Examples from Practice
Considering inclusivity in a lecture on catheterization – Victoria Simpson, Academic Foundation Doctor
Attempting to develop a lecture on practical catheterisation tips, the EDI toolkit prompted me to consider gender bias within my teaching and whether I was making use of inclusive case examples. For instance, urology as a speciality can be male-oriented but this does not mean that "he/him" pronouns need to be assumed for all case examples, so I steered away from this and opted for "they/them". Perusal of the toolkit reminded that it was important to ensure that I had considered a wider range of voices - not only those of female patients but also transgender patients and FGM victims were important to acknowledge. When considering how to advise foundation doctors on how to approach catheterisation conversations in these cases, it was important to check for sources authored by patients who themselves had these lived experiences.
Including diverse cultural backgrounds in Communication for Clinical Practice discussions – Anthony Baynham, MBChB Clinical Teacher and Liaison Psychiatrist
When talking to students about information sharing, I like to include the example of the film The Farewell which is set in China. In the film the Chinese American Billi finds out her grandma has been diagnosed with cancer. Against her parents’ wishes, she goes to visit her in China. She is appalled to learn that grandma does not know her diagnosis, but throughout the film she comes to understand why she has not been told and she agrees not to tell her. The film highlights the cultural differences around disclosure of diagnosis; if in the UK a doctor collaborated with a family to not tell someone their diagnosis it would be considered unethical unless the patient had specifically asked for this.
Increasing diversity in role-play scenarios - Isobel Jenkins, Lecturer in Communication for Clinical Practice
A major part of CCP workshop development is writing scenarios for role-play. Over the past couple of years we have had discussions within the CCP team about ways of increasing the diversity and representation within these scenarios in an authentic rather than a contrived and ‘tokenistic’ manner.
During a memorable workshop for Simulated Patient role-players I was talking about one of our proposed ideas for this, asking the actors – as this was a learning rather than an assessment setting – to bring some diversity to the scenarios by bringing in as much of their own diverse cultural and ethnic background and experience as they were happy to include. The actors however, politely pointed out to me that by giving their characters names such as ‘Gillian Brocklehurst’ and ‘Gordon Tremayne’ I was not making that request very easy for them.
Since then I have started using only initials for role-play scenario characters and limiting social and cultural detail to a minimum (only when relevant to the clinical presentation or task), in order to allow for more variety in character from the SPs. One good experience of how this can work was a role-play around exploring lifestyle and cardiovascular risks where a SP included relevant detail around Chinese food traditions in her family.
The use of non-binary anatomical terminology in HARC – Stephanie Egerton, Anatomy demonstrator
We were conscious of the need to acknowledge the terminology used for sex, particularly during the urogenital module, where recognising differences between the anatomy of those assigned male at birth and assigned female at birth is required by the learning outcomes. We included a note relating to terminology in the practical booklet attached to the session and included a similar message, an invitation for feedback and signposting to relevant advice in the introductory session slides:
“The terms ‘male’ and 'female’ are used in this booklet, as shorthand for ‘assigned male at birth (AMAB)’ and ‘assigned female at birth (AFAB)’, respectively. This is for instructional purposes in an introductory level course and to avoid confusion by matching wider literature. Anatomical variation may exist both within and between the Trans and Cis communities. Descriptions based on anatomy, rather than sex, are likely to be more accurate and should be used, where possible.”
We provided blank paper, pens, and a box at each table for students to anonymously provide feedback or give suggestions for how we could make HARC more inclusive. No comments were made directly during the session or left in the boxes. However, in the end-of-system evaluation, one comment was given that suggested our approach was not enough, highlighting that the language used felt non-inclusive from the respondent’s perspective and that “putting a disclaimer at the start of the practical” did not “excuse continuing to use non inclusive language for the sake of ease”.
In response, this year we have changed all reference to male or female to AMAB or AFAB, respectively, and plan to again provide opportunity for students to leave anonymous feedback. We are aware this approach is far from perfect and are expecting a mixed response. Whilst we appreciate that students may not adopt this terminology in practice, we hope to stimulate discussion and highlight the need to be more aware of the terminology we use.
Brighton and Sussex NHS Trust have created a useful resource on ‘Gender Inclusive Language in Perinatal Services’ and particularly relevant to teaching anatomy is ‘speaking about “women” and “people” side by side. As a next step, we might look into taking a gender-additive language approach to enhance the inclusivity of our practice, for example using ‘women and AFAB’.
Widening the circle of experience: Deaf Awareness – Isobel Jenkins, Lecturer in Communication for Clinical Practice
Our School of Medicine Deaf Awareness workshop which forms part of the ‘Adult Head and Neck’ placement in the Year 4 surgery block is delivered fully in British Sign Language (BSL) by Deaf educators from Merseyside Society for Deaf People, with the support of interpreters. Alongside a wealth of insight around how healthcare is experienced by deaf and hard of hearing people and communication strategies for their future practice, this session also offers many opportunities for reflection, such as a discussion about our use of terminology and how it can be experienced by members of the Deaf community and some insight into cultural differences, for example the fact that BSL users may not always feel confident in their understanding of written English.
Clinical Skills Lecturer Vicky Bond & Dr Isobel Jenkins talking about the work being done in clinical skills to respect the diversity of students and introduce more inclusive learning.
Clinical Teacher & Liaison Psychiatrist Dr Anthony Baynham and Dr Isobel Jenkins talking about introducing EDI topics in small-group teaching and working with case examples.
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