Equality and Diversity Awareness in Undergraduate Medical Education
Johnny Boylan discusses what is happening in the UK and beyond
There is clear evidence that, throughout the world, people from ethnic and cultural minorities experience inferior health care compared to the majority, dominant population. In the United States this applies to African-Americans, the Hispanic population and American Indians; in France to people of North African descent; in Germany to Turkish migrant workers; in Turkey to the Kurds; in Israel to Jews from Ethiopian, North African and Russian backgrounds; and in the United Kingdom to people of Indian, Pakistani and West Indian origin.(1)
This international healthcare issue has led to an increased awareness of the need to educate medical undergraduates in equality and diversity issues (2): for example in Britain in 2007 when the BMA produced their guidelines on Equality and Diversity Education. (3) In addition there is evidence that such educational programmes have positive outcomes and that participant attitudes changed over the period of the teaching. (2)
However, despite such an ostensibly promising background, it seems that the delivery of such programmes in UK universities leaves something to be desired. A recent study, to which 97% of medical schools in the UK and Republic of Ireland responded, concluded that while some progress is being made, the teaching of equality and cultural diversity in UK medical schools seems rather fragmented and a great deal of uncertainty seems to exist about what constitutes diversity teaching. (4)
One possible approach to equality and diversity education has been described.(2) This module included the legal background, stereotyping exercises, exercises to explore perspectives on disability, personal cultural awareness development, interviews with people perceived to be culturally similar or different, barriers to effective cross-cultural communication and scenarios to explore clinical aspects of diversity issues. The objectives included developing students’ knowledge of existing anti-discrimination legislation, developing the skills required to meet people’s cultural needs sensitively within a clinical context and how to demonstrate respect for patients and colleagues from diverse backgrounds.
This is comprehensive and seems a model of good practice. However the BMA clearly states (3) :
- ‘Equality awareness needs to imbue everything a student and clinician does. It is not something that can be compartmentalised’.
- ‘Medical education programmes should have at their core respect for diversity and the promotion of equality. Stand alone training programmes about equality and diversity are of limited value except perhaps as part of a multi-professional programme. Training also suggests a tickbox approach and infers a learned behaviour rather than an understood behaviour. Education, on the other hand, enables an understanding and use of understanding in different situations’.
- ‘Equality and diversity education should be integrated throughout medical education from undergraduate education through post-graduate training to continuing professional development. Standards need to be set, and education programmes with consistent messages need to be developed, to enable students and doctors to gain the competence to meet those standards’.
- ‘A common misconception about equality and diversity education is supposing that doctors need only to understand how the minority differ from the majority, for example knowing about different cultures’ customs and protocols. This knowledge can lead to incorrect assumptions because people are complex: every patient met, and every encounter, is potentially different.’
In other words stand-alone training modules on equality and cultural diversity are likely to be less effective than a coherent medical education process which addresses these issues throughout because diversity education should not be a separate element within medical education. Students should be taught to treat patients as individuals and not stereotyped according to general assumptions about their culture, ethnicity or disability. (5)
How to do this in a systematic, coherent fashion in undergraduate medical education is the challenge which faces medical educators. No doubt it will be disruptive at a time of seemingly endless change. However the rewards are great because equality and diversity awareness develops skills which are essential for competent professional practice.
The dimensions of professional medical competence have been described. (6) They include cognitive, technical, integrative, context, relationship, habits of mind and affective/moral. The affective/moral dimension encompasses tolerance of ambiguity and anxiety, emotional intelligence, respect for patients, responsiveness to patients and society, and caring.
Diversity awareness helps develop all these dimensions of professional competence. For example it has been argued that there will always be fundamental uncertainty in medical practice because each person is unique. (7) Equality and diversity awareness development is as much about responding to the unique needs of each individual as it is about understanding the cultural perspectives of diverse social groups.
Moreover practising medicine in a way which respects equality and diversity requires emotional intelligence. Goleman (8) suggests that emotional intelligence involves being aware of your own feelings, understanding the feelings of others, managing your feelings in an appropriate way, using your emotional awareness for motivational reasons and to facilitate your personal and professional interactions with others. Diversity education has the potential to develop such emotional intelligence because it involves self-awareness, empathy with others and the use of this insight in a helpful way in our professional role.
Therefore, integrating diversity education within all aspects of the undergraduate medical curriculum is justified on grounds that all patient groups will be diverse in terms of gender, age, religion, beliefs, values, ability, disability, culture, class, race, ethnicity and sexual orientation. In addition each patient may differ in the extent to which they subscribe to their anticipated group norms. Equality and diversity awareness is crucially important in the education of all young doctors, throughout the world, because it develops some of the core competencies doctors need if they are to behave in a caring, respectful and professional way towards all their patients and, in doing so, attempt to meet their diverse needs.
Johnny Boylan
3rd year medical student
Queen’s University
Belfast
johnnyboylan@hotmail.com
(1) Geiger,H.J. Racial stereotyping and medicine; the need for cultural competence. CMAJ. June 12 2001; 164 (12).
(2)Dogra, N. The development and evaluation of a programme to teach cultural diversity to medical undergraduate students. Medical Education 2001,35:232-241.
(3) BMA (2007) Equality and diversity education. Available online at www.bma.org.uk/ap.nsf/Content/equalitydiversityeducation
(4) Dogra, N. et al. Teaching of cultural diversity in medical schools in the United Kingdom and Republic of Ireland: Cross sectional questionnaire survey. BMJ 2005; 330:403-404.
(5) Kai, J. Teaching equality in healthcare for a diverse society. Ethnicity, health and primary care. Oxford: Oxford University Press, 2003: 27-37.
(6)Epstein, R.M. and Hundert, E.M. Defining and assessing professional competence. JAMA, Jan 2002; 287:226-235.
(7.) Dogra, N. et al. Cultural diversity teaching and issues of uncertainty: the findings of a qualitative study. BMC Medical Education 2007, 7:8. Published online 2007 (accessed 16/08/2007).
(8) Goleman, D. (1996) Emotional Intelligence: Why It Can Matter More Than IQ. London:Bloomsbury.
Bookmark on delicious | Digg