suggests that many patients from racial and ethnic minority groups are not satisfied with the current state of healthcare which has been attributed to implicit bias on the part of physicians and current challenges faced by practitioners who feel underprepared to address these issues due to differences in language, financial status, and healthcare practice [ 2 , 3 , 4 ].

To contend with health disparities and the challenges faced by practitioners working with a more diverse population, healthcare educators have begun to emphasize the importance of educating healthcare workforce on the practice of cultural competence and developing a skilled-based set of behaviors, attitudes and policies that effectively provides care in the wake of cross-cultural situations and differences [ 4 , 5 , 6 ]. There are several curricular mandates from both medical and dental accreditation bodies to address this issue [ 7 , 8 , 9 ], and large amounts of resources, ideas, and frameworks that exist for implementing and training future and current healthcare providers on the inadequacies of the healthcare system and cultural competence [ 10 , 11 , 12 ]. These current institutional guidelines for accreditation and the numerous amounts of resources for training cultural competence, continue to evolve with work documenting the need for blended curriculum that is continuous throughout student education, starting early as we have done here with pre-dental students, including in-person didactic or online sessions, a service learning component, community engagement and a reflective component [ 4 , 5 , 13 , 14 ].

This study investigates teaching cultural competence in a healthcare curriculum. We hypothesized that early educational exposure to cultural competence through role playing case studies, can serve as an effective mechanism for training early pre-doctoral students the practice of cultural competence. Utilizing student self-reported survey data conducted in a predental master’s curriculum, in which two iterations of role-playing case studies were used to teach components of cultural competence, this study aims to evaluate and support research that suggests role-playing case studies as effective means for educating future clinical professionals on the practice of cultural competence.

This study was determined to be exempt by the Institutional Review Board of Boston University Medical Campus, Protocol # H-37,232. Informed consent was received from all subjects.

Data collection

The role-playing, case-based simulated patient encounter exercises were developed and administered at Boston University Chobanian & Avedisian School of Medicine to predental students in the Master of Science in Oral Health Sciences Program (see Table  1 ). From 2017 to 2020, we administered patient encounter cases [see Additional File 1 ] to students ( n  = 178) in the program as a portion of a case-based, role-playing exercise to teach the importance of cultural competence and cultural awareness during patient encounters. During years 2017–2019, real actors portrayed the patient and physician. In 2020, the session was conducted online via a discussion board through a Blackboard Course Site. The original case was published as part of a master’s students thesis work in 2021 [ 15 ].

Description of patient encounter cases 1 and 2

Patient Encounter Case 1 [see Additional file 1 ] is composed of two subsections, scenario 1 A and scenario 1B, and is centered around a patient/physician interaction in which a patient who is pregnant presents with pain upon urination. The physician in 1 A is short and terse with the patient, immediately looking at a urine sample, prescribing medication for a urinary tract infection, and telling the patient to return for a follow-up in 2 weeks. In scenario 1B, a similar situation ensues; however, in this scenario the physician takes more time with the patient providing similar care as the physician in 1 A, but asking for more information about the patients personal and medical history. At the conclusion of the scenario, the patient is offered resources for an obstetrician and a dentist based on the information that is provided about the patient’s background. The patient is then sent on their way and asked to follow-up in 2 weeks. The patient does not return.

Patient Encounter Case 2 [see Additional file 1 ] follows a similar format to the Patient Encounter Case 1. In scenario 2 A, the same patient from Case 1 returns with tooth pain after giving birth. The physician in 2 A, like 1 A, is short with the patient and quickly refers the patient to a dentist. In 2B, the physician again takes more time with the patient to receive background information on the patient, make a connection, and provides an antibiotic and dental referral.

Each Patient Encounter Case explored topics such as the importance of building a trusting physician/patient relationship, the importance of asking a patient for patient history, making a connection, and the importance of a physician taking all facets of a patient’s circumstances into consideration [ 15 ].

Session outline

The sessions conducted between 2017 and 2019 were composed of three parts: (1) enactment of an abridged patient encounter facilitated by session administrators, (2) group discussion and reflection during which time students were asked to critically reflect and discuss the theme and key take-aways from the role play exercise, and (3) a PowerPoint presentation emphasizing take-away points from the role-play exercise. At the conclusion of the cultural competence training sessions, students participated in a post-session Qualtrics generated survey administered electronically to assess each student’s feelings about the session [see Additional file 3 ].

Role-play enactment

Facilitators dressed-up in clothing to mimic both the physician and patient for all case scenarios in Patient Encounter Case 1 and Case 2. At the conclusion of the role play portion of each of the cases, the facilitators paused to lead students in a real-time class group discussion. After Case 1, students were asked questions such as: What did you think ? Were the patient’s needs met? Did you expect the patient to return? Following Case 2, similar questions were asked by the facilitators, including: What did you think ? Were the patient’s needs met? Did you expect the patient to accept help?

At the conclusion of this portion of the session, the facilitators led a larger general discussion about both cases and how they related to one another. Finally, the course session concluded with a PowerPoint presentation that reinforced the take-home points from the session [see Additional file 2 ] [ 15 ].

Change in session modality due to COVID-19 pandemic

In Fall 2020, due to the COVID-19 pandemic, the course modality moved to an online platform and consisted of three parts on a Blackboard Discussion Board (Blackboard, Inc.). Students were required to: (1) read each of the Patient Encounter Cases and add a brief reflection comparing the scenarios, (2) then comment on at least two peer’s posts in the discussion forum and (3) attend class to hear a PowerPoint presentation by a course session facilitator on the key take-aways from each scenario [ 15 ].

Student surveys

At the conclusion of the cultural competence training sessions, students participated in a post-session Qualtrics ( https://www.qualtrics.com ) generated survey administered electronically to assess each student’s feelings about the sessions [see Additional file 3 ]. The format of the survey included 5 questions with the following Likert scale response options: strongly agree, agree, disagree, strongly disagree. These post-session surveys were not required but rather optional [ 15 ].

A total of 178 students completed the cultural competence sessions between 2017 and 2020. Of these participants, 112 voluntarily completed a post-session survey on the effectiveness of the course in teaching cultural competence and cultural awareness during patient encounters. Between 2017 and 2019, 99 students completed post-session surveys following sessions with role play exercises. In 2020, 13 students completed post-session surveys following discussion board sessions.

Role-play exercises enhanced cultural competence

In responding to post-session survey questions following cultural competence sessions that included role-play exercises (2017–2019), 71% of students surveyed strongly agreed and 24% agreed that the role-play exercises helped them to identify the importance of communication in patient encounters. In asking participants if the role-play exercises made them more aware of different strategies to improve their patient interview skills, 72% strongly agreed and 23% agreed. Also, 68% of the students strongly agreed and 26% agreed that the exercises helped them to better identify the importance of building rapport and trust during patient encounters. When asked if the exercises helped the students to better understand their own bias and/or cultural awareness when working with patients, the results of the survey showed that 62% of students strongly agreed and 31% agreed with this statement. In addition, most students found the role-play exercises to be enjoyable (72% strongly agreed and 22% agreed). See results shown in Fig.  1 .

Cultural Competence Session Survey Data from the Year 2017–2019. Survey data from students at Boston University’s Oral Health Sciences Program for the years 2017–2019. Data is presented as percent of respondents ( n  = 99)

Discussion boards and reflections enhanced cultural competence

Cultural competence sessions held during 2020 did not include role-play exercises due to the Covid-19 pandemic. Instead, students participated in discussion boards and reflections on Blackboard. In response to the post-session survey question asking if the discussion board exercises were helpful in identifying the importance of communication during patient encounters, 67% of students strongly agreed and 25% agreed with this statement. Also, 75% of students strongly agreed and 17% agreed that the discussion board exercises helped them identify the importance of building rapport and trust during patient contact. When asked if the exercises helped the students to better understand their own bias and/or cultural awareness when working with patients, the results of the survey showed that 67% of students strongly agreed and 25% agreed with this statement. In addition, most students found the discussion board exercises to be enjoyable (67% strongly agreed and 22% agreed). See results shown in Fig.  2 .

Cultural competence session survey data from the Year 2020. Survey data from students at Boston University’s Oral Health Sciences Program for the year 2020. Data is presented as percent of respondents ( n  = 13)

Student responses to the reflection portion of the online cultural competency sessions were recorded and categorized. Five themes were selected and 441 reflection responses were coded using NVivo (Version 12). The results showed that 29% of reflections demonstrated student’s ability to understand a holistic approach to clinical care, 24.3% understood the importance of collecting a patient history, 6.8% recognized the socioeconomic factors during a patient encounter, 27.9% reflected on the importance of the patient clinical relationship, and 12% on the effects on improving health outcomes (Table  1 ). Representative student responses to these themes are shown in Table  1 .

There exists a need to develop novel and effective means for teaching and training the next generation of healthcare professionals the practice of cultural competence. Thus, two iterations of a course session using case-based patient centered encounters were developed to teach these skills to pre-professional dentals students. Overall, the results of this study demonstrated that participation in the course, subsequent group discussion sessions, and take-away PowerPoint sessions significantly improved the participant’s understanding of the importance of communication skills and understanding of socioeconomic, environmental, and cultural disparities that can affect a patient’s health outcome.

According to results from the course session implemented in-person from 2017 to 2019, the role-playing exercise significantly improved participants understanding of important components that can be used to improve health outcomes that may be affected due to health disparities. Students were strongly able to identify the importance of communication in patient encounters, to understand strategies such as communication and compassionate care in patient encounters, identify the importance of building a patient-physician relationship with patients, and were able to recognize their own cultural biases. Similarly, in 2020, even with a change in course modality to on-line learning due to COVID-19, students were able to understand the same key take-aways from the course session as demonstrated by reflections using the discussion board regarding the need for a holistic approach to care, importance of the patient clinician relationship, and importance of taking a patient history. Despite promising implications of both iterations of the session, students completing the session online did not find the same success in “understanding my own bias/and or cultural awareness when working with patients.” This decrease may be attributed to change in course modality and the strengths of the role-play enactment of the patient encounter. It is important to recognize that additional learning components, including video recordings of the role-play enactment, may be necessary if the discussion board is used as the primary learning method in the future.

In contrast to previous studies that attempted to determine the effectiveness of cultural competence training methods, this session had many unique characteristics. The simulated role-playing exercise enabled student participants to see first-hand an interactive patient scenario that could be used as an example for when students begin working with patients or communicating with patients who are culturally diverse. Additionally, the nature of the cases created for the course session which were divided into a part A in which the patient physician was more straightforward when diagnosing and treating the patient and a part B with a more comprehensive and nurturing approach to care, allowed the students to compare the scenarios and make their own assumptions and comments on the effectiveness of each portion of the case. Another strength of this training, was the faculty with cultural competence training were uniquely involved in case creation and facilitation of the course session. According to previous studies with similar aims, it was noted that direct observation and feedback from a faculty member who had cultural competence training and direct contact with patients can provide students with a more memorable and useful experience when educating students [ 12 ]. The facilitators of this session were able to emphasize from their own personal experiences how to work with culturally diverse populations.

An important aspect of the 2020 iteration of the course session in which a discussion board format was used, was that it allowed students who may feel uncomfortable with sharing their thoughts on a case and their own biases, the opportunity to share in a space that may feel safer than in person [ 4 ]. Previous studies have mentioned challenges with online discussion boards [ 4 ] but here we had robust participation, albeit required. Students often contributed more than the required number of comments and they were often lengthy and engaging when responding to peers. Finally, in contrast to previous studies, this course session took place in a pre-professional master’s program, the M.S. in Oral Health Sciences Program at Boston University Chobanian & Avedisian School of Medicine. This program, in which students are given the opportunity to enhance their credentials for professional school, provided students with early exposure to cultural competence training. Students that completed this session in their early pre-professional curriculum should be better prepared than peers who did not receive any cultural competence training until they entered their designated professional school. This session is part of an Evidence Based Dentistry course, which incorporates a larger component of personal reflection that serves to engage students in critical thinking as they begin to develop the skills to be future clinicians. Students that understand different cultures, society and themselves through self-assessments will grow and be best suited in time to treat future patients [ 4 , 16 , 17 ].

One limitation of the present study was the number of survey participants that competed the post-session surveys, as survey completion was not required. Thus, the number of student participants declined over the years, reaching its lowest number of participants in 2020 when the discussion board course session was implemented, and students may have been over surveyed due to the pandemic. Another limitation to this study, was the lack of both a pre and post survey that could be used to determine how student’s understanding of cultural competence had evolved from their entry into the course to the conclusion of the course as well as individual bias and self-reporting measures.

In the future, the course should implement both a role-playing format and subsequent discussion board reflections within the same course session. Studies have shown that alternatives ways of drawing students to reflect whether role play, personal narratives, etc. can be extremely advantageous in developing personal reflection and awareness building competency [ 4 , 16 , 17 , 18 ]. It is noted that role-playing exercises that allow students to provide feedback with student colleagues can provide students with more insight into their own behaviors. It has also been shown in previous studies that student writing and reflection activities can also facilitate student’s reflections on their own beliefs and biases [ 4 , 11 ]. Reflective writing skills are an important and effective means for students to continue to gauge their cultural competence throughout the remainder of their academic training and as future clinicians [ 4 , 17 , 19 ]. Further, students may experience emotional responses through the process of reflective writing as they recognize personal bias or stereotypes, creating a profound and impactful response resulting in enhanced understanding of cultural differences and beliefs [ 4 ]. By combining both learning techniques, students would be able to understand their own bias and their classmates and create a dialogue that could be more beneficial than just one learning method alone. Furthermore, by implementing the discussion board into the role-playing session, as stated previously, students that are more cautious about sharing their point of view or about their own implicit bias in a traditional classroom setting would be able to express their opinions and facilitate a more comprehensive discussion more thoroughly.

Here we show an effective means to utilize role-play of a multi-scenario case-based patient encounter to teach pre-professional healthcare student’s components of cultural competence, emphasizing the importance of provider-patient interactions, holistic patient care, and patient history and socioeconomic factors in provider care. This study contributes to the larger body of work that seeks to address this important aspect of education as it relates to enhancing patient health care outcomes.

Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

We would like to acknowledge Boston University’s Chobanian & Avedisian School of Medicine’s Graduate Medical Science students and study participants.

No funding was used for the completion of this study.

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Karen R. Bottenfield, Andrew N. Best & Theresa A. Davies

Department of Medical Sciences & Education, Boston University Chobanian & Avedisian School of Medicine, 72 East Concord Street, Boston, MA, 02118, USA

Maura A. Kelley, David Flynn & Theresa A. Davies

University of Maryland School of Dentistry, 650 W Baltimore Street, Baltimore, MD, 21201, USA

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Contributions

TAD designed the original study concept, taught the classes (roleplay), conducted the surveys, and collected data; MAK designed the original case and PowerPoint, and performed roleplay; DBF and SF evaluated data and drafted original figures; ANB assisted in drafting the manuscript; KRB finalized figures and the manuscript.

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Correspondence to Theresa A. Davies .

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This study was determined to be EXEMPT by the Institutional Review Board of Boston University Medical Campus, Protocol # H-37232.

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Bottenfield, K.R., Kelley, M.A., Ferebee, S. et al. Effectively teaching cultural competence in a pre-professional healthcare curriculum. BMC Med Educ 24 , 553 (2024). https://doi.org/10.1186/s12909-024-05507-x

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Microsoft is thrilled to announce the launch of GPT-4o, OpenAI’s new flagship model on Azure AI. This groundbreaking multimodal model integrates text, vision, and audio capabilities, setting a new standard for generative and conversational AI experiences. GPT-4o is available now in Azure OpenAI Service, to try in preview , with support for text and image.

Azure OpenAI Service

A step forward in generative AI for Azure OpenAI Service

GPT-4o offers a shift in how AI models interact with multimodal inputs. By seamlessly combining text, images, and audio, GPT-4o provides a richer, more engaging user experience.

Launch highlights: Immediate access and what you can expect

Azure OpenAI Service customers can explore GPT-4o’s extensive capabilities through a preview playground in Azure OpenAI Studio starting today in two regions in the US. This initial release focuses on text and vision inputs to provide a glimpse into the model’s potential, paving the way for further capabilities like audio and video.

Efficiency and cost-effectiveness

GPT-4o is engineered for speed and efficiency. Its advanced ability to handle complex queries with minimal resources can translate into cost savings and performance.

Potential use cases to explore with GPT-4o

The introduction of GPT-4o opens numerous possibilities for businesses in various sectors: 

• Enhanced customer service : By integrating diverse data inputs, GPT-4o enables more dynamic and comprehensive customer support interactions.
• Advanced analytics : Leverage GPT-4o’s capability to process and analyze different types of data to enhance decision-making and uncover deeper insights.
• Content innovation : Use GPT-4o’s generative capabilities to create engaging and diverse content formats, catering to a broad range of consumer preferences.

Exciting future developments: GPT-4o at Microsoft Build 2024 

We are eager to share more about GPT-4o and other Azure AI updates at Microsoft Build 2024 , to help developers further unlock the power of generative AI.

Get started with Azure OpenAI Service

Begin your journey with GPT-4o and Azure OpenAI Service by taking the following steps:

• Try out GPT-4o in Azure OpenAI Service Chat Playground (in preview).
• If you are not a current Azure OpenAI Service customer, apply for access by completing this form .
• Learn more about  Azure OpenAI Service  and the  latest enhancements.  
• Understand responsible AI tooling available in Azure with Azure AI Content Safety .
• Review the OpenAI blog on GPT-4o.

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