Fostering an Inclusive Learning Environment at UCSF’s School of Medicine to Help Learners Thrive New solutions to improve equity in performance assessments at medical schools

“Healthcare disparities due to racially based differences in the quality of care delivered represent an invisible, silent epidemic. It’s in our wheelhouse to mobilize for this as we have for other epidemics, to educate our learners and graduates on these issues, and to collectively envision a better world where education programs and institutions are models of inclusion and equity,” says Catherine Lucey, MD, Professor of Medicine, Executive Vice Dean and Vice Dean for Education.

Presenting on the topic during her keynote address at this year’s Education Showcase, Dr. Lucey encouraged educators to partner in redesigning educational programs to help learners from diverse racial and ethnic groups. “We must redesign learning experiences that equalize social capital for all learners, and implement assessment programs that eliminate normative- based decisions and capture the additional burdens that under-represented-in-medicine (UIM) students face. This work must be embedded in everything we do in healthcare systems and in education.”

Dr. Lucey referenced current research in collaboration with Arianne Teherani, PhD, which showed how small differences in assessed performance lead to larger differences in grades and selection for awards. These differences impact opportunities for UIM students to compete successfully for competitive residency programs and to potentially enter academic careers.

Their findings on the impact of differences in assessed clinical performance of UIM versus non-UIM students on academic performance were published earlier this year in Academic Medicine, in collaboration with UCSF School of Medicine colleagues Karen Hauer, MD, PhD, Associate Dean for Competency Assessment and Professional Standards, Alicia Fernandez, MD, Professor of Medicine, and Talmadge E. King Jr., MD, Dean of the School of Medicine.

“We embarked upon this study as part of our institutional educational continuous quality improvement process,” says Dr. Teherani, Professor of Medicine, Director for Program Evaluation for the School of Medicine, and lead author of the study.

“We found that small differences in assessed performance between students underrepresented and not-underrepresented in medicine could impact critical outcomes such as future career opportunities. We hope that our work will prompt others to consider similar exploration of how their institutional procedures may perpetuate existing inequities. We also hope to further a nationwide conversation and research agenda on how medical schools can initiate change to equalize opportunities for all learners.”

As part of an educational continuous quality improvement process at UCSF’s School of Medicine, Dr. Teherani, Dr. Lucey and colleagues examined data for the classes of 2013–2016 to determine whether differences existed between UIM and non-UIM students’ clinical performance and honor society membership—all of which influence residency selection and academic career choices.

The analysis showed differences that consistently favored not-UIM students. While the size and magnitude of differences in clerkship director ratings were small, UIM students received approximately half as many honors grades as not-UIM students and were three times less likely to be selected for honor society membership.

“Efforts to diversify the nation’s physician workforce cannot focus only on pipeline programs and holistic admissions processes,” says Dr. Teherani. “Ultimately, mitigating the impact of differential attainment by UIM students on selection for competitive residencies and faculty careers will require national conversations about inclusive learning environments, equity in performance assessments at medical schools, and equitable, not-colorblind strategies in candidate evaluation and selection at residency programs.”

For additional learning on this topic:

If you missed the keynote address on equity pedagogy by Dr. Lucey at UCSF’s 2018 Education Showcase, you can also see a presentation she delivered on this topic earlier this year at the University of Virginia.

Collaborative work between the UCSF School of Medicine Differences Matter initiative, UCSF’s Office of Diversity and Outreach, and the student-led group White Coats for Black Lives 4BL is underway to address both structural racism and interpersonal biases that contribute to inequities in healthcare for patients and education for students. Review a summary of these initiatives, as described in last year’s annual report.

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