Addressing disparities in medicine through medical curriculum change: a student perspective

Didactic faculty checklist

This checklist (Figure 1) prompts teaching faculty to reconsider images they are including and examine whether the presented content perpetuates stereotypes about underrepresented groups. Furthermore, it guides teaching faculty to ensure that referenced images and other sources are up-to-date and evidence-based.

Figure 1:

The didactic faculty checklist items to be considered by faculty developing teaching materials such as lecture slides, patient cases, worksheets, and videos.

Facilitator question script

In order to further supplement small-group case-based learning courses, a suggested facilitator question script was developed (Figure 3). This script details a series of questions to be asked of small groups during case-based learning courses. Its purpose is to encourage small group facilitators to initiate discussions regarding race, social determinants of health, and cultural competency. Engaging in dialog in small groups could be a promising method to hone critical thinking skills when discussing sensitive topics. We anticipate that medical schools will develop comprehensive faculty training in order to ensure that student-facilitator encounters take place in a supportive environment where students have the opportunity to make mistakes and learn from one another.

Figure 3:

Facilitator question script aimed at encouraging facilitators to initiate discussions and inspire critical thinking about patient cases during small-group case-based learning sessions.

Student reflection form

This form (Figure 4) is intended to be utilized for students who are on clinical rotations. Its purpose is to help students think about their role in the medical system and address various health disparities, racism in healthcare, or microaggressions. The authors felt it was important to prompt the students to reflect on how they might practice medicine differently as a physician so that students are proactively thinking about how they may prevent or address these situations as they continue in their medical careers. These forms may be submitted to the dean’s office, a diversity task force office that develops medical curricula, and/or physician mentors (if the medical school has a mentorship program in place). This tool may be utilized to determine how frequently students encounter difficult situations regarding race, gender, or socioeconomic status and which clinical rotation sites have these encounters happen more frequently. With this knowledge, they may determine if additional support, mentorship, or training would be needed in the medical curricula as a whole or within specific training sites. It may be utilized as a tool to help students anchor their cultural competency training to real-world scenarios. If utilized as a jumping-off point for discussion with senior faculty (senior medical students or physicians who have trained in cultural competency), this tool can extend cultural competency training to clinical rotations.

Figure 4:

Student reflection form.

Limitations and future considerations

Student involvement was based upon voluntary signup, which resulted in a limited study cohort. This study may be improved by receiving feedback from the entire student body. Future research includes statistical analysis on the effectiveness of these tools in improving cultural competency and developing more objective tools for assessing the cultural competency of medical curricula.

One limitation of these curricular changes is their lack of focus on racial minorities. Although these tools may be expanded to include many other marginalized groups, focus on all minority groups and overlap within these groups (such as Black transgender patients) must be considered. Additional exploration focusing on the implicit bias regarding these factors would be beneficial to expanding these proposed curriculum changes. Furthermore, the investigation of social determinants of health within the realm of osteopathic manipulative medicine was not examined. Considerations for curriculum change specific to osteopathic manipulative training in medical school is another avenue of curricular change that should be explored. Finally, the student reflection form is only utilized to identify racial, gender, and socioeconomic disparities. Although there is space for students to discuss other disparities, this tool can be expanded to prompt students to reflect on disparities with the LGBTQIA + communities, patients with disabilities, etc.

The student reflection form is best utilized when there is protected time for students to navigate these situations with a physician mentor. If left unaddressed, there is a missed opportunity for students to learn how to effectively address problems such as racism or microaggressions within the workspace. Mentorship groups can be formed around this feedback form to support medical students if they encounter difficult situations while on clinical training (microaggressions against themselves or anyone else in the medical setting). A small group of medical students may meet with their mentor after each rotation to discuss the results of their reflection forms and gain feedback from peers and (cultural competency trained) physician mentors. After each year, these responses may be compiled from all students and reviewed by a diversity task force committee to determine if any updates to cultural competency training are required, especially training in the preclinical years.

Furthermore, the authors feel that a panel discussion provided to medical students just before embarking on clinical rotations may offer a pivotal opportunity to prepare students to handle microaggressions or other similarly complex scenarios in the workplace. Those students who submitted reflection forms the prior year may wish to speak to rising third-year medical students on the best way to handle these difficult scenarios. A cultural competency-trained physician may moderate these student panelists. The authors propose a three-tiered approach — student reflection, small group discussion, and facilitated panel discussion — to rising third-year students in order to provide robust cultural competency training in the clinical years to anchor training to real-life scenarios. A diversity task force from which all of these initiatives may be organized will greatly support the organizational structure needed in updating medical curricular changes.