Towards equitable learning environments for medical education: Bias and the intersection of social identities

Abstract

Context: Medical educators are increasingly paying attention to how bias creates inequities that affect learners across the medical education continuum. Such bias arises from learners' social identities. However, studies examining bias and social identities in medical education tend to focus on one identity at a time, even though multiple identities often interact to shape individuals' experiences.Methods: This article examines prior studies on bias and social identity in medical education, focusing on three social identities that commonly elicit bias: race, gender and profession. By applying the lens of intersectionality, we aimed to generate new insights into intergroup relations and identify strategies that may be employed to mitigate bias and inequities across all social identities.Results: Although different social identities can be more or less salient at different stages of medical training, they intersect and impact learners' experiences. Bias towards racial and gender identities affect learners' ability to reach different stages of medical education and influence the specialties they train in. Bias also makes it difficult for learners to develop their professional identities as they are not perceived as legitimate members of their professional groups, which influences interprofessional relations. To mitigate bias across all identities, three main sets of strategies can be adopted. These strategies include equipping individuals with skills to reflect upon their own and others' social identities; fostering in-group cohesion in ways that recognise intersecting social identities and challenges stereotypes through mentorship; and addressing intergroup boundaries through promotion of allyship, team reflexivity and conflict management.Conclusions: Examining how different social identities intersect and lead to bias and inequities in medical education provides insights into ways to address these problems. This article proposes a vision for how existing strategies to mitigate bias towards different social identities may be combined to embrace intersectionality and develop equitable learning environments for all.

Examining Social Identities of Patient Diversity Through Cases Presented in a Therapeutics Course Series

“…Purposeful consideration of the application of each identity is critical to remove barriers for equitable health care. Identifying and utilizing the intersections of identities among students, instructors, and patients 16 is necessary to break down biases and further ingrain the identities within health care education. As shown in this study, the examined cases provided few opportunities to utilize and view these intersections.…”

“…Others could include language spoken and use of an interpreter, or immigration or citizen status. A final limitation of this study, as well as of other published data, 16 is that the intersection of these social identities is difficult to measure. For example, the perceived value of learning by including a patient who is Black versus a female patient who also identifies as Black and LGBTQIA with a lower socioeconomic status may not always be accurately measured.…”

I and thou: Challenging the barriers to adopting a relational approach to medical education

“…highlight how an individual's multiple identities interact to shape their experiences, which can be negatively affected by bias. 19 Acknowledging Aida as a unique and multidimensional being (as a 'Thou' rather than an 'It') is essential and allows the authors to advance suggestions as to how bias across identities may be challenged.…”

Imagining the future: Social connections and new methodologies

“…How do biases affect the development of, for example, professional identities and the interactions of interprofessional teams? In addressing this issue, Bochatay et al 1 point out that students may simultaneously meet more than one type of bias and discrimination throughout their education. This ‘intersectionality’, whereby multiple social identities are managed concurrently, impacts growth and students' sense of self derived from membership across multiple groups.…”

“…As Vanstone and Grierson 4 observe, power relations in the HPE context may, paradoxically, be either oppressive or productive, constraining or supportive of cultures and customs and ‘fluid’ or ‘calcified’. Given the complexity of these power relationships, have we questioned how these interactions impact our own social structures and our own interprofessional teams? 1,4 Interdisciplinary partnerships are key for breaking down knowledge silos and opening up new spaces for learning and research. Team members are constructed by the systems in which they operate, and in turn construct these systems, so research methodologies that effectively uncover the complex dynamics of these teams are to be encouraged.…”