Equity Diversity & Inlcusion - Recommended Reading

The Lancet Series on racism, xenophobia, discrimination, and health

Available at: www.thelancet.com/series/racism-xenophobia-discrimination-health

Executive Summary:

Racism, xenophobia, and discrimination exist in every modern society causing avoidable disease and premature death among groups who are often already disadvantaged. This Series examines how the historic systems and structures of power and oppression, and discriminatory ideologies have shaped policy and practice today, and are root causes of racial health inequities. Furthermore, by applying a global lens and intersectional framework, overlapping forms of oppression such as age, gender, and socioeconomic status and their impact on discrimination are analysed. Interventions to address the spectrum of drivers of adverse health outcomes with a focus on the structural, societal, legal, human right, institutional and system level are reviewed. Research recommendations and key approaches for moving forward are proposed.

Saleem Razack, Thirusha Naidu

Published:December 10, 2022DOI:https://doi.org/10.1016/S0140-6736(22)02454-0

Available at: Honouring the multitudes: removing structural racism in medical education - The Lancet

Divided: Racism, Medicine and Why We Need to Decolonise Healthcare

by Dr Annabel Sowemimo

In the wake of the COVID-19 pandemic, we are all too aware of the urgent health inequalities that plague our world. But these inequalities have always been urgent: modern medicine has a colonial and racist history.

Here, in an essential and searingly truthful account, Annabel Sowemimo unravels the colonial roots of modern medicine. Tackling systemic racism, hidden histories and healthcare myths, Sowemimo recounts her own experiences as a doctor, patient and activist.

Multicultural Council of Saskatchewan (2022), Resources for Anti-Racist Education.

Available at: https://mcos.ca/programs/anti-racism/resources/

Race Forward/Center for Social Inclusion (2022), Tools.

Available at: https://www.raceforward.org/practice/tools

Extract
One of the very few Black women's studies books is entitled All the Women Are White; All the Blacks Are Men, But Some of Us are Brave. I have chosen this title as a point of departure in my efforts to develop a Black feminist criticism because it sets forth a problematic consequence of the tendency to treat race and gender as mutually exclusive categories of experience and analysis.'

Crenshaw, K. (1989) ‘Demarginalizing the Intersection of Race and Sex: A Black Feminist Critique of Antidiscrimination Doctrine, Feminist Theory and Antiracist Politics’, University of Chicago Legal Forum, 1989(1), pp.139-167.

Available at: https://chicagounbound.uchicago.edu/uclf/vol1989/iss1/8

Abstract
The author presents a theoretic framework for understanding racism on 3 levels: institutionalized, personally mediated, and internalized. This framework is useful for raising new hypotheses about the basis of race-associated differences in health outcomes, as well as for designing effective interventions to eliminate those differences. She then presents an allegory about a gardener with 2 flower boxes, rich and poor soil, and red and pink flowers. This allegory illustrates the relationship between the 3 levels of racism and may guide our thinking about how to intervene to mitigate the impacts of racism on health. It may also serve as a tool for starting a national conversation on racism.

Jones, C.P. (2000), ‘Levels of racism: a theoretic framework and a gardener’s tale’, American Journal of Public Health, 2000(90), pp.1212-1215.

Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1446334/

Extract
Conceptions of race have evolved and become more nuanced over time. Most scholars in the biologic and social sciences converge on the view that racism shapes social experiences and has biologic consequences and that race is not a meaningful scientific construct in the absence of context. Race is not a biologic category based on innate differences that produce unequal health outcomes. Rather, it is a social category that reflects the impact of unequal social experiences on health. Yet medical education and practice have not evolved to reflect these advances in understanding of the relationships among race, racism, and health. More than a decade after the Institute of Medicine (IOM, now the National Academy of Medicine, or NAM) issued its report Unequal Treatment, racial/ethnic disparities in the quality of care persist, and in some cases have worsened. Such inequalities stem from structural racism, macrolevel bias intrinsic in the design and operations of health care institutions, and implicit bias among physicians. The majority of U.S. physicians have an implicit bias favoring White Americans over Black Americans, and a substantial number of medical students and trainees hold false beliefs about racial differences.

Amutah, C. at al (2021), ‘Misrepresenting Race — The Role of Medical Schools in Propagating Physician Bias’, The New England Journal of Medicine, 384, pp.872-878

Available at: https://www.nejm.org/doi/full/10.1056/nejmms2025768

Abstract

While students entering medical schools are becoming more diverse, trainees in residency programs in competitive specialties and academic medicine faculty have not increased in diversity. As part of an educational continuous quality improvement process at the University of California, San Francisco, School of Medicine, the authors examined data for the classes of 2013–2016 to determine whether differences existed between underrepresented in medicine (UIM) and not-UIM students’ clinical performance (clerkship director ratings and number of clerkship honors grades awarded) and honor society membership—all of which influence residency selection and academic career choices.

Teherani, A. et al (2018), ‘How Small Differences in Assessed Clinical Performance Amplify to Large Differences in Grades and Awards: A Cascade With Serious Consequences for Students Underrepresented in Medicine’, Academic Medicine: Journal of the Association of American Medical Colleges, 93(9), pp.1286-1292.

Available at: https://journals.lww.com/academicmedicine/Fulltext/2018/09000/How_Small_Differences_in_Assessed_Clinical.16.aspx

Abstract

Importance  Previous studies have found racial and ethnic inequities in the receipt of academic awards, such as promotions and National Institutes of Health research funding, among academic medical center faculty. Few data exist about similar racial/ethnic disparities at the level of undergraduate medical education.

Boatright, D. et al (2017), ‘Racial Disparities in Medical Student Membership in the Alpha Omega Alpha Honor Society’, Journal of the American Medical Association: Internal Medicine, 177(5), pp.659-665.

Available at: https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2607210

Abstract

Phenomenon: Performance during the clinical phase of medical school is associated with membership in the Alpha Omega Alpha Honor Medical Society, competitiveness for highly selective residency specialties, and career advancement. Although race/ethnicity has been found to be associated with clinical grades during medical school, it remains unclear whether other factors such as performance on standardized tests account for racial/ethnic differences in clinical grades. Identifying the root causes of grading disparities during the clinical phase of medical school is important because of its long-term impacts on the career advancement of students of color.

Insights: This single institution study is among the first to document racial/ethnic disparities in MSPE summary words and clerkship grades while accounting for clinical clerkship final written examinations. A national focus on grading disparities in medical school is needed to understand the scope of this problem and to identify causes and possible remedies.

Low, D. et al (2019), ‘Racial/Ethnic Disparities in Clinical Grading in Medical School’, Teaching and Learning in Medicine, 31(5), pp.487-496.

Available at: https://www.tandfonline.com/doi/abs/10.1080/10401334.2019.1597724?journalCode=htlm20

National Academy of Medicine (2022), Assessing Meaningful Community Engagement: A Conceptual Model to Advance Health Equity through Transformed Systems for Health.

Available at: https://nam.edu/assessing-meaningful-community-engagement-a-conceptual-model-to-advance-health-equity-through-transformed-systems-for-health/

Abstract
Introduction: To describe structural changes that can be made in an emergency medicine residency program to increase diversity and foster an inclusive environment.
[…]
Conclusions: Implementation of a Diversity Committee in emergency medicine training programs can be an important tool to improve diversity on a structural level.

Bod, J. and Boatright, D. (2022), ‘Implementation of a Diversity Committee to Improve Structural Inclusion in an Emergency Medicine Residency’, Journal of Advances in Medical Education & Professionalism, 10(2), pp.126-130.

Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9005756/

Extract:

Dunlop, B.J. (2022),The Queer Mental Health Workbook A Creative Self-Help Guide Using CBT, CFT and DBT, London, UK: Jessica Kingsley Publishers.

Abstract

Background
The mental health and well-being of gender and sexuality diverse (GSD) people needs to be understood within a socio-political and cultural context.

Aims
In this paper, an intersectional, social and system-based framework for understanding the mental health and well-being of GSD people is presented, for practitioners within this field to consider GSD mental health experiences and challenges within context.

Materials and Methods
Starting with a consideration of the current landscape of understanding, pivotal theories and understandings within the field are outlined. The need for a framework that centralises intersectionality and broader systemic considerations is presented.

Results
The framework provided has an explicit focus on four key features: (1) intersectionality, (2) institutions, policies and laws, (3) people and groups and (4) social stories.

Discussion
Consideration of each of these ‘circles of influence’ can help practitioners to understand the multi-layered and intersectional experience of GSD folk and allows for an understanding of potential intervention at both an individual and systemic and societal level.

Conclusion
Use of such a framework in practice goes above and beyond what is currently available by centralising the role and impact of such wider systemic variables through an intersectional lens. The framework can be applicable worldwide given its flexibility to consider and apply pertinent policies, laws, people, groups and social stories within a particular country or culture.

Dunlop, B.J. and Lea, J. (2022), ‘It's not just in my head: An intersectional, social and systems‐based framework in gender and sexuality diversity’, Psychology and Psychotherapy, 96(1), PP.1-15.

Available at: https://bpspsychub.onlinelibrary.wiley.com/doi/full/10.1111/papt.12438

Abstract
Bisexual people demonstrate higher rates of Non-Suicidal Self-Injury (NSSI) in comparison to other groups. This study aimed to explore bisexual people’s experiences of sexuality, NSSI and the COVID19 pandemic. Fifteen bisexual people (16–25 years old) with experience of NSSI participated in online qualitative interviews. Thematic analysis was used. Preliminary findings were shared with a subset of participants for member-checking. Participants described experiences of falling between the binary worlds of heterosexuality and homosexuality and described discrimination and invalidation related to this. Lack of access to positive bisexual representation contributed to feelings of self-loathing, with NSSI used to manage emotions or self-punish. The effect of lockdown was not clear cut, depending on personal circumstances and meanings of social interaction for participants. There is a need for greater recognition of significant societal narratives around bisexuality within clinical formulations of mental health difficulties and NSSI within this population.

Dunlop, B.J. et al (2021),‘”Why is it so different now I’m bisexual?”: young bisexual people’s experiences of identity, belonging, self-injury, and COVID19’, Pyschology and Sexuality, 13(3),pp. 756-773.

Available at: https://www.tandfonline.com/doi/abs/10.1080/19419899.2021.1924241?journalCode=rpse20

Abstract
Self-disclosure for mental health practitioners can have benefits for the therapeutic relationship. Most practitioners, however, are wary of doing so, or do not know how to navigate this. This paper aims to present a comprehensive framework to assist mental health practitioners when choosing to self-disclose lived experiences. This framework was created by a working group of academics, clinicians, service users and recovery workers, based on an international project investigating self-disclosure among professionals. Results from this project informed the content of this framework, considering theoretical models of supervision to guide development. The Sharing Lived Experiences Framework (SLEF) details six areas for practitioners to consider: Preparedness, Confidence, Competence, Relevance, Comfort and Supervision. The connection between preparedness and supervision is emphasised. Preliminary data on the SLEF indicates that staff felt more able to navigate disclosure after training on this framework. To the authors’ knowledge, this is the first comprehensive framework to guide practitioners through the disclosure process; from planning, to in-the-moment considerations, to post-disclosure reflection. Although limited available data exist on clinical utility, the SLEF crucially provides a framework for supervision discussions and guided self-reflection for a full range of practitioners on a range of lived experiences.

Dunlop, B.J. et al (2021), ‘Sharing Lived Experiences Framework (SLEF): a framework for mental health practitioners when making disclosure decisions’, Journal of Social Work Practices, 36(1), pp. 25-39.

https://www.tandfonline.com/doi/abs/10.1080/02650533.2021.1922367?src&journalCode=cjsw20

Extract
According to a 2019 study,1 medical student disclosure of disability increased by 69% from 2016 to 2019. In a comparison of data from schools that responded both years, the largest gain was in psychological disability. To better understand whether a meaningful proportion of students with mental health diagnoses disclose their disability, we assessed the proportion of MD students reporting psychological disabilities and examined subcategories of psychological disability.

Meeks, L.M. et al (2020), ‘Assessment of Disclosure of Psychological Disability Among US Medical Students’, Journal of the American Medical Association: Network Open, 3(7).

Available at: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2768564

Abstract
Background:
This study aimed to evaluate and report the national prevalence of disability across undergraduate medical education (UME) and examine differences in the category of disability, and accommodation practices between allopathic (MD)- and osteopathic (DO)-granting programs.

Methods:
Between May 20 and June 30, 2020, 75% of institutional representatives at eligible DO schools responded to a web-based survey. The survey assessed the aggregate prevalence of disabled DO students, prevalence of DO students by category of disability, and prevalence of accommodations granted. Descriptive statistics were used to summarize results. Using 2019 MD data, comparisons were made between MD and DO programs to calculate overall prevalence and differences in accommodation practices across undergraduate medical education.

Results:
DO-granting programs reported a disability prevalence of 4.27% of the total enrollment. Attention-deficit/hyperactivity disorder (ADHD), psychological disabilities, and chronic health disabilities were reported most frequently. DO-granting programs reported higher rates of ADHD than the MD-granting program. The national pooled prevalence of disability across MD- and DO-granting programs was 4.52%. MD-granting programs reported a higher number of students with disabilities and higher rates of psychological disabilities when compared with DO-granting programs. One hundred percent of DO students disclosing disability received some form of accommodation. General clinical accommodations were more frequently provided in MD-granting programs when compared to DO-granting programs.

Meeks, L.M. et al (2020), ‘National Prevalence of Disability and Clinical Accommodations in Medical Education’, Journal of Medical Education and Curricular Development, 20th Oct.

Available at: https://journals.sagepub.com/doi/10.1177/2382120520965249#core-collateral-self-citation

Abstract

Curry, R.H., Meeks, L.M. and Iezzoni, L.I. (2020), ‘Beyond Technical Standards: A Competency-Based Framework for Access and Inclusion in Medical Education’, Academic Medecine, 95(12S), pp. 109-112.

Available at: https://journals.lww.com/academicmedicine/Fulltext/2020/12001/
Beyond_Technical_Standards__A_Competency_Based.18.aspx

Abstract

Problem

When medical students with disabilities fail, identifying the underlying cause is challenging. Faculty unfamiliar with disability-related barriers or accommodations may falsely attribute academic struggles to disability. Fear of legal action may prompt inappropriate promotion of students with disabilities who are struggling to meet competencies. Therefore, a clear understanding of the origin of difficulty is critical to determining an appropriate response to the student’s failure, including revision of accommodations, academic remediation, probation, and dismissal.

Approach

A large Midwestern medical college created an innovative approach to differentiate between disability-related barriers and academic deficits by creating a diagnostic objective structured clinical examination (OSCE). The goal of this OSCE was to determine the need for additional or refined accommodations versus clinical remediation, and to guide future decision making about a student on academic probation. Using 3 simulated cases that drew on a cross section of clinical knowledge, a team of clinical and disability specialists observed a disabled student to determine the origin of that student’s difficulties in a clinical rotation.

Outcomes

Using the diagnostic OSCE, the team quickly identified clinical reasoning and fund of knowledge deficits, and need for further accommodations. As a result, the team was able to remediate the clinical deficits, augment the current accommodations in vivo, and determine the potential impact on performance. The team approach was documented and facilitated the legally required interactive process for determining additional barriers, efficacy of existing accommodations, and need for additional reasonable accommodations. All parties reported a positive experience. The collective knowledge and expertise of the team helped confirm the origin of the deficit: a fundamental lack of knowledge and reasoning skills versus a disability-related barrier.

Patwari, R., Ferro-Lusk, M., Finley, E. and Meeks, L.M.(2020), ‘Using a Diagnostic OSCE to Discern Deficit from Disability in Struggling Students’, Academic Medecine, 96(2), pp. 228-231.

Available at: https://journals.lww.com/academicmedicine/Fulltext/2021/02000/
Using_a_Diagnostic_OSCE_to_Discern_Deficit_From.39.aspx

Extract

Recognition of the need for equitable health care for people with disabilities and the need to appropriately educate the health-care workforce has emerged over the past few decades.
Although people with disabilities experience the same general health-care needs as other people, they are more likely to experience health-care inequities due to the inadequate skills and knowledge of health-care providers and inaccessible health-care facilities.
In 2009, an art of medicine essay in The Lancet by Tom Shakespeare and colleagues
posited that “perhaps the most dramatic learning can come when it is a peer who is disabled, rather than a patient”. Medical schools are beginning to consider students with disabilities as a constituent part of their diversity, equity, and inclusion agenda, and several organisations and academic leaders from around the world are now offering formal guidance to medical schools, with the goal of fully realising the value that people with disabilities bring to medical education.

Meeks, L.M., Maraki, I., Singh, S. and Curry, R.H. (2020), ‘Global commitments to disability inclusion in health professions’, The Lancet, 395(10227), pp. 852-853.

Available at: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30215-4/fulltext

Extract

In 2016, a survey found that 2.7% of US allopathic medical students disclosed a disability, which exceeded prior estimates.1 Data from a follow-up survey, using the same methodology, were used to compare the prevalence of disability and accommodation practices between 2016 and 2019.
Methods

Between September 2018 and March 2019, a web-based survey was administered to disability professionals at eligible schools, defined as having full accreditation through the Liaison Committee on Medical Education and excluding schools on probation. The survey assessed the prevalence of students with disabilities, the category of disabilities (Table 1), and types of accommodations (Table 2). Survey results were linked to the 2018 Association of American Medical Colleges Organizational Characteristics Database. Descriptive statistics were used to summarize results. Characteristics of nonresponding and responding schools were compared using χ2 and t tests.

Comparison between identical items on the 2016 and 2019 surveys were conducted for schools that responded with data for both years. Differences in the proportions of students with disabilities and by disability type were compared using z tests specifying a 2-sided significance level of .05. All statistical analyses were conducted in R version 3.5.1. The study was exempt by the University of Michigan Medical School institutional review board.
Results

In 2019, 140 US allopathic schools were eligible for participation, and 87 (62.1%) completed the survey. Responding schools were similar to nonresponding schools in all characteristics examined (public vs private ownership, community-based status, research intensity, and financial relationship with the parent university), except for geographic region (P < .001). Compared with nonrespondents, responding institutions had a lower percentage of schools in the South (22%% vs 58%), a higher percentage of schools in the West (18% vs 4%), and a higher percentage of schools in the Central region (30% vs 15%). Schools in the Northeast were more similarly distributed (30% responding vs 23% nonresponding).

Meeks, L.M. et al (2019), ‘Change in Prevalence of Disabilities and Accommodation Practices Among US Medical Schools, 2016 vs 2019’.322 (20), Journal of the American Medical Association, 322(20), pp. 2022-2024

Available at: https://jamanetwork.com/journals/jama/fullarticle/2756168

Extract

Over the past decade, research institutions have embraced the importance of diversity and inclusion in the biomedical workforce. Yet people with all categories of disability remain absent from ongoing efforts to enhance workforce diversity.

Swenor, B. and Meeks, L.M. (2019) ‘Disability Inclusion — Moving Beyond Mission Statements’ , New England Journal of Medicine. 380(22), pp. 2089-2091.

Available at: https://www.nejm.org/doi/full/10.1056/NEJMp1900348

Extract:

The waters of medical education are inherently turbulent and diffcult to navigate. This is especially true for learners with disabilities,who experience unique barriers in the course of their training. Medical educators have sought guidance in their efforts to support these learners as they enter and graduate from medical school. What was once relatively unusual
has become much more common in medical education: About 1,500 medical students with disabilities in the United States currently receive accommodations. While there has certainly been growth in the number of students who disclose a disability, the proportion of those students who seek accommodations remains small, at 2.7%.

The Association of American Medical Colleges (AAMC) and the University of California, San Francisco, School of Medicine (UCSF) sought to understand the lived experiences of learners with disabilities navigating medical education by gathering the perspectives of students, residents, and physicians with disabilities. This report weaves together the major themes shared by these individuals and current research in order to capture the current state of medical education for qualifed learners with disabilities. The intended audience includes medical students, residents, faculty, institutional leaders and administrators, and aspiring applicants and their advisors. The report is designed to help the reader understand the lived
experiences of learners with disabilities and to catalyze movement toward practices that ensure that all qualifed learners, regardless of disability, have equal access to medical education and the profession of medicine.

Meeks, L.M. and Jain, N.R. (2018), Accessibility, inclusion, and action in medical education: Lived experiences of learners and physicians with disabilities, Washington, DC, USA: Association of American Medical Colleges.

Available at: https://sds.ucsf.edu/sites/g/files/tkssra2986/f/aamc-ucsf-disability-special-report-accessible.pdf

Abstract

Nearly one-fifth of the U.S. population has a disability, and many of these Americans experience disparities in the health care they receive. In part, these health care disparities result from a lack of understanding about disability by health care providers. The education of physicians is grounded in a biomedical model that emphasizes pathology, impairment, or dysfunction, rather than a social model of disability that focuses on removing barriers for individuals with disabilities and improving their capabilities. According to a recent report, only 2.7% of medical students disclosed having disabilities—far fewer than the proportion of people with disabilities in the U.S. population. Including students and other trainees with disabilities—those with lived experiences of disability who can empathize with patients and serve as an example for their peers—in medical education is one mechanism to address the health care disparities faced by individuals with disabilities. At present, medical students and residents with disabilities face structural barriers related to policies and procedures, clinical accommodations, disability and wellness support services, and the physical environment. Additionally, many face cultural barriers related to the overarching attitudes, beliefs, and values prevalent at their medical school. In this Commentary, the authors review the state of disability in medical education and training, summarize key findings from an Association of American Medical Colleges special report on disability, and discuss considerations for medical educators to improve inclusion, including emerging technologies that can enhance access for students with disabilities.

Meeks, L. M., Herzer, K., and Jain, N. R. (2018), ‘Removing Barriers and Facilitating Access: Increasing the Number of Physicians With Disabilities’, Academic Medicine, 93(4), pp. 540-543.

Available at: https://journals.lww.com/academicmedicine/Fulltext/2018/04000/
Removing_Barriers_and_Facilitating_Access_.27.aspx

Abstract

Many students with chronic health conditions successfully attend and graduate from medical school. The barriers students encounter are often related to symptom flares, which may occur suddenly and can be brought on by multiple factors. Flares may include a period of symptoms such as joint pain and stiffness, fatigue, headache, slowed cognitive processing, and gastrointestinal disruption. Students also live with the potential for disease progression that further impacts their health and functioning, creating uncertainty about future accommodation needs.

Meeks, L. M., and Jain, N. R. (2018), ‘Accommodating chronic health conditions in medical education’, Disability Compliance for Higher Education,23(10), pp: 1-6.

Available at: https://onlinelibrary.wiley.com/doi/10.1002/dhe.30432

Meeks, L.M., Richards, A., Chang, A., and VanSchaik, S. (2017), ‘Working with students with disabilities: simulation-based faculty development’, Medical Educatio, 51 (11), pp. 1181-1182.

Available at: https://onlinelibrary.wiley.com/doi/10.1111/medu.13423

Abstract

Determining accommodations for anatomy and other lab exams (often referred to as “practicals”) takes coordination, a team effort, and a commitment to full access. Faculty may believe that accommodations are not possible in complex lab environments. Logistical challenges and questions about fundamental alteration are often at the crux of these concerns.

Meeks, L.M., and Jain, N.R (2017) ‘Accommodating students on anatomy and other lab practical exams’, Disability Compliance for Higher Education, 23(3), pp. 1-7.

Available at: https://onlinelibrary.wiley.com/doi/10.1002/dhe.30347

Abstract

This chapter introduces the reader to the autism spectrum and discusses the characteristics, traits, common concerns, and potential supports for this population. The chapter also provides some recommendations for proactive and collaborative support efforts for students with both an autism spectrum disorder and mental health issues.

Brown, J. T.,Meeks, L.M, and Rigler, M. (2017), Mental Health Concerns of Students on the Autism Spectrum. New Directions for Student Services, Winter 2016, pp: 31–40.

Available at: https://onlinelibrary.wiley.com/doi/abs/10.1002/ss.20189

Abstract

Meeks, L.M.,Thierfeld Brown, J., and Warczak, J. (2017), ‘Accommodating learners with Autism Spectrum Disorders in a Clinical Setting’, Disability Compliance for Higher Education, 34(4), pp:1-5.

Available at: https://onlinelibrary.wiley.com/doi/abs/10.1002/dhe.30356

Extract

Studying the performance of medical students with disabilities requires a better understanding of the prevalence and categories of disabilities represented.It remains unclear how many medical students have disabilities; prior estimates are out-of-date and psychological, learning, and chronic health disabilities have not been evaluated. This study assessed the prevalence of all disabilities and the accommodations in use at allopathic medical schools in the United States.

Meeks, L.M., and Herzer, K.R. (2016), ‘Prevalence of Self-Disclosed Disability Among Medical Students in U.S. Allopathic Medical Schools’, Journal of the Americal Medical Association, 316(21), pp: 2271-2272.

Available at: https://jamanetwork.com/journals/jama/fullarticle/2589334

Abstract

Color Vision Deficiency (CVD) is a commonly occurring condition in the general population. For medical students, it has the potential to create unique challenges in the classroom and clinical environments. Few studies have provided medical educators with comprehensive recommendations to assist students with CVD. This article presents a focused review of the literature about the impact of CVD on medical education. Universal Design for Instruction (UDI) principles are leveraged to identify and provide recommendations for mitigating the effects of CVD and rendering medical education curricula more accessible to all students regardless of their CVD status.

Examples of recommendations for the classroom, lab, and clinical settings include: adjusting the color of laser pointers, providing high quality grayscale images alongside microscope images, and coaching around strategies for recognizing clinical indicators (instead of color-related signs). The experience of a prominent medical school in the United States, which was faced with a high number of first-year students with CVD and implemented these recommendations, is described. Other medical schools can similarly adapt and implement these recommendations within their own programs

Meeks, L.M.,Jain, N.R., Herzer, K. R. (2016), ‘Universal Design: Supporting Students with Color Vision Deficiency (CVD) in Medical Education’, Journal of Postsecondary Education and Disability, 29(3), pp: 303-309.

Available at: http://www.ahead-archive.org/uploads/publications/JPED/jped_29_3/JPED%2029_3_Final%20Doc.pdf

Extract

For all students, the transition to graduate or professional school requires the use of many skills to adapt to the new environment. One’s professionalism, especially regarding communication skills, is key to making an effective transition. It is essential that students with disabilities effectively communicate with faculty, colleagues, and other administration and staff in order to ensure access to approved disability accommodations.

This guide was developed to assist graduate and professional students in the health sciences to effectively communicate information about their disabilities and their classroom and clinical placement accommodations with faculty and administrators. The goal is to outline several key issues for students with disabilities, including: (1) the appropriate amount of information to share, (2) tips for professional communication, and (3) the students’ roles
and responsibilities in this process.

Meeks, L.M., and Jain, N.R.(2015). The Guide to Assisting Students with Disabilities: Equal Access in Health Science and Professional Education, New York, NY, USA:Springer.

Available at: https://www.springerpub.com/media/springer-downloads/9780826123749_Student-Resource.pdf

Abstract

Increasing numbers of deaf students in the health professions require accommodations in the clinical setting to ensure effective learning and accurate communication. Although classroom learning barriers have long been identified and addressed, barriers to clinical education have been far less analyzed. Operating room clerkships, which include many competing auditory and visual stimuli, pose unique obstacles to deaf students. Disability Services worked collaboratively with other campus offices to accommodate a fourth-year medical student with almost complete hearing loss in an anesthesia clerkship who had limited knowledge of any manual language such as ASL. Accommodations implemented for the student are reviewed within the context of their successes and challenges, with the goal of providing a roadmap for future deaf graduate health sciences students in the operating room environment.

Meeks, L.M et al (2015), ‘Accommodating Deaf and Hard of Hearing students in Operating Room Environments: A Case Study’, Journal of Postsecondary Education and Disability. 28(3), pp. 383-388.

Available at: http://www.ahead-archive.org/uploads/publications/JPED/jped28_3/JPED28_3_Final.pdf

Objectives
Among the measures taken to combat sexism and sexual harassment, prevention courses for medical students are one possibility. We aimed to describe the process of implementing a training course on the prevention of sexism and sexual harassment for medical students in two Swiss medical schools by using the Theater of the Oppressed as an interactive and reflexive tool within the course. The purpose of this theater was to give the students the opportunity to express themselves and to collectively look for and discuss ways to combat and escape from oppressive situations.

Lüthi, A. at al (2022), ‘Preventing sexism andsexual harassment inmedical schools byusing Theater oftheOppressed asaninteractive andreflexive tool’, BMC Research Notes, 15(1).

Available at: https://bmcresnotes.biomedcentral.com/articles/10.1186/s13104-022-06084-2

Abstract

Objectives Gender bias interferes with medical care for both men and women, leading to health inequalities. Reflexivity is used in medical education to improve health provision. This study aims to understand if a reflective approach integrated in medical practice enables raising awareness of gender bias during medical school teaching. Methods We conducted this study in general ambulatory medicine in Lausanne Hospital, Switzerland with 160 Master’s students. Through group discussions and reflection questionnaires, students were asked to discuss clinical cases they encountered focusing on potential gender bias. We analyzed the data using a thematic analysis approach. Results The reflection on the clinical reasoning steps from a real case identified gender bias at each stage of the clinical case management. The analysis revealed two factors that facilitated gender reflexivity: guidance from a gender expert and peer-to-peer exchange. Conclusions Our study shows that a reflective approach integrated in medical practice enables raising awareness of gender bias during medical teaching. It provides students with a systematic method they can apply in their future clinical work, thus improving care processes and experiences towards more equitable care.

Geiser, E. et al (2022), ‘Reflexivity as a tool for medical students to identify and address gender bias in clinical practice: A qualitative study’,  Patient Education and Counseling, 105(12), pp. 3521-3528.

Available at: https://www.sciencedirect.com/science/article/pii/S0738399122003974?via%3Dihub

Abstract

In this article, we report abstracts of eight interviews, showing how clinicians use their interest in gender in their everyday practice. Clinicians report that being acquainted with a person interested by the question of gender raises their own awareness about the subject. In practice, they notice biased acquisition of knowledge due to non-inclusion of gender in research on one hand, and influence of gender stereotypes on clinical care on the other hand. Gender also influenced carriers. Some interviewed clinicians expressed they wished for more training, to reduce inequalities attributable to gender.

Le Biudec, J. et al (2021), ‘Le genre en médecine : quels apports pour la pratique ? Huit témoignages choisis’, Revue Médicale Suisse,17(774-2), pp.1254-1256

Available at: https://www.revmed.ch/revue-medicale-suisse/2021/revue-medicale-suisse-744-2/le-genre-en-medecine-quels-apports-pour-la-pratique-huit-temoignages-choisis

Background

Gender is an important social determinant, that influences healthcare. The lack of awareness on how gender influences health might lead to gender bias and can contribute to substandard patient care. Our objectives were to assess gender sensitivity and the presence of gender stereotypes among swiss medical students. Methods A validated scale (N-GAMS – Nijmegen Gender Awareness in Medicine Scale), with 3 subscores assessing gender sensitivity (GS) and gender stereotypes toward patients (GRIP) and doctors (GRID) (ranging from 1 to 5), was translated into French and was distributed to all medical students registered at the University of Lausanne, Switzerland in April–May 2017. Reliability of the three subscales was assessed calculating the alpha Cronbach coefficient. Mean subscales were calculated for male and female students and compared using two sample t-tests. A linear model was built with each subscale as a dependent variable and students’ sex and age as covariables. Results In total, 396 students answered the N-GAMS questionnaire, their mean age was 22 years old, 62.6% of them were women. GS and GRID sub-scores were not significantly different between female and male students (GS 3.62 for women, 3.70 for men, p = 0.27, GRID 2.10 for women, 2.13 for men, p = 0.76). A statistically significant difference was found in the GRIP subscale, with a mean score of 1.83 for women and 2.07 for men

Rrustemi, I. et al (2020), ‘Gender awareness among medical students in a Swiss University’, BMC Medical Education, 20(1).

Available at: https://bmcmededuc.biomedcentral.com/articles/10.1186/s12909-020-02037-0

Abstract

Since four decades epidemiological research has emphasised the necessity to consider social determinants and the social distribution of illnesses in the Swiss population, particularly by gender. Gender influences social position, living conditions as well as health behaviours over the life-course which all together influence health outcomes. Despite this evidence, national health policies and strategies tend to consider gender as a background factor, if not to omit its influence on health. The Health2020 policy and the recent specific national strategies are particularly illustrative. To exclude or reduce gender as a mere biological factor however hampers the implementation of specific interventions aiming at reducing health inequalities in the name of the social justice principle.

Schwarz, J. et al (2019), ‘Déterminants sociaux de la santé en Suisse – comment le genre s’est perdu en chemin’, Revue Médicale Suisse, 15(640), pp.485-489.

Available at: https://www.revmed.ch/view/416510/3632890/RMS_640_485.pdf

Abstract

Biological sex and social gender jointly influence health. Failure to take into account differences in health between women and men is an issue. What is more, undue differences based on stereotypes can also lead to biased care. This article illustrates the influence of sex and gender on health through clinical situations affecting various dimensions of medical care (diagnosis, investigations, treatments, prognosis). It also gives tools and introduces a project aimed at integrating the gender dimension into the pregraduate education of medical students at the University of Lausanne. The aim is to ensure equitable quality care between women and men, taking into account gender specificities based on unbiased scientific evidence.

Legros-Lefeuvre, A., Schluter, V. and Clair, C. (2021), ‘Intégrer le genre dans l’enseignement médical prégradué : actualités et perspectives pédagogiques’, Revue Médicale Suisse, 17(744-2), pp.1257-1261.

Available at: https://www.revmed.ch/revue-medicale-suisse/2018/revue-medicale-suisse-625/medecine-et-genre-quels-enjeux-pour-la-pratique

Abstract

The United Nations Population Fund (UNFPA) posits that every individual—including young people—has the right to make their own choices about their sexual and reproductive health (United Nations Population Fund 2020). A rapid fact-check looking at young people’s realities suggests that there is a considerable gap between global policies and local realities. Young people have to navigate their sexual and reproductive health at the conjuncture of individual and social, economic, cultural, and political realities. They necessarily balance intimacy and societal prescriptions, often in contexts of inequitable gender norms and gerontocracy (Van der Sijpt 2013). Their ability to start a healthy sexual and reproductive life is thus reliant on multiple factors beyond their control, embracing, besides individual capabilities, also social norms and structural conditions. In many societies, sexual norms are more restrictive for young unmarried women, and their access to sexual and reproductive health information and services may be restricted due to the stigma associated with these conditions (Heise et al. 2019).

Merten, S., Mlotswha, L. And Schwarz, J. (2020), ‘Youth, sexuality, gender, and health: dealing with a social phenomenon’, International Journal of Public Health, 65(4).

Available at: https://link.springer.com/article/10.1007/s00038-020-01392-5
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