Cross-cultural care awareness and self-perceived skillfulness among medical students in Egypt: a national study

BACKGROUND: Cross-cultural care (CCC) enables effective, patient-centered care for individuals from diverse backgrounds. Despite its importance in improving care quality and reducing health disparities, evidence on CCC among medical students in Egypt remains scarce. This study assessed medical students' cross-cultural self-perceived skillfulness and cultural awareness, examined their association, and identified sociodemographic and educational factors linked to both. METHODS: A multicentric cross-sectional study was conducted between November 2025 and March 2026 across 14 Egyptian medical schools. Using convenience sampling, 1,645 medical students from all academic years and interns participated. Data were collected using an online questionnaire that included sociodemographic and educational factors, the Modified Cultural Awareness Scale (mCAS), and the Harvard CCC Survey skillfulness subscale. Statistical analyses included correlation, group comparisons, and multivariable linear regression. RESULTS: Among 1,645 participants (mean age 21.8 ± 1.9 years; 53.7% female), the mean self-perceived cross-cultural skillfulness score was 3.55/5 (SD 0.78). Students felt most skilled in identifying a patient's Arabic literacy and taking a social history, and least skilled in counseling on complementary and alternative medicine and identifying patient mistrust. The mean total cultural awareness score was 4.69/7 (SD 0.75), highest in the Cognitive Awareness and Clinical Issues domains and lowest in General Educational and Research Experience. Higher awareness was associated with advanced English fluency and greater perceived adequacy of clinical experience and training (all p < 0.001), and skillfulness correlated positively with total awareness (r = 0.383, p < 0.001). In multivariable analysis, advanced English fluency, prior cultural sensitivity training, and all four cultural awareness domains were independently associated with skillfulness (all p ≤ 0.036). CONCLUSION: Among medical students in Egypt, self-perceived cross-cultural skillfulness was at an intermediate level and was independently associated with advanced English fluency, prior cultural sensitivity training, and greater cultural awareness across all mCAS domains. These findings identify cultural sensitivity training and cultural exposure as actionable targets for strengthening cross-cultural skillfulness in the medical curriculum.