Race, ethnicity, and gender representation in clinical case vignettes: a 20-year comparison between two institutions

Abstract

Background The medical case vignette has long been used in medical student education and frequently includes demographic variables such as race, ethnicity and gender. However, inclusion of demographic variables without context may reinforce assumptions and biases. Yet, the absence of race, sexual orientation, and social determinants of health may reinforce a hidden curriculum that reflects cultural blindness. This replication study compared proportions of race, ethnicity, and gender with University of Minnesota (UMN) findings. This study sought to determine if there has been progress in the representation of demographic characteristics in case vignettes. Methods: University of North Carolina (UNC) case vignettes from 2015–2016 were analyzed and compared to UMN case vignettes from 1996–1998. Data included mentions of race, ethnicity, gender and social determinants of health. Results: In the 278 UNC vignettes, white race was noted in 19.7% of cases, black race was in 7.9% cases, and 76.6% of cases were unspecified. In the 983 UMN vignettes, white race was recorded in 2.85% cases, and black race in 0.41% cases. The institutions were significantly different in the proportion of their cases depicting race (0.20; 95% CI (0.15, 0.25)). Males were represented in the majority of vignettes. Discussion: Comparing case vignettes results from two medical schools suggests that reporting explicit demographic diversity was not significantly different. The findings illustrate that sex was the demographic characteristic consistently described, where males were over-represented. Based on these findings, greater cultural diversity as it intersects with social determinants of health is needed in medical student education.

Evaluating the domains of generalism and equity, diversity and inclusion in preclinical simulated cases for targeted curricular improvements

“…Minorities that are under-represented in medicine should be of particular interest for depiction in teaching cases, not just as patients but as the health professionals in the cases, so that students are able to further develop cultural awareness and cultural competency prior to beginning their clinical work. A study by Lee et al emphasized the importance of including diverse identities such as race, ethnicity, gender and sexual orientation in clinical case vignettes as failing to do so would perpetuate the cycle of cultural blindness [ 18 ]. However, while there is an impetus to include more diverse representation in curricular materials, it is important to ensure that appropriate context is provided as inclusion of different identities without such context may only serve to reinforce pre-existing biases and stereotypes [ 29 ] and fail to recognize the impact of SSDOH on the outcomes of individuals and particular communities [ 30 ].…”

“…Several groups have developed curriculum innovations regarding healthcare disparities [ 13–16 ], and others have developed strategies and tools to review teaching cases for diversity and inclusion [ 17 , 18 ]. One standout example was Krishnan et al [ 19 ], who reviewed the content of teaching cases used in the commercially available Aquifer platform ( https://aquifer.org/ ) widely used by North American undergraduate medical programs.…”

Using artificial intelligence to create diverse and inclusive medical case vignettes for education

“…Medical case vignettes are widely used for educational purposes, but they often fall short in representing the diverse patient population encountered in clinical practice. 1,2 The process of clinical reasoning begins the moment healthcare professionals access a patient's electronic health record. The patient's name may lead us to make assumptions about their ethnicity, while their prior medical history provides information about their condition and healthcare utilization.…”

“…Medical case vignettes are widely used for educational purposes, but they often fall short in representing the diverse patient population encountered in clinical practice 1,2 . The process of clinical reasoning begins the moment healthcare professionals access a patient's electronic health record.…”

Faster, higher, stronger – together? A bibliometric analysis of author distribution in top medical education journals

“…Many are written as commentaries and perspectives pieces, providing reflections on personal experiences and theoretical explorations of ways that dominant approaches (generally white and EuroAmerican centric) constrain and limit the field 23–31. There are some empirical studies examining various aspects of representation within medical education, with recent attention given to gender, sociocultural and racial equity within academic medicine’s leadership, student body and curricula 32–47. There is also growing documentation of the paucity of published voices from low-income and middle-income countries (LMICs) and non-English speaking scholars in medical education journals that position their reach as international 48–52.…”