Representation of diversity within written patient cases: Exploring the presence of a “hidden curriculum”

Abstract

Background: There are urgent calls to dismantle systemic racism and discrimination in pharmacy education and practice. It is recommended that educational programs critically review learning materials for occurrences of stigmatization that may reinforce population biases and stereotypes. Previous studies, as well as premises from race and queer theories, suggest that written cases that do not appropriately include or acknowledge patient diversity may promote a "hidden curriculum" that may foster implicit biases in student healthcare professionals. Objectives:The purpose of this study was to explore the existence of a "hidden curriculum" within case-based learning materials by determining the extent to which underrepresented populations were represented in case descriptions and how representation occurred within groups.Methods: This was a qualitative content analysis of written patient cases (n = 76) used throughout the problem-based learning curriculum at the College of Pharmacy, Dalhousie University (Halifax, Nova Scotia, Canada). Proportions were calculated for each variable identified to represent the categories of interest (race, gender, sexual orientation, relationship status, and presence of disabilities). Quantified data were analyzed and themes were identified to represent each category assessed.Results: Data across all categories were mostly "undefined." The most defined variables within each category were: white (race, 17.1%), female (gender, 53.9%), heterosexual (sexual orientation, 35.2%), married (relationship status, 29.6%), and wheelchair (disability, 1.3%). Defined variables were representative of dominant cultural groups with little representation of underrepresented populations. Themes identified were undifferentiated (race), binary (gender), heteronormative (sexual orientation), traditional (relationship status), and absent (disabilities). Conclusion:Findings support the notion that there may be a "hidden curriculum" reinforcing biases and stereotypes due to the undefined nature of the cases. Educators should prioritize inclusion of diversity within cases as part of a coordinated plan, in order to ensure representation is appropriate and well-distributed across the curriculum.

Hetero‐ and cisnormativity—UK pharmacy education as a queer opponent

“…Where previous studies 20,33,34,38–40 have sought to establish the extent of LGBTQI+ representation in undergraduate curricula, given medical and health professions curricula still struggle with designing inclusive programmes suggests that either educators are not acting on the findings of this research or that they are unsure of how to enact representation in their pedagogic practice. To this end, the research presented here adopts the lens of queer pedagogy to critique heteronormative hegemonic power.…”

“…Consequently, in 2022, the British Medical Association (BMA) renewed its call for teaching and learning about LGBTQI+ people and their health needs in undergraduate and postgraduate medical education and for the removal of stereotyped teaching. 37 Where previous studies 20,33,34,[38][39][40] have sought to establish the extent of LGBTQI+ representation in undergraduate curricula, given medical and health professions curricula still struggle with designing inclusive programmes suggests that either educators are not acting on the findings of this research or that they are unsure of how to enact representation in their pedagogic practice. To this end, the research presented here adopts the lens of queer pedagogy to critique heteronormative hegemonic power.…”

“…32,33 It is not just pharmacy education that needs to include representation of LGBTQI+ people. There is evidence that medical and other health profession curricula exclude sociocultural information in case studies or clinical presentations 24,34 at the expense of the role that culture and identity play in health and well-being. Arguments that medical education fails to train doctors to address LGBTQI+ health inequalities, and ignores LGBTQI+ people and/or medicalises queer issues, persist as a product of a training gap.…”

Patient representation in New Zealand general practice and rural health case-based teaching: a quality improvement exercise

“…Explicit biases are conscious attitudes, whereas implicit biases are unconscious cognitive associations. 8 Medical school culture can teach and reinforce biases, 9,10 influencing how students respond to their patients. 11 A biased health workforce is one driver of inequity.…”