A well-established and fundamental goal within health professions learning environments is ensuring that all students, trainees, faculty, and staff feel a sense of belonging and have opportunities to thrive. This benefits not only learners and providers, but is critical for patients as well. It remains imperative today, even as it becomes more challenging to pursue. Currently, leaders of academic health centers are encountering pressure to respond to federal executive orders that call on them to abandon lawful efforts to increase diversity, equity, and inclusion (DEI) in health care.
A team at Drexel University, in the heart of Philadelphia, is attempting to address this critical value of health professions education while helping others across the field. With support from the Josiah Macy Jr. Foundation, faculty at the Drexel University College of Medicine developed a free online curriculum to advance DEI in health professions education. The curriculum can be used to teach students, faculty, and staff about topics such as health disparities, racism and antiracism, and harmful bias and discrimination, which are critical to creating positive changes in their institutions and communities that will lead to equitable care for all.
“The bottom line is, the principles of DEI are a foundation of professionalism,” said Dr. Dennis Novack, co-principal investigator of the project and Associate Dean of Medical Education at the Drexel University College of Medicine. “To best serve our learners and, in turn, our patients, we must be willing to incorporate DEI into our learning. Ultimately, our job is to prepare the doctors of the future to take the best possible care of their patients, and that goal is hindered when learning environments are not inclusive, unwelcoming, and at times, harmful.”
The roots of the project extend beyond the current environment. At a curriculum committee meeting in 2021, the College of Medicine’s DEI Director at the time shared concerns expressed by students about not feeling comfortable in their learning environments. Through additional conversations about the school’s culture and listening to student experiences—including microaggressions, racism, bias, and more—Dr. Novack recognized that a curriculum change was needed to ensure learners’ success. Partnering with his colleagues Camille Burnett, PhD, MPA, APHN-BC, BScN, RN, DSW, FAAN, CGNC, and Leon McCrea II, MD, MPH, they worked alongside 12 pilot institutions and their faculty to create the Antiracism Curriculum to Promote Diversity, Equity and Inclusion in Healthcare Education: An Online Module with Workshops for Learners, Faculty and Staff over a three-year period.
Developing the Curriculum
Soon after the project’s inception, Barbara Lewis, PhD, MBA, also of Drexel University’s College of Medicine, joined the team as the grant project director. Reaching out to institutions that the project leads had previously worked with, they asked if anyone would like to be a part of designing and developing the antiracism and belonging curriculum. The response was emphatic and overwhelming. Nearly everyone they contacted wanted to be involved, and the work got started.
“In 2021, folks in HPE were actively searching for resources in the DEI space to implement into their curricula,” explained Dr. Lewis. “There was certainly no shortage of interest in creating one to adequately address the structural, cultural, and individual racism that exists within learning environments. And we quickly learned that the curriculum needed to include resources for not just students, but faculty and staff as well.”
To provide structure, the project team decided to create four development groups, each focused on a core element of developing and disseminating the expansive project: Module, Curriculum, Assessment, and Faculty Development. Individuals from each of the 12 pilot institutions, as well as others, volunteered for one of the four groups that met monthly over the three-year period. The individuals ranged in expertise, including Associate Professors, Deans, curriculum developers, and more. Some regularly focused on DEI or multicultural student initiatives, while others specialized in more technical aspects of HPE, including faculty development and academic coordination. Over time, involvement grew, and the 46 individuals who worked on the grant were from 20 separate institutions and five disciplines, providing a more comprehensive approach to the curriculum and its parts.
The Module Content Group met several times to discuss what content should be covered, recognizing the broad scope of antiracism. The discussions allowed them to identify key areas that were significant and absent from their academic programs. The goal was to strike a thoughtful balance between a foundational understanding of antiracism and practical strategies for combating racism. The group concluded that there were 17 different topics—plus an epilogue—that were most needed. Examples include racial disparities in health care, ethical dimensions of racism, racial conflict, discrimination, advancing racial equity, antiracism in action, and more. The group also created an overview of the content, including a synopsis, instructional videos with links, and discussion questions to help institutions identify resources from the curriculum that could be most useful in their learning environment. The modules are expansive, thorough, and flexible enough to be easily incorporated into learning.
The Curriculum Guides Group worked to develop comprehensive guides to help faculty facilitators deliver the modules. These provide guidelines and address key challenges that often arise when discussing these complex topics. They also developed a set of student guides to aid students as they progress through the modules. The student guides focus on providing learners with clear objectives, expectations, and other background to provide context for topics like confronting our own biases, understanding and responding to microaggressions, the skills of allyship, and even advocacy in health care systems.
“We knew that simply compiling all of the relevant material and content on these complex topics would not be adequate for students or faculty,” said Dr. Novack. “These are often difficult discussions that require immense trust for both facilitators and participants. We knew we had to provide support for everyone involved.”
The Assessment and Educational Research Group focused on integrating the curriculum into programs and on how to provide learners with opportunities to practice these critical but sensitive skills. They created an allyship Objective Structured Clinical Examination (OSCE) station—a safe space to practice skills in different scenarios with standardized patients. In the OSCE station, students are assigned videos from YouTube (created by the project team) and the module on “calling in” in response to a microaggression, and then partake in a reenactment of a scenario with a standardized patient, who then provides personalized feedback to the student. When the entire OSCE wraps, all standardized patients and faculty involved debrief and discuss the allyship case. These discussions are moving and compelling as group members share their different perspectives and experiences.
The group also reworked the Johns Hopkins Learning Environment Survey, including 14 dimensions about experiences of racism in clinical training, which can be used to assess how respectful, inclusive, and welcoming the learning environment is perceived by students.
The Faculty Development Group addressed a key but often overlooked component of comprehensive and impactful DEI curriculum: engaging deeply with faculty to encourage them to develop their awareness and skills related to the topics. They created a 58-slide deck on the role of DEI in faculty development to supplement the Race and Consciousness section of the curriculum. They also developed three one-hour workshops focused on key topics for faculty, including Why People Have Biases, Discussing Structural Factors of Biases, and Creating Brave Spaces for Your Learners. They hope to carry these workshops further by producing interactive videos that can be used as self-directed faculty development or a group program.
“Our team and partners were thoughtful about all of the necessary touchpoints and materials,” said Dr. Lewis. “We are so grateful for their time and energy in developing something so critically important for learners to know and understand.”
Implementation
In the summer of 2023, once all 46 participants provided their feedback on the various aspects of the curriculum and revisions were incorporated, the curriculum was completed and posted on the Drexel University College of Medicine website. Dr. Lewis then contacted the pilot institutions to help incorporate the modules into their curricula. Eleven of the 12 original pilot institutions were the first to implement the curriculum into practice. To ensure faculty and staff were equipped to teach the modules, Dr. Lewis created an introductory faculty presentation and conducted a webinar with co-principal investigator Dr. Burnett in March 2024. Additionally, Dr. Lewis created a mapping service to review syllabi and use ChatGPT to recommend specific content, videos, and discussion questions that could be easily incorporated into a specific curriculum. Approximately 39 courses have been reviewed and given recommendations on incorporating the module and resources, with no shortage of positive faculty feedback.
“It’s not a matter of reading through all the modules and answering a few questions about the concepts; it’s about having flexible material that can be used in a variety of learning environments to supplement and enhance existing coursework,” said Dr. Lewis. “The superpower of this work is that, because there is so much thoughtful instruction, it can be used in student curricula, staff onboarding, workshops for health staff, and re-education for faculty.”
The team has learned a lot from the pilot implementations. At the Albert Einstein School of Medicine, 180 students participated in a mandatory, self-directed assignment of three sections from the module: Antiracist Approaches to Clinical Care, Antiracism in Action, and Advocacy. While successful, this implementation was particularly important due to student feedback. The students noted the sections were too long, prompting the project team to reorganize the content and focus on essential concepts. The students also suggested that the content be taught in smaller group sessions, a recommendation that has also been adopted. At the Renaissance School of Medicine at Stony Brook, the faculty inspired the syllabus mapping, and the project team was validated by faculty, staff, and students alike, who affirmed they had experienced some of the allyship scenarios and felt stuck on what to say. The videos and reenactment helped normalize the experiences and provided opportunities for practicing reactions and responses in the health care setting. Once the initial rollout was complete at pilot institutions with appropriate changes made, the project team turned to promotion.
Promotion & What’s Next
As the modules are being used across the country, Dr. Lewis and the team are working to promote the resources for an even wider range of audiences.
They contacted over 100 boards and organizations about supporting and promoting the modules (i.e., linking them on their website), resulting in 29 collaborating institutions—including Oprah Winfrey’s Color of Care Documentary site, the American Medical Association, the National Academy of Medicine, the American Association of Medical Colleges, and more.
Additionally, they have shared the curriculum at 24 conferences, written about it in six articles/book chapters, and presented it at two grand rounds. The Professional Formation Newsletter, co-sponsored by Drexel University College of Medicine and the Academy for Professionalism in Health Care, frequently features the module resources and is distributed monthly to approximately 20,000 individuals. The podcast Healthcare Professionalism: Education, Research, and Resources also included several grant participants discussing the curriculum, and social media posts across Facebook, X, and LinkedIn have expanded its exposure. Although the reach of the curriculum is not quantifiable, the project team estimates that thousands of students, faculty, and others have accessed the resources so far.
Most recently, Dr. Lewis started a webcast series on YouTube. She sits down with those who helped author the modules and those who have implemented them or featured the curriculum on their website to learn more about their motivation to join the project or incorporate it into their work and instruction. The module authors offer personal anecdotes that connect them to the work and the group they were a part of, and provide a behind-the-scenes look at production. In another episode, Dr. Lewis spoke with the Director of Strategy and Impact at the media agency partnering with the Oprah Winfrey Color of Care Documentary about how their team came across the module and why they felt compelled to include it in three places on their website (Medical or Nursing Student, Medical Professional, Doctor or Nurse). These webcasts help showcase the work that has been done and its partners in spreading the word, which the project team hopes will continue for years to come.
“While we’d hope to be able to eliminate racism in healthcare ultimately, we know that is a lofty goal,” said Dr. Novack. “As educators and health professionals, we felt we had to make a plan and start somewhere. This project and these materials create a crucial database to help those who want to do something have the tools to do so.”
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