Curiosity, Humility, and Accountability: Key Elements to Advance a Culture of Diversity, Equity, and Inclusion in Health Professions Education

Background

Health professions education has struggled to eliminate bias based on race and other demographic identifiers. Just as such biases have been historically woven into the legal, financial, and housing industries, health professions education has been impacted by systemic racism. Consequently, newly trained health professionals are graduating from programs with curricula that may fail to acknowledge the inherent biases and may have gaps addressing diversity, equity, and inclusion which have been unconsciously incorporated into their core teachings. Examples of these limitations include course materials that use gender-specific language for sexual health topics, textbooks and diagrams that exclusively use light skin tones as models and representations of skin diseases, and epidemiologic data that indicates individuals of a particular racial or ethnic demographic have a propensity for a particular disease. Evidence has shown that these limitations perpetuate unconscious biases amongst health professionals, leading to race essentialism (Herd et al., 2021; Rhodes & Moty, 2020) and can negatively impact health outcomes (Amutah et al., 2021).

Reexamining the inherent biases in health professions curricula is a necessary step to begin to address how biases perpetuate health disparities amongst marginalized groups. Medical, physician assistant, dental, nursing, and other health professions students benefit from curricula that directly and intentionally address the patient diversity that trainees will see in future clinical practice. Patients often have intersectional identities with complex and individualized social determinants of health, which should not be simplified to race or socioeconomic status alone. Health professions students must be trained to see beyond their own unconscious biases and recognize the limits of their own lived experiences. Only then can students begin to identify inherent biases built into the healthcare system and understand the challenges patients face in overcoming them.

By nature of current events and internet-based grassroots movements for social justice, today’s health professions students are more aware of their own biases and of historic injustices towards marginalized groups in healthcare (Brooks, 2015). Yet health professions educators are uniquely positioned to encouragae trainees to consider how that awareness can translate to clinical practices and professional actions which can directly address disparities and gaps in care for patients historically marginalized (Cuellar et al., 2008). Health professions educators not only have a responsibility to instruct students in the basic science and technical aspects needed for their future careers, but also have an ethical duty to mentor them on how to become effective and altruistic practitioners and caregivers (“Beyond the Curriculum: Academic Nursing’s Responsibility for Excellence in Diversity, Equity, and Inclusion.,” 2021). The spirit of service is inherent to clinical practice; society places health professionals in an important and powerful role to serve as patient advocates. With such power comes the responsibility to train health profession students to be mindful of both their individual impact on patients and their ability to become agents of systemic change at the population health level.

A major challenge to large scale improvements and change in health professions curricula is the fact that current educational models have numerous components, each of which is usually overseen by dozens, if not hundreds, of faculty members (Carter & Phillips, 2021). At many institutions, the preclinical component of the curriculum is split into several distinct units, each with a team of faculty leaders who oversee a subsection that is specific to their clinical specialty (McOwen et al., 2020). Attempting to address bias in every aspect of a curriculum at once would be a massive project. It is therefore necessary to institute a culture of change (Parkhurst et al., 2017), wherein the work to address bias in a curriculum is divided across many individuals and becomes a collective and continuous quality improvement effort. This effort would enable multiple approaches and perspectives to address different identities and their intersectionality, and encourage self-reflection from faculty and students alike (Haley & Brown, 2022). Establishing a culture of self-reflection and self-critique in the effort to address unconscious biases within ourselves and our health professions curricula requires administrators to promote three core values for their entire education community: curiosity, humility, and accountability.