Incorporating diversity into the medical school curriculum is an effective way to develop culturally responsive competencies in future physicians.
In 2000, the Liaison Committee on Medical Education, the accrediting body for medical education programs, introduced a standard for cultural competence; it called for students and faculty to develop an understanding of the social and cultural influences that affect the quality of medical care received by an increasingly diverse patient population. The standard also advanced the idea that prospective and current medical professionals should be educated to address cultural issues effectively.
Additionally, in its report Cultural Competence Education, the Association of American Medical Colleges identified the following five factors for an effective cultural competency curriculum:
● Institutional support of the college’s leadership, faculty, and students
● A commitment of institutional resources to address the curriculum
● Involvement of leaders from all segments of the medical college community in the design of the curriculum
● A commitment to providing educational interventions for the learner
● A clearly defined evaluation process
Recently, Penn State College of Medicine undertook concerted efforts to increase the representation of diversity in its medical curriculum. Students were tasked with administering a survey to the entire student body to gather feedback on the existing curriculum and share their recommendations. The results indicated that they perceived the curriculum lacked diversity educational components and that there was a significant opportunity to better prepare them to care for patients from different backgrounds.
Following the survey, the medical college convened focus groups of students to discuss the ways in which the curriculum could be improved and to determine what specific topics should be added. Of particular note was that the patients portrayed in the problem-based learning (PBL) cases — a significant component of the curriculum — could be diversified. Based on the feedback from the focus groups, the college of medicine convened a curriculum task force, which included faculty, staff, and students, to make recommendations for incorporating diversity into the curriculum. As the recommendations were being developed, we had three significant advancements:
The students participated in “town hall” meetings to develop a vision and mission statement for a diverse curriculum.
A review was completed of the more than 80 PBL case scenarios to eliminate stereotypes and diversify the patients represented; this step was critical because PBL represents approximately 20 percent of curricular time in every science course during the first two years of medical school.
PBL facilitators were trained on non-inclusive terminology and strategies for creating classrooms that are inclusive of all genders, races, and ethnicities.
There have been challenges with diversifying the curriculum. First, it is a slow process — diversity can’t be “sprung” on faculty or students, so sufficient time had to be given for them to adjust. Second, faculty frequently were not on the same page when it came to making the changes. And third, the curriculum was already extremely full, so adding more content was difficult.
One of the greatest successes in diversifying the curriculum was the training of the small-group facilitators. Over a two-month period, we delivered 13 Diversity and Cultural Sensitivity sessions to 156 PBL course facilitators. These included an after-session survey to measure three dimensions of the learning effectiveness: 1) knowledge gained from the session; 2) actions inspired by the session; and 3) desired future learning needs.
We analyzed the responses for the last 11 training sessions. In total, 77 percent of physicians and faculty members, 15 percent of students, 5 percent of administrators, and 3 percent of other staff participated. Physician representation in each session ranged from 58 to 100 percent, and student representation ranged from none to 42 percent. Even though the discussion among the audience played a role in the survey outcomes, no correlation was found between the composition of the audience and the learning effectiveness. The survey revealed the following:
Thirty percent of respondents said 50 percent or more of the content was new knowledge to them.
Eighty-eight percent listed a specific action they will take to advance diversity and inclusion at the college as a result of what they learned.
The respondents identified their topic areas for further education: microaggressions, unconscious bias, and LGBTQ+ inclusion.
In addition to training the small-group facilitators, the college’s PBL course directors agreed to review all case scenarios for the incorporation of diversity into the fact patterns. For example, one case involving a female patient who had experienced stomach pains and depression was modified to add that the patient had served in the military but had returned to civilian life. This change allowed students to identify a learning objective related to the experiences of being in the military, patient care options in military versus civilian hospitals, and experiences serving in combat that can lead to a patient’s medical challenges.
The training of the small-group facilitators and the revision of the case scenarios were two of 18 recommendations developed by the college’s curriculum task force that were ultimately approved by the curriculum committee and implemented. An additional recommendation, establishing a director of inclusive medical education who will lead the diversification of the curriculum, has also been enacted. Next steps include the creation of an action plan for implementing the remaining recommendations.
As patients become more diverse, incorporating diversity into the medical school curriculum will become increasingly critical to providing students with education on how to effectively care for individuals from different backgrounds. Including students and faculty in the decision-making process ensures that faculty become engaged in diversification efforts and that students, as customers, share what is important to them.●
Lynette Chappell-Williams, JD, is chief diversity officer and associate dean for diversity and inclusion at Penn State Health Milton S. Hershey Medical Center and Penn State College of Medicine. She is also a member of the INSIGHT Into Diversity Editorial Board. Nancy Adams, EdD, is associate librarian, assistant dean of foundational sciences, and coordinator for education and instruction at Penn State College of Medicine. Jing Wang is project manager of diversity and inclusion analytics at Penn State Health Milton S. Hershey Medical Center and Penn State College of Medicine. This article was published in our December 2018 issue.