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Addressing Issues in Medical Education: Updating a Course for Increased Inclusion

Challenging times call for challenging responses. This year, Drs. Teresa Patitucci and Stephen Humphrey worked to meet this challenge with changes to the Foundations of Pathological Processes – Musculoskeletal and Skin (FPP-MSS) course. Recently, we met with these faculty to discuss the changes they made.

What changes were made to FPP-MSS this year?

Each year, the course goes through updates, from grammatical changes to the slides to updating the content on disease processes and new treatment data. In Winter 2019, Drs. Patitucci and Humphrey sat down to discuss making the course more inclusive. One of the more glaring issues to address was lack of diverse skin pigmentation images for many of the conditions being taught.

The biggest change they made this year was to make sure they were including more examples of skin diseases in different colors of the skin, as common things like eczema, psoriasis, etc., can look very different. While dermatology is a small specialty, many primary care visits are related to skin issues. Therefore, it is important these conditions be taught in the context of diverse skin pigmentations.

Additionally, a reflection assignment about skin tone and how it affects clinicians was added to the course. This felt very appropriate after the events of Summer 2020 and changes made to the FPP-MSS unit. Students were asked to compose a reflection on what skin tone meant to them as a future physician, and were encouraged to use whatever medium (writing, poetry, painting, etc.) they desired to submit their response. Student submissions were anonymous to allow them to express themselves freely. Students expressed appreciation for having a forum to express themselves on such an important topic.

What was your motivation to make these changes?

As this year unfolded, many of us have been hurt by the racial injustices that we have witnessed; for many, this year is nothing new, sadly. Injustice can be big or small, and as a vocation where we all aspire to care for everyone, then we need to teach in an equitable and inclusive manner. This is true in medicine and in dermatology, where many of our textbooks lack examples of common and rare diseases in skin of color. The motivation was to make this course more inclusive for the medical students, so that they can better care for their patients.

Dr. Patitucci was heartened by MCW’s statement about becoming an anti-racist institution and felt that provided the support they needed to address these issues directly in the classroom. We often struggle with incorporating non-medical knowledge into coursework or assessments. This was an opportunity to be creative and meaningful in placing such content into the course.

Requiring students to take moments to pause and reflect on the meaning behind moments is important. The reflection exercise allowed the directors to capitalize on an important moment in the curriculum. What does this mean for me? How can I be different? What can I do differently? How does this affect others? They wanted students to think about what happens when they interact with others and what impact that has. The hope is that students understand skin tone is important and needs to be recognized as such in order to provide quality care to patients.

How did the students respond to the changes?

This year, images of conditions on white skin were presented first with findings on differently pigmented skin presented after. Students remarked that they would appreciate side-by-side images or something more equal, as it felt that the current presentation still favored white skin as “normal.” Presenting the images side-by-side or in different orders may help alleviate that messaging.

Unfortunately, lack of resources is an issue. Most image databases contain predominantly white-skinned images. Efforts to diversify images are ongoing, and we must take advantage of those updates when making changes to course slides each year.

Dr. Humphrey was heartened by the students’ feedback and willingness to engage on this topic. He was able to meet with students and received several e-mails providing candid feedback and suggestions for improvements. He is excited about the opportunity to incorporate this feedback into next year’s course.

Dr. Patitucci feels it is important to provide students with a forum to reflect and share their responses in a way that helps our students feel seen, heard, and supported. Ideally, we would thread such topics throughout the curriculum to address development of the whole person we are working to train to become a physician. There is a need to incorporate more humanity into the classroom.

What would you do differently?

Dr. Patitucci plans to rename and reorder some sessions for next year’s unit. Many of the changes to the course will take place by engaging with individual faculty to hone their sessions. Her process for revising the course involves taking a first pass at the information and obtaining student feedback. She acknowledges it can be hard for individual faculty to understand all the mechanics of the course and works with them to make updates.

One aspect of making changes is being open to feedback and responsive to it. When an image shared as part of a presentation upset a student, Patitucci responded immediately and apologized for the oversight. Acknowledging the mistake was an important part of the process, as students need to understand their voices are heard and appreciated.

We commend Drs. Patitucci and Humphrey for their efforts in making the FPP-MSS course more diverse and inclusive, and working to incorporate humanity into the educational process. OEI looks forward to working with them throughout the upcoming year to make their goals a reality.

“If we want to stimulate our students’ curiosity, we need to give them space to explore areas where we aren’t experts. We need to be more humble. Students don’t expect us to know everything about a topic; they respect when we are curious as well.” – Dr. Teresa Patitucci

“Through the changes, I learned more about myself - as a physician, as an educator, and how I can adjust my own style of teaching to be more effective. This year’s experience with our course has been all the more rewarding on both a professional and a personal level.” – Dr. Stephen Humphrey