Forbedring af racerepræsentation i medicinske undervisningsmaterialer

For Iku Nwosu, en sort medicinstuderende ved Queen's, sidder i dermatologiske forelæsninger, og se dias efter dias af hudtilstande præsenteret på for det meste hvide hudtoner, har været frustrerende.

"Det har været ret nedslående ikke at se min hudtone repræsenteret i forelæsningsmaterialerne, " siger Nwosu, nu på tredje år. "På grund af dette, Jeg er muligvis ikke i stand til at diagnosticere tilstande på mig selv, mine familiemedlemmer, medlemmer af samfundet, eller mine fremtidige børn, og det kan andre i min klasse heller ikke.

"Til mig, det antyder, at universitetet er medskyldig i at udsende en gruppe medicinstuderende, fremtidige læger, som ikke ved, hvordan tingene ser ud i en stor del af befolkningen. Jeg troede, det her var virkelig farligt."

Tilsvarende Shakira Brathwaite har også følt sig skuffet og frustreret over manglen på forskellighed i undervisningsressourcer. Mens hun var på en dermatologisk anbringelse uden for Kingston, hun siger, at hun var spændt på at se patienter, der lignede hende, med sort hud, men samtidig, hun følte sig uforberedt til at håndtere deres sager, fordi hun ikke havde lært at genkende sværhedsgraden af ​​visse tilstande i farvet hud.

"Det var oprørende. Jeg følte ikke, at jeg gav dem optimal pleje på det tidspunkt, " siger Brathwaite, bemærker, at dermatologer har specialiseret uddannelse og kan genkende tilstande i forskellige hudtoner, men de fleste praktiserende læger har ikke denne evne, hvilket betyder, at patienter med andre hudtoner end hvid ikke får den passende behandling på afgørende tidspunkter.

På grund af deres erfaringer, Brathwaite og Nwosu, sammen med andre medicinstuderende, Aquila Akingbade og Eric Zhang, har søgt at lave forandringer hos Queen's med hensyn til racerepræsentation i lægeskolens undervisningsmaterialer og læseplaner.

Brathwaites erfaring skubbede hende til at søge finansiering gennem Ontario Medical Student Association, en proces hun startede i 2019, at skabe et interaktivt undervisningsmodul, der giver information om forskellige hudsygdomme, hvad skal man kigge efter i forskellige hudtoner, samt billeder, der viser, hvordan lidelser optræder i forskellige hudfarver. Den kompakte, kurateret modul vil være nemt at bruge, tilgængelig, og tilgængelig som en point-of-care ressource for praktiserende læger, siger Brathwaite.

Sammen, Nwosu, Akingbade, og Zhang besluttede at bringe spørgsmålet om hudrepræsentation op med ledelsen i School of Medicine. De foreslog en gennemgang af ikke kun dermatologiske undervisningsmaterialer, men alt læringsmateriale inden for kontoret inden for lægeuddannelsen (UGME).

Med bred opbakning til deres projekt, Nwosu, Akingbade, og Zhang rekrutterede mere end 120 Queens studerende til at gennemgå omkring 900 undervisningsmaterialer, og identificere læringsbegivenheder, der trængte til forbedring med hensyn til racerepræsentation. De studerende fandt ud af 168 læringsbegivenheder med hudpræsentationer, 131 af disse begivenheder indeholdt kun præsentationer af hvid hud. De studerende har også markeret 89 læringsbegivenheder for potentielle forbedringer i indfødte repræsentation.

"Der er talrige statistikker, der viser, at hudkræft ikke bliver fanget tidligt hos sorte patienter, og at det bliver diagnosticeret på et meget mere dødeligt stadium, " siger Akingbade. "Sorte repræsenterer en mindre procentdel af hudkræftpatienter generelt, but there is a much higher proportion of Black people who are likely to die from the disease.

"This is something that is wholly preventable and it starts at the institutional level. We have to start teaching and normalizing what conditions look like in darker-skinned individuals."

A representative image collection

A key component in improving racial representation in lecture materials has been the need for a central repository of images, and one that contains a significant number of images with different skin tones. Til det formål, and because of the students' work and leadership involvement, Bracken Health Sciences Library has purchased access to VisualDX, a medical image database that is currently the best repository of diverse images.

"The students have done a really great job of mobilizing a lot of resources, and acquiring VisualDX through the library is an important step in addressing challenges in this area, " says Michelle Gibson, Assistant Dean, Curriculum, UGME, who has supported Nwosu, Akingbade, and Zhang on the review project.

"At UGME, we do not want to depend on student work to support our curricular reform, " says Dr. Gibson, noting that there are many different projects currently in the works to improve racial diversity in UGME curriculum. "But we are grateful to the students for their work, and we always welcome and value student partnerships. This has been a strength of our curriculum for years."

Nwosu, Zhang, and Akingbade have prepared a draft framework for racial representation of learning materials in UGME, including standards that all materials should meet, and where to find images to meet the criteria. Student volunteers are also ready to help implement changes to learning materials for lecturers to use in the next academic year.

For the teaching module, Brathwaite has created the script for the interactive, curated resource, and is currently in the process of gaining permissions for image use, learning more about VisualDX and how it may be used in the module, and working with dermatologists to incorporate the most up-to-date information on certain skin conditions.

Interest in advocacy work

Momentum behind these two projects, as well as several others, has been fuelled by the global Black Lives Matter protests in spring and summer of 2020, along with the pandemic, which the students say forced more people to pay attention to racial disparities, around the world and at a local level. Last summer, Queen's students were eager to get involved in advocacy work, and Nwosu, Akingbade, and Zhang say the group effort made a huge difference, making the time commitment to review learning materials much more feasible.

"We are a smaller community and the medical school here has very involved students, " Nwosu says. "I think it's important that if students see a gap, they feel empowered to propose a solution."

Zhang emphasizes that their work on this project has been conducted with the understanding that the issue is not just a local one, but a national and international problem.

"This is not just a Queen's problem, " Zhang says. "We've always had in the back of our minds that if we can do this successfully here, then we can create resources that will be helpful to other schools across the country."