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Fostering an Inclusive Learning Environment at UCSF’s School of Medicine

New research by leading educators proposes solutions to improve equity in education at medical schools
 |  By Karin Fleming
2017 White Coat Ceremony

2017 White Coat Ceremony

“Healthcare disparities due to racially based differences in the quality of care delivered represent an invisible, silent epidemic. It’s in our wheelhouse to mobilize for this as we have for other epidemics, to educate our learners and graduates on these issues, and to collectively envision a better world where education programs and institutions are models of inclusion and equity,” said Catherine Lucey, MD, Executive Vice Dean and Vice Dean for Education during her keynote address at the annual Center for Faculty Educators Education Showcase at the Mission Bay Center and UCSF Parnassus campus last month in San Francisco.

Dr. Lucey encouraged educators to partner in redesigning educational programs to help learners from diverse racial and ethnic groups. “We must redesign learning experiences that equalize social capital for all learners, and implement assessment programs to capture the additional burdens that underrepresented-in-medicine (UIM) students face. This work must be embedded in everything we do in healthcare systems and in education.”

She referenced current research in collaboration with Arianne Teherani, PhD, which showed how small differences in assessed performance lead to larger differences in grades and selection for awards which in turn impact opportunities for UIM students to compete for competitive residency programs and to potentially enter academic careers.

Their findings on the impact of differences in assessed clinical performance of UIM versus non-UIM students on academic performance were published today in Academic Medicine, in collaboration with UCSF School of Medicine colleagues Karen Hauer, MD, PhD, Associate Dean for Competency Assessment and Professional Standards, Alicia Fernandez, MD, Professor of Medicine, and Talmadge E. King Jr., MD, Dean of the School of Medicine. 

“We responded to student concerns about grading equity by embarking on an analysis of grades using our institutional educational continuous quality improvement,” said Dr. Teherani, Professor of Medicine, Director for Program Evaluation for the School of Medicine, and lead author of the study. “We found that small differences in assessed performance between students underrepresented and not-underrepresented in medicine could impact critical outcomes such as future career opportunities. We hope that our work will prompt other schools to consider a similar exploration of how their institutional procedures may perpetuate existing inequities. We also hope to further a nationwide conversation and research agenda on how medical schools can initiate change to equalize opportunities for all learners.”

As part of an educational continuous quality improvement process at UCSF’s School of Medicine, Dr. Teherani, Dr. Lucey and colleagues examined data for the classes of 2013–2016 to determine whether differences existed between UIM and non-UIM students’ clinical performance and honor society membership—all of which influence residency selection and academic career choices.  

This analysis showed differences that consistently favored not-UIM students. While the size and magnitude of differences in clerkship summary ratings were small, UIM students received approximately half as many honors grades as not-UIM students and were three times less likely to be selected for honor society membership.

“Efforts to diversify the nation’s physician workforce cannot focus only on pipeline programs and holistic admissions processes,” said Dr. Teherani. “Ultimately, mitigating the impact of differential attainment by UIM students on selection for competitive residencies and faculty careers will require national conversations about inclusive learning environments, equity in performance assessments at medical schools, and equitable, not-colorblind strategies in candidate evaluation and selection at residency programs.”

Access the abstract and full paper.


If you missed the keynote address by Dr. Lucey at UCSF’s 2018 Education Showcase, watch her full presentation here.  You can also see a presentation she delivered on this topic earlier this year at the University of Virginia.

Collaborative work between the UCSF School of Medicine Differences Matter initiative, UCSF’s Office of Diversity and Outreach, and the student-led group White Coats for Black Lives is underway to address both structural racism and interpersonal biases that contribute to inequities in healthcare for patients and education for students.

Review a summary of these initiatives, as described in the UCSF Medical Education 2017 annual report.