Adaptive Listening Tour and Survey to Promote Faculty Reflection on Antiracism in Medical Curriculum

Background: There is an increasing awareness of the devastating impact of health disparities and the need to integrate the principles of diversity, equity, and inclusion (DEI) into medical education. However, few studies use faculty reflection and listening as the first step to critically appraise institutional culture and climate relative to DEI topics in medical education.

Methods: We encouraged faculty to critically reflect on their teaching of DEI topics in the foundation of medicine coursework, which integrates basic, clinical, and health systems sciences into blocks organized by the organ systems. Utilizing the Association of American Medical Colleges' (AAMCs) Key Steps for Assessing Institutional Culture and Climate as a framework, we conducted listening tours with all faculty who teach in the preclinical blocks. We also created a cross-sectional, dichotomous (yes/no), and open-ended questions survey. We sent the survey to each of directors of each of the 10 preclinical block directors to better understand the opportunities and challenges related to integrating DEI into the curriculum. Specifically, we implemented the first three steps of the AAMC framework: “Step 1: Reflective questions for personal exploration on relevant criteria, Step 2: Data collection processes and tools to capture the determinants of the culture of diversity and inclusion, Step 3: Synthesis and analysis to identify areas of strength and opportunities."3 We collected data from April-December 2021 and calculated percentages for the dichotomous responses. We conducted a thematic analysis to synthesize the qualitative data from the listening tour and open-ended survey responses.

Results: Thirty-four faculty who teach in the preclinical curriculum participated in the listening tours, and all 10 block directors responded to the survey. Themes from faculty included a need to improve the integration of DEI into the curriculum. Opportunities included diversifying cases and incorporating more variety in standardized patients, including more information on systemic racism and social determinants of health (SDoH), and increasing training on racial humility and population genetics/epigenetics. Faculty felt they needed more knowledge of the 'correct ways' and terminology to incorporate DEI and more time to teach these topics in an already condensed curriculum. Furthermore, the survey highlighted that 70% of blocks present information on racial sensitivity, and 60% discuss unconscious bias and address gender and sexual minorities; however, 70% currently do not assess racial sensitivity or discuss ableism in their blocks.

Discussion: The listening tour built a collaborative relationship between the education faculty and the DEI Office via candid discussions, specifically related to barriers, opportunities, fears, and the needs of our faculty as they improve DEI in our curriculum. One quote captured a concern expressed by many of the participants: "We are uncertain how to teach this correctly.” The survey provided further anonymous reflection opportunities for faculty. We will continue to follow the AAMC framework to leverage our findings by creating DEI objectives for the blocks in the pre-clinical curriculum and increasing formal faculty development programs. Simultaneously, we will establish faculty and student DEI education taskforces to assist in curriculum review and development of assessment tools to evaluate DEI curricular content and student learning.