Equality and diversity in medical education
The need for equality and diversity education
Equality legislation requires that people are not discriminated against on the basis of their race, gender, sexual orientation, disability, age or religion or belief. The law puts a duty on employers to promote equality within the workplace as well as in the provision of goods and services. As service providers working for organisations, or as employers themselves, doctors are required to comply with the law. Read further information on equality legislation in the UK
Doctors need to be able to interact effectively with patients from a diverse range of backgrounds and with differing needs. In some cases these may fall outside the doctor’s own range of experiences and it is possible that patients may not receive the most appropriate healthcare due to prejudicial attitudes and discriminatory behaviour. It is also essential that doctors are equipped to interact and communicate effectively with colleagues.
Doctors recognise that properly engaging with patients in decisions about treatment and care can improve outcomes. Competence in equality and diversity is paramount in delivering patient-centred care in order to ensure equality of healthcare access, service delivery and health outcomes.
Responsibilities for equality and diversity education in medicine
Medical students and trainee doctors follow curricula, which are now increasingly competence or outcomes based, in order to successfully complete the various stages of education. The current curricula for undergraduate and postgraduate medical education have been set by medical schools and medical royal colleges and faculties respectively. Evaluation is normally through regular assessment and examination. Education on equality and diversity should therefore be included within, and assessed as part of, any curricula.
The General Medical Council (GMC) and the Postgraduate Medical Education and Training Board (PMETB) are the regulators for undergraduate and postgraduate medical education respectively, and have a responsibility to ensure that those organisations setting curricula and those delivering medical education do so in accordance with their standards. The GMC and the PMETB have also jointly set standards for the foundation years programme. They monitor whether or not those standards are met through quality assurance processes.
The GMC’s core guidance for doctors is 'Good medical practice' which sets out the principles and values on which good practice is founded [reference 2]. The guidance makes clear a doctor’s duties to equality and diversity, as outlined in Part 1. The GMC also sets the outcomes for undergraduate medical education in 'Tomorrow’s doctors' with one of these outcomes being that graduates demonstrate 'Respect [for] patients regardless of their lifestyle, culture, beliefs, race, colour, gender, sexuality, disability, age, or social or economic status' [reference 3]. It also says that graduates must be able to 'Communicate effectively with individuals regardless of their social, cultural or ethnic backgrounds, or their disabilities.'
The PMETB’s 'Generic standards for training' set the standards required for the implementation and delivery of postgraduate training [reference 4]. The standards are divided into a number of domains, with domain 3 on equality, diversity and opportunity briefly covering access to training programmes and information, and promoting equality. The PMETB also has 'Standards for curricula' [reference 5]. These standards are 'a statement of the intended aims and objectives, content, experiences, outcomes and processes of an education programme'. Standard 8 on equality and diversity states 'The curriculum should describe its compliance with anti-discriminatory practice'.
In undergraduate medical education, medical schools have multiple roles as curriculum developers, education deliverers and in selecting and assessing students. The GMC quality assures medical schools to ensure that its standards and outcomes are being met. Postgraduate deaneries are responsible for delivering training within the NHS (for the majority of training specialties) and GP teaching practices, and for the selection and annual formal assessment of trainees. The medical royal colleges and faculties have a role in facilitating training locally in conjunction with the postgraduate deans. They also ensure that trainees meet the requirements of their training programme through examinations which are normally required as part of curricula in order to progress, and on completion. The PMETB quality assure postgraduate deaneries to their standards are being met.
Employers, including the NHS, hospitals, clinics, GP training practices, authorities employing public health doctors and places of work employing occupational medicine doctors, also have a role in equality and diversity education. As employees, doctors and trainees need to comply with equality and diversity policies and procedures, and so relevant education should be in place to ensure this is achieved.
Good medical practice
The BMA welcomes the update to the GMC’s 'Good Medical Practice' [reference 2] which strengthens the doctor’s duty towards equality and diversity (see box 1). It sets out principles for equality and diversity and is explicit as to what the duty is, but not the detail of how that duty can and should be achieved. The duty should be incorporated within medical education to ensure that equality and diversity is fully integrated within medical practice.
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BMA views on equality and diversity education
Members of the BMA Equal Opportunities Committee and Medical Education Sub-committee were asked for their views on equality and diversity education. These are summarised below:
- There are two different aspects of equality and diversity education for doctors: the impact of diversity on health and disease especially in relation to health inequalities, and the potential barriers to healthcare delivery caused by discrimination against/by individuals (both patients and professionals).
- Equality awareness needs to imbue everything that a student and clinician does. It is not something that can be compartmentalised. It applies equally to work with patients, the public and colleagues. The responsibility to ensure learning and good practice lies equally with employers and educational authorities. There is also a need to be impartial and comprehensive about equality and diversity education. For example, in an area with high racial and cultural diversity, it is essential that the all equality strands are given equal consideration.
- Medical education programmes should have at their core respect for diversity and the promotion of equality. Stand alone training programmes about equality and diversity are of limited value except perhaps as part of a structured multi-professional programme. Training also suggests a tick box approach and implies a learned behaviour rather than an understood behaviour. Education, on the other hand, enables an understanding and use of understanding in different situations.
- A common misconception about equality and diversity education is supposing that doctors need only to understand how the minority differ from the majority, for example knowing about different cultures’ customs and protocols. This can lead to incorrect assumptions because people are complex: every patient met, and every encounter, is potentially different.
- It is important to recognise and understand that people have different views and perspectives without applying ‘labels’. An individual’s race, religion or belief, gender, disability, sexual orientation and age can impact on, but does not define, their personal view of the world and their perception of how others see them.
- Personal views must not adversely affect the care delivered to patients. This requires an understanding of one’s own view of the world and how that affects perceptions of others.
- Communication skills are important, but equality and diversity education is about more than just good communication. The aim should be to develop demonstrably competent doctors who are skilled at communicating and working as effective members of a diverse team. Read more information on non-discriminatory language.
The responsibility for equality and diversity education lies with regulators, employers, educational authorities, and students and doctors themselves. Equality and diversity education should be integrated from undergraduate education through postgraduate training to continuing professional development. Standards need to be set, and education programmes with consistent messages must be developed to enable students and doctors to gain the competence required to meet those standards.
The NHS, as an employer, also has a responsibility to include equality and diversity as an organisational goal. It must be seen as important and integral to the ethos of the NHS. In supporting this, NHS Employers has developed a rolling three year strategy for the integration of equality and diversity as a central component of all workforce strategies in the NHS. Read more information on the work of NHS Employers on equality and diversity.
With the establishment of the Equality and Human Rights Commission, the healthcare system must embrace the principle of human rights and equality so that individuals are enabled to access education, jobs, goods and services on an equal basis. A wider approach to equality, including human rights, is also important to meet the requirements of 'Good Medical Practice' [reference 2], which go beyond the six equality strands.
Diversity monitoring is an important tool which can be used to identify inequalities and highlight the discrimination experienced by diverse groups. It is an important part of organisational performance management since, without it, an organisation will never know whether its equal opportunities policies are working, or be able to review practice and address areas where changes need to be made.
Inequalities between patients, in terms of access to healthcare and health information, are also a prime concern. The Department of Health (DH) attempts to break down inequalities through policy. For example, 'Choosing Health: making healthy choices easier' sets out the key principles for reducing health inequalities by supporting the public to make more informed decisions regarding their health [reference 6].
Although policies on improving the working lives of doctors and on access to healthcare are important, they do not directly impact on the individual interactions between the doctor and a patient where prejudice and discrimination can occur. Similarly, monitoring diversity in the workforce, which public bodies are legally required to do, will identify inequalities but will not by itself improve healthcare outcomes. Equality and diversity education for students and doctors is, therefore, an imperative in order to effect culture change.
BMA equality and diversity policies
The BMA Equal Opportunities Committee undertakes work within the BMA and on behalf of BMA members on all aspects of equality and diversity.