Later is too late: Exploring student experiences of diversity and inclusion in medical school orientation

Buuren, Asia van; Yaseen, Wid; Mylopoulos, Maria; Law, Marcus

doi:10.1080/0142159x.2021.1874326

Cited by 15 publications

(12 citation statements)

References 24 publications

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“…Groups of students are being denied equitable educational experiences in both university and clinical settings. Measures towards inclusion often effectively require suppression of minority identities and cultures, and assimilation of dominant, privileged culture and practices (17), disrupting both professional identity formation and belonging (39)(40)(41), dynamics also highlighted in ndings here. Negative experiences, including microaggressions, framing inappropriate behaviours as jokes and direct and indirect exclusions and are disruptive to students' professional identity formation and belonging as minoritized identities are devalued (8,9,37,42).…”

Section: Impact On Learning and Professional Identify Formationmentioning

confidence: 76%

Medical Student Experiences of Equality, Diversity, and Inclusion: an Ecological Systems Theory Analysis

Nolan

Owen

2023

Preprint

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Background Issues relating to equality, diversity, and inclusion (EDI) significantly impact on medical student achievement and wellbeing. Interventions have been introduced at curricular and organizational levels, yet progress in addressing these issues remains limited. Timely evaluation is needed to assess effectiveness of interventions, and to explore issues and interactions in learning environments impacting on student experience. We introduced an anonymous question concerning students’ experiences of EDI into routine online student feedback questionnaires, to scope the nature of ongoing issues and develop greater understanding of students’ experiences in our programme environment. Ecological systems theory, which conceptualizes learning as a function of complex social interactions, determined by characteristics of individual learners and their environment, provides a framework for understanding.Methods Free-text responses regarding experiences of EDI gathered over 20 months from all programme years (n = 760) were pooled for analysis, providing a holistic overview of experiences in the learning environment. Content analysis of the qualitative dataset was undertaken. Bronfenbrenner’s ecological systems model was applied as a framework to demonstrate interdependencies between respondents’ experiences and environments, and associated impacts.Results Three hundred and seventy-six responses were received relating to wide-ranging EDI issues, most frequently gender or ethnicity. Responses mapped onto all areas of the ecological systems model, with frequent links between subsystems, indicating considerable complexity and interdependencies. Interpersonal interactions and associated impacts like exclusion were frequently discussed. Differential experiences of EDI-related issues in medical school compared to clinical settings were reported. Impacts of institutional leadership and wider societal norms were considered by respondents. Respondents discussed their need for awareness of EDI with reference to future professional practice.Conclusions Implementation of a regular free-text evaluation question allowed data-gathering across cohorts and throughout several stages of the curriculum, illuminating student experience. Connections established demonstrated intersectionality and how environment and other factors interact, impacting on student experiences. Students experience EDI-related issues on multiple levels within the educational environment, with consequent impacts on learning. Any successful approach towards tackling issues and promoting equity of opportunity for all requires multi-level actions and widespread culture change. Students may better understand change needed than staff. Student voice should be enabled to shape change.

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Section: Impact On Learning and Professional Identify Formationmentioning

confidence: 76%

Medical Student Experiences of Equality, Diversity, and Inclusion: an Ecological Systems Theory Analysis

Nolan

Owen

2023

Preprint

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“…In fact, in a recent qualitative study, first-year medical students at 2 Canadian medical schools remarked on the complex social pressures that appear during orientation, especially with negotiating the dominant identity of medical professional, and how these pressures exposed diversity and inclusion dynamics from these very first days. 28 In teaching and modeling RCC skills, faculty can provide an environment that establishes a positive learning climate. At the same time, the orientation is an introduction requiring longitudinal practice and long-term follow-up.…”

Section: Discussionmentioning

confidence: 99%

Start the Way You Want to Finish: An Intensive Diversity, Equity, Inclusion Orientation Curriculum in Undergraduate Medical Education

Davis

Tran-Taylor

Imbert

et al. 2021

Journal of Medical Education and Curricular Development

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Problem: Medical students often feel unprepared to care for patients whose cultural backgrounds differ from their own. Programs in medical schools have begun to address health: inequities; however, interventions vary in intensity, effectiveness, and student experience. Intervention: The authors describe an intensive 2-day diversity, equity, and inclusion curriculum for medical students in their orientation week prior to starting formal classes. Rather than using solely a knowledge-based “cultural competence” or a reflective “cultural humility” approach, an experiential curriculum was employed that links directly to fundamental communication skills vital to interactions with patients and teams, and critically important to addressing interpersonal disparities. Specifically, personal narratives were incorporated to promote individuation and decrease implicit bias, relationship-centered skills practice to improve communication across differences, and mindfulness skills to help respond to bias when it occurs. Brief didactics highlighting student and faculty narratives of difference were followed by small group sessions run by faculty trained to facilitate sessions on equity and inclusion. Context: Orientation week for matriculating first-year students at a US medical school. Impact: Matriculating students highly regarded an innovative 2-day diversity, equity, and inclusion orientation curriculum that emphasized significant relationship-building with peers, in addition to core concepts and skills in diversity, equity, and inclusion. Lessons learned: This orientation represented an important primer to concepts, skills, and literature that reinforce the necessity of training in diversity, equity, and inclusion. The design team found that intensive faculty development and incorporating diversity concepts into fundamental communication skills training were necessary to perpetuate this learning. Two areas of further work emerged: (1) the emphasis on addressing racism and racial equity as paradigmatic belies further essential understanding of intersectionality, and (2) uncomfortable conversations about privilege and marginalization arose, requiring expert facilitation.

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“…Along with a better understanding of the educational process, including more refined theories and their practical implementations, increasing awareness of the importance of diversity, equity, and inclusion (DEI) brought much-needed reforms that focused on optimization of outcomes while providing highly individualized approaches and emphasis on "building on one's strengths" [29][30][31][32]. Such concepts are becoming more and more important as physicians need to understand, appreciate, and converse with an extremely broad range of demographics and individual identities.…”

Section: Diversity Equity and Inclusionmentioning

confidence: 99%

Introductory Chapter: Medical Education at the Crossroads - Things Are Not How They Used to Be, Things Are Not as They Seem

Firstenberg¹,

Stawicki²

2022

Medical Education for the 21st Century

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Later is too late: Exploring student experiences of diversity and inclusion in medical school orientation

Cited by 15 publications

References 24 publications

Medical Student Experiences of Equality, Diversity, and Inclusion: an Ecological Systems Theory Analysis

Medical Student Experiences of Equality, Diversity, and Inclusion: an Ecological Systems Theory Analysis

Start the Way You Want to Finish: An Intensive Diversity, Equity, Inclusion Orientation Curriculum in Undergraduate Medical Education

Introductory Chapter: Medical Education at the Crossroads - Things Are Not How They Used to Be, Things Are Not as They Seem

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