Widening participation: Moving from diversity to inclusion
The BMJ investigation ‘Are medical schools turning a blind eye to racism’ (1) describes the ongoing racial discrimination that ethnic minority medical students face and the lack of meaningful response from medical schools. We must consider these serious issues in light of ongoing widening participation initiatives aimed at increasing the numbers of under-represented ethnic minorities in medical education.
Widening participation to medicine in the UK can be seen as actively recruiting under-represented students into a system where they are likely to face discrimination, harassment, and systematic educational disadvantage (1-3). There is urgent need to shift the practice of widening participation away from a myopic focus on recruitment and selection (‘getting in’), to include the student experience (‘getting through’), differential attainment, and career progression (‘getting on’). Such an approach would advance the widening participation discourse from ‘diversity in medicine’, which emphasizes numbers of students, to ‘inclusion in medicine’ focusing on equity of experience and shared power.
Instituting policies and procedures to effectively deal with racial harassment in medical education is an important step (4). Additionally, medical schools should consider other strategies to redress institutional racism and promote inclusion:
1) Implement broadly sampled assessments to reduce differential attainment (5)
2) Achieve staff diversity and promote visible role models and mentors (6,7)
3) Critically review how diversity and inclusion, as well as ‘race’ more specifically, is taught in the curriculum (8)
4) Diversify the medical curriculum and teaching materials (9)
5) Support co-creation of educational polices, practices and norms in which learner voices are valued (10)
1) Kmietowicz Zosia. Are medical schools turning a blind eye to racism? BMJ 2020; 368 :m420
2) Linton Samara. Taking the difference out of attainment BMJ 2020; 368 :m438
3) Woolf Katherine. Differential attainment in medical education and training BMJ 2020; 368 :m339
4) BMA. Addressing racial harassment in medical education: a charter for medical schools and guidance for medical students. www.bma.org.uk.
5) van Andel, Chantal EE, et al. "Broadly sampled assessment reduces ethnicity‐related differences in clinical grades." Medical education 53.3 (2019): 264-275.
6) Thomas, K and Willis, L.A. (2007) Mentoring minority graduate students: Issues and strategies for institutions, faculty and students Equal Opportunities International, 26(3), p.178-192.
7) Wright SM, Carrese JA. Serving as a physician role model for a diverse population of medical learners. Academic Medicine 2003; 78(6)623–628
8) Tsai, Jennifer, et al. "Race matters? Examining and rethinking race portrayal in preclinical medical education." Academic Medicine 91.7 (2016): 916-920.
9) Gishen Faye, Lokugamage Amali. Diversifying the medical curriculum BMJ 2019; 364 :l300
10) Razack, Saleem, and Ingrid Philibert. "Inclusion in the clinical learning environment: Building the conditions for diverse human flourishing." Medical teacher 41.4 (2019): 380-384.
Competing interests: No competing interests