Teaching Cultural Humility and Implicit Bias to Veterinary Medical Students: A Review and Recommendation for Best Practices

Abstract

Cultural humility, with its concomitant understanding of the importance of the influences of diversity and inclusion, improves health outcomes in the human medical field. Recent changes to the American Veterinary Medical Association Council on Education requirements in veterinary medicine include teaching the impact of implicit bias on the delivery of veterinary medical services. Because overt enhancement of self-awareness is not fodder for traditional veterinary medical education delivery systems, in this article we review existing literature on the impact of recognition of implicit bias on health care and offer insights on ways to help veterinary students learn this skill, drawing on evidence from an inter-professional intervention called WisCARES (Wisconsin Companion Animal Resources, Education, and Social Services).

A Qualitative Analysis of Clinical Year Veterinary Student Journal Entries for a Shelter Medicine Rotation

“…There is ample literature demonstrating that facilitated discussion and reflective journaling has been found to be key to improving cultural competence in medical, pharmacy, public health, dental, and veterinary students ( 37 , 65 – 70 ). There is also evidence that reflective skills and reflective practice seem to be essential for continuing personal and professional development in young veterinarians ( 71 ).…”

“…Additionally, in 2016, the AVMA COE expanded curriculum standards to ensure opportunities for students to “…gain and integrate an understanding of the important influences of diversity and inclusion in veterinary medicine, including the impact of implicit bias…” as well as the skills necessary for caring for the well-being of animals in the “context of ever-changing societal expectations” ( 11 ). Shelter medicine training can provide an authentic clinical experience that not only fulfills gaps in veterinary curriculum ( 25 – 32 ) but also provides service-learning opportunities ( 33 – 35 ) which creates an environment for students to engage in and gain a deeper understanding of cultural humility, implicit bias, diversity, and inclusion ( 36 , 37 ).…”

“…Studies in human medical fields have found that CBR projects and service-learning may impact professional and personal growth ( 54 ), increase confidence in one's ability to communicate effectively with their patients ( 55 , 56 ), improve overall communication and interviewing skills ( 57 ), improve self-confidence and self efficacy ( 58 ), and enhance students' perceptions of their clinical reasoning skills ( 59 – 64 ). Additionally, facilitated discussion and reflective journaling are identified in literature as key to improving cultural competence in medical, pharmacy, public health, dental, and veterinary students ( 37 , 65 – 70 ). There is also evidence that reflective skills and reflective practice seem to be essential for continuing personal and professional development in young veterinarians ( 71 ).…”

“…Finally, this review suggests there is a care gap in veterinary medicine and animal welfare because clients do not understand the importance of and need for routine pet care ( 18 , 72 ). While there is literature in veterinary medicine assessing service-learning programs utilizing shelter medicine ( 33 – 35 , 38 ), and literature assessing service-learning's impact on veterinary students not specific to shelter medicine ( 36 , 37 ), to the author's knowledge there has not been a study evaluating authentic-learning experiences specific to a shelter medicine program and its potential impacts on students.…”

“…Reflective journaling has been utilized as an educational tool for students in various human medical fields as well as a way to evaluate a program's efficacy through qualitative analysis ( 37 , 65 – 70 , 73 – 75 ). While most qualitative approaches seek to arrive at an understanding of a particular phenomenon from the perspective of those experiencing it, qualitative content analysis is appropriate when existing theory or research literature on a phenomenon is limited ( 76 ).…”