The pandemic has accelerated the ongoing transformation of higher education, pushing institutions
As the diversity, equity, & inclusion (DEI) movement continues to make headway, it’s important to consider how it applies to health education and how DEI principles can foster more effective teaching environments and outcomes.
In health science education, the concept of DEI extends beyond including people from diverse backgrounds. Today, diversity and inclusion are just as much about meaningful contributions, intersectional representation, cultural safety, and intellectual diversity. If the goal of health science faculties is to create genuinely inclusive leaders, academic institutions have to equip healthcare professionals with the tools to provide culturally sensitive education and care to the learners and communities they serve.
This article provides an overview of diversity and inclusion in health science education and explores various strategies to create inclusive learning environments for culturally competent teaching.
Understanding Diversity and Inclusion in Health Science Education
Let’s first look at how diversity and inclusion fit into health science education by answering four principal questions:
What are diversity and inclusion?
The DEI concept represents policies and programs that reduce the underrepresentation of racial, ethnic, and socioeconomic groups in medical education. Expanding beyond the traditional focuses of race and gender, diversity factors in ages, ethnicities, abilities, disabilities, gender identities, religions, cultures, and sexual orientations.
Concurrently, inclusion requires uncovering the unconscious biases, stereotypes, and microaggressions that have been at the source of inequity in health science education in the past, paving the way for a new atmosphere of true inclusivity.
Why do we need diversity and inclusion?
There’s a need for health science education to develop culturally and socially competent physicians. There was indeed an increase in the diversity of applicants to medical schools in the U.S. last year. But while that’s an encouraging fact, the real work happens in the classroom, where fostering empathy, creating culturally safe spaces, and reducing disparities (both real or perceived) are fundamental to success.
For instance, a lack of diversity can often lead to misunderstandings that create further disparities. This makes it difficult for individuals from underrepresented groups to find mentorship, thus giving them fewer opportunities to build their confidence and their professional network.
How do diversity and inclusion benefit the learning environment?
Interaction with diverse peers enhances students’ educational experience and confidence. But that’s just one example. Here are a few more ways diversity and inclusion contribute in the classroom:
- Reduce stereotypes and biases
- Enhance creative problem-solving
- Encourage student collaboration and respect
- Promote practical cross-cultural communication skills
- Facilitate a deeper understanding of diverse patient populations
- Build an inclusive community, fostering a sense of belonging for all students
- Enrich the learning environment with a range of experiences and viewpoints
What’s the impact on healthcare outcomes?
When students learn in an inclusive environment, they become better at tackling the complexities of serving a diverse population. Culturally competent teaching helps students learn to engage, build trust, and establish rapport with patients from various backgrounds. This enhanced patient-doctor communication is critical to decreasing healthcare disparities and encouraging better health outcomes in diverse patient populations.
So, how can health science departments incorporate cultural competence in their faculty, students, curricula, and culture?
Culturally Competent Teaching Strategies
Let’s start with the classroom. Here are four culturally competent teaching strategies you can incorporate into your programs:
The curriculum matters, so start there.
An outdated curriculum quickly thwarts your intention for diversity and inclusion, so pay attention to what’s in there. Including materials that represent diverse perspectives might be obvious advice, but it’s often overlooked. Take the time to do the research and seek these voices out. You may also have to revise or replace content that presents a skewed or stereotypical view of certain groups or add materials with stereotype-challenging images. Finally, consider including hypothetical patients’ attributes in the curriculum to recognize potential biases and enhance equity and inclusion.
If you notice something that shouldn’t be there, call it out.
Even with the best intentions, getting it right every time takes work. Call it out if you notice material in the course curriculum that goes against diversity principles or has the potential to make anyone feel alienated. Address biases and stereotypes in teaching materials openly, discuss them with the class, and apologize for the oversight. Inclusivity isn’t about perfection but aspiring to always be better.
Talk about it, be impeccable with your words, and ask students to do the same.
Creating inclusive classroom environments starts with fostering respectful dialogue. While there is some nuance, respect can pave the way for openly discussing most things. Always use inclusive language, as this type of modeling helps normalize respect in the learning environment.
Remember the difference between curriculum and pedagogy.
While curriculum design comes first, getting to know your students and developing culturally relevant pedagogies that resonate with students is just as important. This might involve relating course content to students’ cultural backgrounds or employing teaching techniques that align with cultural learning styles and preferences.
Case Study: Augmenting novel pedagogies for culturally sensitive training
The Orange Grove Center hires people with intellectual and developmental disabilities as “standardized patients” (SPs) for medical training. Individuals are trained to simulate symptoms and answer questions to guide medical students through the history-taking process and physical examination. This immersive learning experience enhances students’ communication skills, increases their understanding of sensory-friendly environments and the role of caregivers, and helps them recognize the influence of implicit bias in healthcare.
Developing Cultural Competence Among Students
The above strategies will help you create a culturally competent learning environment, but that’s just the first step. It’s also critical to know various educational approaches that promote inclusivity by getting students to collaborate. Here are some strategies to foster a culturally safe and inclusive environment among students:
Encourage regular reflection exercises.
An effective technique is to have periodic opportunities for students to reflect on their cultural circumstances, beliefs, and biases. Self-awareness brings different prejudices, stereotypes, and patterns of microaggressions to the surface, allowing students to heal and bond as they become more conscious through self-reflection.
Teach humility and empathy.
Demonstrate the power of humility by teaching students to apologize for missteps or lapses of judgment in reverting to old ways of thinking. You can’t achieve inclusivity overnight, but humility and empathy are the biggest drivers facilitating group bonding. There is a significant difference between making mistakes and punishing yourself privately versus publicly acknowledging the error and resolving to improve. Teach your students the difference!
Have intercultural communication be the rule, not the exception.
Intercultural communication and collaboration are usually elements in most classrooms, but DEI principles say they should be the norm. One challenge in encouraging intercultural communication is that awkward initial period while everyone finds their comfort level, and pushing through that is important. What may feel forced in the early days of a semester will have become the standard by the end.
Make exposure to diversity a priority.
Practical experiences in diverse settings can help students develop cultural competence. This could involve clinical placements in diverse communities or healthcare settings that cater to specific cultural groups.
Case Study: Creating an inclusive environment
The Icahn School of Medicine’s Center for Antiracism in Practice developed a “curriculum clinic” series to encourage anti-racist pedagogy through initiatives that included workshops aimed at identifying and dismantling racist ideologies and practices in all curriculum aspects, along with continuous one-on-one sessions with a CAP facilitator. Participants learn to recognize racism manifestations, understand its impacts on learners and their future patients, and establish concrete change targets for implementing anti-racist policies.
Promoting Diversity and Inclusion in Assessment and Evaluation
Assessments are necessary for education, whichever form they take. Historically, they’ve been rigid, standardized, and imperfect indicators of how well a student is progressing. And while curricula and materials tend to evolve with more agility, assessments remain static for longer and are less prone to redesign. For health science faculties who want to promote more diversity and inclusion, that needs to change:
Provide students with assessment options.
Although it’s not easy to get academics to agree on the issue of “learning styles” in health science education, there’s no question that assessment significantly affects student learning. One way to address this is by offering various assessment options to accommodate different preferences and aptitudes in assessment methods.
Additionally, it’s crucial that assessments (and learning materials) are understandable for non-native/bilingual students and that alternate-language options are available when possible.
Review current materials for inherent or “carry-over” biases.
Current assessment materials will typically have biases, stereotypes, or lack of representation carried over from earlier iterations. Also, some content may not age well or need radical updating, so it’s good to regularly review all assessment materials.
Include diversity in the content of evaluations.
Assessment materials should be checked for cultural bias, which could disadvantage students from certain backgrounds. Incorporating diverse perspectives in case studies and clinical scenarios also means a larger group of learners will engage with the material. By recognizing intrinsic, contextual, and instrumental equity as key components in assessments, health science faculties can avoid designing modes of evaluation that influence the performance of underrepresented learners.
Faculty Development and Support
Promoting diversity and inclusion extends beyond the classroom. For these ideas to stick and become part of the university culture, here’s what department heads and faculty leaders can do:
Provide the latest training and resources in cultural competency.
Providing staff with training, recourses, and workshops is common in academia. However, the type, frequency, and accessibility of this training all need to change. Professional development opportunities must cover a broader range of issues, be conducted by those with firsthand experience, and include cultural competence training that teaches humility and sensitivity.
Making resources more widely available helps as well. While some people might recoil at the idea of a 6:00 am workshop, others might welcome it. Giving faculty options empowers them to take responsibility for their cultural competency and reduces the barriers many often use as excuses.
Establish support networks within the department or university.
Whether in a classroom, course grouping, department, faculty, or university, establishing support networks and communities to practice inclusive teaching is paramount. Support networks can be official and unofficial. For example, faculty can celebrate diversity among themselves and create formal means of creating inclusivity. Support is the lifeblood of DEI, and you can never have too much!
Case Study: DEI professional development model.
Harvard Medical School initiated a program incorporating sexual and gender minority (SGM) health content across its curriculum. The department established faculty competencies, and nine interactive online professional development modules were designed to tackle topics like mitigating implicit bias and power imbalances, fostering respectful communication regardless of gender identity or sexual orientation, and incorporating intersectional identities into case presentations without stereotyping.
Collaborating with Community Organizations, Existing Pipeline Programs, and Stakeholders
The final step is outreach. From community organizers and stakeholders to the programs that act as the main pipelines to new admissions, everyone must get involved to reflect diversity principles within academia and in the communities that support it.
Reach out to local communities.
Health science faculties and the institutions that house them need to factor in the influence of local communities and engage with them to promote diversity and inclusion. Whether partnering with community organizations to enhance cultural competence or advocating for similar values at the elementary and high school level through community efforts, bringing diversity and inclusion to education is ultimately a community effort.
Check in with your existing pipelines.
Like faculties auditing current course and assessment materials, the university department can check in and collaborate with the existing program pipelines to examine avenues and innovative ways to create pathways for underrepresented students.
Remember your stakeholders.
Finally, feedback from diverse stakeholders—including students, community members, and healthcare professionals from different cultural backgrounds—can help ensure the curriculum is culturally sensitive and relevant. This could be through regular meetings, surveys, or open forums for feedback.
Diversity and Inclusion in Caduceus Courses
For two decades, Caduceus International has specialized in developing customized, meaningful courses in health sciences for university curricula. Through dynamic materials, resources, and support, Caduceus strives to incorporate the principles of diversity and inclusion in all its materials.