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Nolan HA, Owen K. Medical student experiences of equality, diversity, and inclusion: content analysis of student feedback using Bronfenbrenner's ecological systems theory. BMC MEDICAL EDUCATION 2024; 24:5. [PMID: 38172809 PMCID: PMC10765790 DOI: 10.1186/s12909-023-04986-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 12/18/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Issues relating to equality, diversity, and inclusion (EDI) significantly impact on medical student achievement and wellbeing. Interventions have been introduced at curricular and organisational levels, yet progress in addressing these issues remains limited. Timely evaluation is needed to assess effectiveness of interventions, and to explore issues and interactions in learning environments impacting on student experience. We introduced an anonymous question concerning students' experiences of EDI into routine online student feedback questionnaires, to scope the nature of ongoing issues and develop greater understanding of students' experiences in our programme environment. Ecological systems theory, which conceptualizes learning as a function of complex social interactions, determined by characteristics of individual learners and their environment, provides a framework for understanding. METHODS Free-text responses regarding experiences of EDI gathered over 20 months from all programme years (n = 760) were pooled for analysis, providing a holistic overview of experiences in the learning environment. A counting exercise identified broad categories reported by students. Content analysis of the qualitative dataset was undertaken. Bronfenbrenner's ecological systems theory was applied as a framework to demonstrate interdependencies between respondents' experiences and environments, and associated impacts. RESULTS Three hundred and seventy-six responses were received relating to wide-ranging EDI issues, most frequently gender or ethnicity. Responses mapped onto all areas of the ecological systems model, with frequent links between subsystems, indicating considerable complexity and interdependencies. Interpersonal interactions and associated impacts like exclusion were frequently discussed. Differential experiences of EDI-related issues in medical school compared to clinical settings were reported. Impacts of institutional leadership and wider societal norms were considered by respondents. Respondents discussed their need for awareness of EDI with reference to future professional practice. CONCLUSIONS Implementation of a regular free-text evaluation question allowed data-gathering across cohorts and throughout several stages of the curriculum, illuminating student experience. Connections established demonstrated intersectionality, and how environment and other factors interact, impacting on student experiences. Students experience EDI-related issues on multiple levels within the educational environment, with consequent impacts on learning. Any successful approach towards tackling issues and promoting equity of opportunity for all requires multi-level actions and widespread culture change. Students can offer fresh and distinct perspectives regarding change needed, to complement and diversify perspectives provided by staff and organisational leadership. Student voice should be enabled to shape change.
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Czech H, Hildebrandt S, Reis SP, Chelouche T, Fox M, González-López E, Lepicard E, Ley A, Offer M, Ohry A, Rotzoll M, Sachse C, Siegel SJ, Šimůnek M, Teicher A, Uzarczyk K, von Villiez A, Wald HS, Wynia MK, Roelcke V. The Lancet Commission on medicine, Nazism, and the Holocaust: historical evidence, implications for today, teaching for tomorrow. Lancet 2023; 402:1867-1940. [PMID: 37951225 DOI: 10.1016/s0140-6736(23)01845-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 08/07/2023] [Accepted: 08/29/2023] [Indexed: 11/13/2023]
Affiliation(s)
- Herwig Czech
- Ethics, Collections, and History of Medicine, Medical University of Vienna, Vienna, Austria
| | - Sabine Hildebrandt
- Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA.
| | - Shmuel P Reis
- Center for Medical Education, Hebrew University Hadassah Medical School, Jerusalem, Israel; Department of Digital Medical Technologies, Holon Institute of Technology, Holon, Israel
| | - Tessa Chelouche
- Rappaport Faculty of Medicine, Technion Institute, Haifa, Israel
| | - Matthew Fox
- Jakobovits Center for Jewish Medical Ethics, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Esteban González-López
- Division of Family Medicine and Primary Care, Department of Medicine, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| | - Etienne Lepicard
- Center for Medical Education, Hebrew University Hadassah Medical School, Jerusalem, Israel
| | - Astrid Ley
- Memorial and Museum Sachsenhausen, Oranienburg, Germany
| | - Miriam Offer
- Center of the Study of Jewish Medicine during the Holocaust, Western Galilee College, Acre, Israel
| | - Avi Ohry
- Rehabilitation Medicine, School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Maike Rotzoll
- Institute for the History of Pharmacy and Medicine, Marburg University, Marburg, Germany
| | - Carola Sachse
- Institute of Contemporary History, University of Vienna, Vienna, Austria
| | - Sari J Siegel
- Center for Medicine, Holocaust, and Genocide Studies, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Michal Šimůnek
- Institute of Contemporary History of the Academy of Sciences of the Czech Republic, Prague, Czech Republic
| | - Amir Teicher
- Department of History, Tel Aviv University, Tel Aviv, Israel
| | - Kamila Uzarczyk
- Department of Humanities and Social Sciences, Wrocław Medical University, Wrocław, Poland
| | - Anna von Villiez
- Memorial Israelitische Töchterschule, Hamburger Volkshochschule, Hamburg, Germany
| | - Hedy S Wald
- Department of Family Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Matthew K Wynia
- Center for Bioethics and Humanities, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Volker Roelcke
- Institute for the History, Theory and Ethics of Medicine, Giessen University, Gießen, Germany
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