We are not formal authorities, rather informal allies who have enacted a few small classroom and content related changes related to diversity and inclusivity in our medical school. We hope that our experience will help you in your pursuits in the education of all students.
It took someone in power (a Departmental Leader and Course Director) to act. Author KSC recognized that key person group diversity content was missing and that societal and student sentiment had shifted. This was in the early fall following the 2020 “Black Lives Matter” demonstrations. Knowing that even with firm institutional commitment, change would take time, author KSC inserted intentional diversity and inclusivity curricular time into the Cardiovascular Systems course (USA medical year 2, 5-week Fall course) in 2020. The social determinants of healthcare and related topics received some curricular coverage but were less present in foundational coursework. Three required elements were added to the course that would both have learning objectives and corresponding assessment items, as assessment often indicates importance in coverage and content to students.
Having passion and insight does not mean that this person must deliver the content. Author TEW was the person selected to deliver the material since the topic of “normal” had been informing his teaching for several years, especially in developing physiology content for Pediatrics and Gerontology medical blocks and an understanding that 50% of people could be excluded if sex as a biological variable is not included. In 2017, author TEW also led a teaching workshop at the International Union of Physiological Sciences in Brazil with the goal of challenging physiology educators from across physiology societies to include sex and lifespan material in physiology education and to teach these differences not as special topics but as “normal” physiology.
The three elements covered included: sex, lifespan (older and younger), and USA person groups with historic health disparities. One lecture (“Normal” physiology and how it changes across the lifespan and between sexes – covering respiratory, renal, and cardiovascular systems) and 6 podcasts (Selected sex-specific issues in BP control & hypertension, Selected race & ethnicity issues in BP control & hypertension, An innovative approach to hypertension care in African American males, Sex-specific physiology: CV signs and symptoms, Sex-specific physiology: Heart disease, and CV epidemiology delineated by race and ethnicity) were incorporated and spaced within an integrative organ-based content. We attempted to have material that was race/culture-informed but not race/culture based, which allows some separation of social constructs, the individual vs. person group, and a determinant vs. prevalence. In other Year 2 medical courses, Department physiologists added information on historical bias in normative prediction equations (pulmonary function testing and glomerular filtration rate) as well as environmental justice and air quality. These other additions were in the form of one to a few formally presented slides, part of a case presentation, or as a brief class discussion topic.
Were the additions easy? No. It took curricular time, administrative support, and a great deal of learning on our part. Documents such as APS Medical Physiology Learning Objectives do not directly address diversity and inclusivity to guide the field in what is important to include. Perhaps as a Society this is a change we can implement. Some take-homes for physiology educators: 1) no matter your background, you can contribute (very few people have formal training in this area), 2) collaborate with other faculty, 3) obtain feedback from all person groups and from students, as perception and intent can be quite different, 4) be intentional and precise with wording, and 5) implement small changes. We encourage you to expand “normal” physiology in one or two ways this upcoming semester, but do not be surprised if students are quite interested and request more.