How Diverse Is Your Universe? An Activity for Students to Reflect on Ethnoracial Diversity During Orientation

Abstract

Introduction: Physicians' unconscious biases have been linked to health disparities within ethnic and racially diverse communities. Addressing these unconscious biases is difficult but may be ameliorated by raising individuals' awareness of the ethnoracial makeup of their personal and professional networks and reflecting on whether it needs to be expanded while in medical school. Methods: First-and second-year students were provided with an overview of the ethnoracial makeup of individuals within the state, community, and medical school as a means to reflect on the ethnoracial makeup of their future patient population. Following this overview, students engaged in an activity adapted from the University of Houston, which allowed them to visually represent the ethnoracial diversity within their networks. Written reflections on the adapted activity were collected, analyzed using manifest content analysis, and reported according to themes. Results: The results indicated that the activity was valuable in helping students visualize their current exposure to ethnoracially diverse individuals (143 of 357 responses [40%]) and reflect on their need to expand the level of ethnoracial diversity in their lives (47 of 357 responses [13%]). Additionally, students provided comments to help improve the activity when used in another institution. Discussion: Assisting students in raising their awareness of the ethnoracial diversity in their personal and professional networks is a step toward addressing the unconscious biases that emerge in physicians while in clinical practice. This activity, designed to raise students' awareness of ethnoracial diversity, originated in Augusta, Georgia, but can be adapted to any state.

All inside our heads? A critical discursive review of unconscious bias training in the sciences

“…While Hannah and Carpenter‐song (2013) combined introductory course readings on unconscious bias with reflective writing exercises, participants in Lueke and Gibson's (2016) completed a mindfulness exercise, and West et al. (2019) used visual mapping exercises to make visible the diversity in participants' own networks. Saetermoe et al.…”

“…(2017) as notable exceptions where interventions themselves were guided by concepts and histories of anti‐racist movements and aims beyond merely raising awareness. But rather than providing an analytic framework to understand axes of privilege and oppression, intersectionality was often invoked to rationalize an aspect of complexity or aspect of unrealistic ambition at the individual level (Hennes et al., 2018; West et al., 2019), effectively becoming another tool to encourage “buy‐in.” Some of the more creative and unstructured courses did include exercises in critical reflexivity, for example, reading groups engaging with histories of racism (see Hannah & Carpenter‐song, 2013), a broader focus on institutional barriers (Saetermoe et al., 2017), and discussion of better support systems (Krutkowski et al., 2019). Yet, it could be argued that these examples offered a shift away from UBT rather than a development of the underlying principles of the intervention per se.…”

“…Such individualized solutions meant that across the included studies, very few engaged meaningfully with the literature on intersectional inequalities that centers structural causes, and even fewer demonstrated how the intervention design had accounted for these, with White-Davis et al (2018) and Saetermoe et al (2017) as notable exceptions where interventions themselves were guided by concepts and histories of anti-racist movements and aims beyond merely raising awareness. But rather than providing an analytic framework to understand axes of privilege and oppression, intersectionality was often invoked to rationalize an aspect of complexity or aspect of unrealistic ambition at the individual level (Hennes et al, 2018;West et al, 2019), effectively becoming another tool to encour age "buy-in." Some of the more creative and unstructured courses did include exercises in critical reflexivity, for example, reading groups engaging with histories of racism (see Hannah & Carpenter-song, 2013), a broader focus on institutional barriers (Saetermoe et al, 2017), and discussion of better support systems (Krutkowski et al, 2019).…”

“…Five of the 22 interventions entailed more interactive workshops and creative learning activities, centered around group discussions and reflexive learning (see Table S2). While Hannah and Carpenter-song (2013) combined introductory course readings on unconscious bias with reflective writing exercises, participants in Lueke and Gibson's (2016) completed a mindfulness exercise, and West et al (2019) used visual mapping exercises to make visible the diversity in participants' own networks. Saetermoe et al (2017) report on a wider empowerment and mentoring program, which combines readings, field trips, and social activities together with more formal courses in critical race theory.…”

Critical Consciousness as a Framework for Health Equity–Focused Peer Learning

“… 7 The educational content described here overlaps with that of other publications in MedEdPORTAL, including discussions of identity, 8 – 10 privilege, 8 microaggressions, 7 , 11 , 12 racism, 13 , 14 health disparities, 15 , 16 the social determinants of health, 15 , 17 , 18 and implicit bias. 19 , 20 However, CCM is unique in that it adopts critical consciousness as the unifying concept and approach for a series of student-led workshops spanning these topics for all first-year medical students at our institution. In so doing, we hope to contribute to the growing movement away from medical education in health equity, diversity, and inclusion that is focused on teaching and learning terminology (e.g., the flawed notion of cultural competence) to one that is centered in phenomenology—supporting student inquiry about the lived experience of peers and patients.…”