Lynette Reid introduces the work accomplished at Dalhousie to diversify the case-based studying curriculum within the medical program.
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Medical educators in Canada have been implementing an accreditation normal round social accountability as a part of de-coupling our accreditation course of from the USA (achieved this previous summer time). As well as, medical observe and the medical sciences are quickly altering in relation to problems with variety and inclusion. The confluence of those influences was the stage for an essential curriculum revision we undertook at Dalhousie in 2022-24.
Lately, I chaired a curriculum mission—“case diversification”— that I’m going to explain in a sequence of weblog posts.
Our medical college students have three case-based studying (CBL) tutorial discussions per week within the first two years of their curriculum. Our working group used an anti-oppressive lens to revise the 200 CBL session supplies (case narratives with dialogue questions and tutor notes). The preliminary objectives of the mission have been to diversify the sufferers portrayed within the medical case situations utilized in CBL and to overview the instances for dated and stigmatizing language and suggest revisions. However the work quickly expanded.
Photograph Credit score: pxhere. Picture Description: A photograph exhibiting a various group of health-care staff.
Anti-oppressive observe is a helpful framework for incorporating the care of equity-denied teams into medical observe. It’s now mirrored within the Medical Council of Canada qualifying examination aims. There are systematic and intersectional ways in which persons are privileged and deprived (e.g. colonialism, racism, cishetoronormativity, sexism, ableism), and these have an effect on well being (as social and structural determinants of well being) and healthcare. Clinically, anti-oppressive observe contains approaches like trauma and violence-informed care, inclusive observe (adaptation/common design), and affirming care.
The mission was extremely collaborative. A key participant was Leanne Picketts, a medical schooling practitioner who labored on it full time. Leanne has a background in simulated affected person schooling, curriculum design, and academic analysis. We met month-to-month with a committee that had interprofessional (social work), medical, biomedical, moral and epidemiological experience, employees experience in group engagement, program analysis, and evaluation, and naturally college students with lived and educational experience, expertise, and dedication to the work. The College of Drugs invested in employees and school collaboration within the mission and the suggestions of the working group got here with an expectation from management that (for probably the most half) our help in updating instances can be accepted. This was distinctive of Dalhousie’s method—in different faculties, this type of work has been accomplished on a student-led foundation, which sounds nice, however in actuality means downloading the work of school onto minoritized college students (the “conscripted curriculum”).
A vital perception that Leanne dropped at the method was the hyperlink between presenting various identities and enhancing the patient-centredness of the instances. The scholars advocated for including to every case a possibility for significant dialogue of the sufferers’ experiences of well being and well being care. Our visiting scholar from Social Work, Eli Manning—who very sadly handed away within the 12 months after the mission—introduced rigour and a powerful vital lens to our method to weaving collectively the social and the biomedical sciences. Once we piloted the method with the tutors, they requested that we offer particular tutor notes for every case. And as we reviewed for language, we noticed that behind language lay normative narratives and biases and assumptions constructed into the science. Our work prolonged from revising how the affected person id and medical care have been portrayed to updating the medical and medical science that was woven into the instances. We used the experience of individuals within the group to revise the affected person identities, edit the narratives, and add the dialogue questions; we had library help for on-demand speedy lit critiques. We did some centered group engagement and invited specialists exterior our group to participate in particular instances. We accepted (and remunerated) provides of assist when college students noticed what we have been doing and wished to see their communities higher represented.
Most days I used to be as a lot a thinker of science as I used to be an ethicist, though to be clear this work was not about my very own de novo critique of medical science. It was translational work: bringing probably the most up-to-date assets on intercourse, gender, capability, and race/ethnicity to our case authors and curriculum leaders for his or her consideration.
A key objective of our anti-oppressive method was to disrupt the normative assumption that, except acknowledged in any other case, the affected person is a 70 kg white male (who can be city, straight, cisgender and of medium to excessive socioeconomic standing). Every case was supplied with an upfront assertion of the affected person’s social id (gender id, sexual orientation, racialized id, indicators of socio-economic standing and incapacity; additionally faith and household formation). We elevated illustration of rurality and unfold the instances higher throughout the 2 provinces our medical college serves. We had targets for identities and audited as we went. We acknowledged these dimensions of id whether or not they have been “medically related” or not, and whether or not they have been normatively taken as a right or seen as “totally different”.
These opening id statements weren’t supposed to signify what it’s best to collect in a social historical past or put within the affected person’s chart. However in some methods these descriptions did “put sufferers in bins.” We resisted this categorization by together with descriptions of the ways in which sufferers accepted or resisted these social figuring out classes, or how sufferers discovered them related or not, or whether or not they would select to share or not, and with whom; the intersectionality of those identities additionally provided some resistance.
Within the following weblog posts, I’ll replicate on a few of the methods we approached dimensions of id: race and ethnicity; intercourse, gender and sexual orientation; incapacity; socio-economic standing; and Indigenous well being.
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Lynette Reid is an affiliate professor within the Division of Bioethics at Dalhousie College
