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Examples of practice in equality and diversity education

The information in Part 1 of this briefing was circulated to the General Medical Council (GMC), the Postgraduate Medical Education and Training Board (PMETB), the Medical Schools Council, the medical royal colleges and faculties, and postgraduate deaneries in order to initiate discussion and the sharing of views. A summary of the 24 responses received is provided here. The organisations were asked to explain how they currently incorporated or supported equality and diversity education for students or doctors, what education and assessment methods were used, and what the expected outcomes were. Views were also sought on how equality and diversity education should be included in medical curricula and continuing professional development, how it should be assessed, and how it should be monitored to demonstrate outcomes. Of the 24 responses received, five were from medical schools, eight were from medical royal colleges and faculties, and eight were from postgraduate deaneries (including a response from the Conference of Postgraduate Medical Deans (COPMeD)). Both the GMC and the PMETB also responded. Read the full list of respondents.

Regulators
The GMC’s response reiterated its commitment to equality and diversity through the outcomes set for undergraduate education in 'Tomorrow’s doctors' [reference 3]. In addition, new outcomes for determining full registration after provisional registration (on transition from foundation year 1 to year 2) were published in August 2007 [reference 7]. These outcomes say that to obtain full registration doctors must 'Demonstrate that they are sensitive and respond to the needs and expectations of patients, taking into account only where relevant their lifestyle, culture, religion, beliefs, ethnic background, sex, sexuality, disability, age, or social and economic status' and 'Demonstrate respect for everyone they work with (including colleagues in medicine and other healthcare professions, allied health and social care workers and non-health professionals) whatever their qualifications, lifestyle, culture, religion, beliefs, ethnic background, sex, sexuality, disability, age, or social and economic status'.

The GMC recognises the need to build on current arrangements and is reviewing the 2003 edition of 'Tomorrow’s doctors' through extensive consultation. The new edition is due to be published in 2009. It is also building on its existing support for disabled medical students through the development of new guidance on disability, 'Advising medical schools; encouraging disabled students'. The BMA provided extensive input during the consultation process for this new guidance. The GMC has also placed on its website examples of good practice at medical schools in relation to widening participation.

The PMETB’s response outlined its equality scheme, its diversity monitoring of applicants for certification and its reference panels, which includes an informal diversity reference group. Part of the response looked at integrating equality and diversity into postgraduate medical training, but concentrated on equality and diversity in terms of selection, assessment and process rather than education for trainee doctors. The response highlighted how the medical royal colleges were gradually integrating equality and diversity into the new curricula for specialist training, with particular reference to the specialties of general practice and psychiatry.

Medical schools
The responses from medical schools addressed equality and diversity education in terms of students learning about how equality and diversity can affect health outcomes as well as the interactions they have with patients and colleagues.

The medical undergraduate programme at the University of Birmingham includes the core module ‘human diversity’. The module looks at the impacts of diversity on clinical practice and the effects of prejudiced behaviour on clinical judgements and healthcare provision. The planned outcomes look for students to:

• be able to analyse prejudice affecting clinical decisions and service planning
• be able to discuss, in respectful terms, differences of opinion and belief
• understand how diversity influences service provision and uptake.

The learning objective is to change “students’ attitudes in some respects, but this is perhaps a secondary aim. The primary aim is to inculcate an informed professional attitude which promotes fair and humane treatment of patients and colleagues, regardless of an individual’s personal prejudice.”

The Peninsula Medical School integrates diversity education into the first two years of its curriculum but thereafter this is fragmented, reflecting the infrequent opportunities for students to interact with different types of patient. The rotations students undertake in hospitals, however, do allow further opportunities to see patients and work with staff from different backgrounds. The learning objectives include:

• to demonstrate practice that values diversity and uses an equality based approach to healthcare and its outcomes
• a recognition that people from different cultures and with disabilities have different needs, identities and preferences
• a recognition of the danger of excluding other diagnoses based on preconceptions about people with an impairment, or from different cultural backgrounds
• a recognition that a patient’s particular health needs may not be related to their disabilities, lifestyle, culture, beliefs, race, colour, gender, sexuality, age, mental or physical disability or socio-economic status.

At the University of Southampton diversity teaching is embedded in all aspects of the course with the intention 'to ensure that graduates can demonstrate diversity awareness and competence with any patient; in other words that we wish to achieve competence in Professional Behaviour as much as knowledge'. The outcomes are planned to enable graduates to:

• analyse current patterns of cultural diversity and their effects on the prevalence of disease, access to healthcare, and healthcare delivery
• demonstrate diversity awareness and competence with any patient
• manage cultural differences in the consultation
• demonstrate awareness of their own cultural identity and others’ perception of it
• demonstrate awareness of stereotyping cultural groups and its effects in medical practice.

In terms of assessment the University would ideally like to demonstrate that students progress in diversity competence from year to year, but this has proved difficult to achieve. However, diversity is one of the aspects included in third and final year examinations and as a component of the final year mini clinical evaluation exercise, to reflect both the teaching delivered and the clinical settings where diversity would be encountered.

Glasgow, Hull, York and Leicester medical schools integrate equality and diversity education throughout their programmes. Glasgow Medical School has timetabled personal and professional development sessions on misconceptions, social stereotyping, communication skills and people, patients and communities. They also run sessions on disability hosted by disabled people, and on gender and sexual orientation. Leicester Medical School includes teaching blocks on psychology and diversity, and health in the community which uses inter-professional teaching in a community setting.

Medical royal colleges and faculties
The majority of responses from the medical royal colleges and faculties concentrated on equality and diversity in terms of policy for selection and assessment rather than on the content or expected outcomes of education. There were, however, some notable exceptions. The Royal College of Obstetricians and Gynaecologists has a module on professional skills and attitudes which aims for doctors to 'Acknowledge and respect cultural diversity' and 'Demonstrate an awareness of the interaction of social factors with the patient’s illness'. The Royal College of Ophthalmologists has equality and diversity as a theme throughout its new curriculum with the learning outcomes reflecting equality and diversity.

The response from the Royal College of General Practitioners stated that great importance had been placed on equality and diversity in its curriculum. The equality and diversity champion of the college is the President. Equality and diversity is one of 15 individual statements which complement the curriculum, and is a strand of assessment for trainees. The response says that the learning outcomes set in the curriculum go further than simply acknowledging the law in terms of equality and diversity, and that in order to demonstrate the core competences of being a GP, promoting equality and valuing diversity will require the appropriate knowledge, skills and attitudes. The outcomes require trained GPs to:

• recognise the importance of individual differences and social context to health, illness and healthcare when dealing with patients from ethnically diverse backgrounds
• recognise the concepts of diversity and equality including within the context of migration, demography of cultural groups, socio-economic disadvantage and patterns of illness and disease
• recognise appropriate behaviour and specific practical knowledge including nutrition, naming systems, religion, attitudes towards illness, death and pregnancy.

The college is also working on a CPD strategy to include equality and diversity.

Postgraduate deaneries
COPMeD, the umbrella organisation for the postgraduate medical deans, welcomed the paper and indicated that deans would value further discussion about their contribution to equality and diversity in the medical curriculum. Responses were received from seven of the 24 UK postgraduate deaneries. The majority of responses concentrated on selection procedures and equal opportunities training for those involved.

A number of the deaneries outlined how they are including equality and diversity education specifically into their training programmes. The East Midlands deanery is implementing run-through programmes in general practice where learning and teaching in ethics and equality and diversity will be reinforced throughout the curriculum. The North West deanery has incorporated equality and diversity into its educational schedule which forms part of the learning development agreement between the SHA and NHS organisations.

Some deaneries offer specific education in equality and diversity, and the London deanery is developing a course on cultural competence. The West of Scotland deanery reports that equality and diversity is a major work-stream for NHS Scotland, and in general practice a training package called ‘Same difference’ has been purchased for all GP trainers. The directorate for GP education in the South Yorkshire and South Humber deanery has offered courses on diversity regularly over the years with the aspiration to encourage trainees to develop their consultation skills towards a patient centred approach which enables equality of treatment.