Exploring Diversity, Equity, and Inclusion-Related Pedagogy Across Different Professions

PURPOSE

Diversity, equity, and inclusion (DEI) have become an important priority for academic medicine. However, several barriers challenge the effective implementation of DEI-related pedagogy. An exploration of the barriers to and enablers of DEI-related pedagogy-as they relate to professional contexts-can inform how to advance DEI in medical education. Shulman's notion of signature pedagogies offers a foundation for understanding and exploring the influence of such contexts on teaching and learning. Comparisons across professions may help make signature pedagogies more visible and may facilitate change. In this study, the authors aim to explore how the professional contexts of medicine, nursing, and teacher education approach DEI-related pedagogy.

METHOD

The authors conducted a qualitative exploratory study using constructivist grounded theory methodology. Using both purposive and theoretical sampling, 24 participants from across the United States and Canada were interviewed, including physicians, nurses, and K-12 teachers in practice as well as professional educators in each discipline (May-December 2022). Interviews included a case-based elicitation approach, and data were analyzed iteratively across the data collection period using constant comparative analysis.

RESULTS

Medicine and nursing tend to prioritize objectivity and seek to avoid or neutralize emotions that are intrinsic to DEI-related learning, view DEI expertise as being outside the purview of their profession, and view time for DEI as limited in a clinical learning environment. In contrast, teaching is built on the assumption that DEI expertise is co-constructed and inclusive of community voices and lived experiences. DEI-related pedagogy in teaching allowed for exploration of deep assumptions and learning about structural inequities.

CONCLUSIONS

Findings suggest that assumptions and values held in professions, such as medicine and nursing, that valorize objectivity and neutrality, while stigmatizing vulnerability and suppressing emotions, may constrain DEI-related teaching and learning in such contexts.

Supportive and collaborative interdependence: Distinguishing residents' contributions within health care teams

INTRODUCTION

Individual assessments disregard team contributions, while team assessments disregard an individual's contributions. Interdependence has been put forth as a conceptual bridge between our educational traditions of assessing individual performance and our imminent challenge of assessing team-based performance without losing sight of the individual. The purpose of this study was to develop a more refined conceptualisation of interdependence to inform the creation of measures that can assess the interdependence of residents within health care teams.

METHODS

Following a constructivist grounded theory approach, we conducted 49 semi-structured interviews with various members of health care teams (e.g. physicians, nurses, pharmacists, social workers and patients) across two different clinical specialties-Emergency Medicine and Paediatrics-at two separate sites. Data collection and analysis occurred iteratively. Constant comparative inductive analysis was used, and coding consisted of three stages: initial, focused and theoretical.

RESULTS

We asked participants to reflect upon interdependence and describe how it exists in their clinical setting. All participants acknowledged the existence of interdependence, but they did not view it as part of a linear spectrum where interdependence becomes independence. Our analysis refined the conceptualisation of interdependence to include two types: supportive and collaborative. Supportive interdependence occurs within health care teams when one member demonstrates insufficient expertise to perform within their scope of practice. Collaborative interdependence, on the other hand, was not triggered by lack of experience/expertise within an individual's scope of practice, but rather recognition that patient care requires contributions from other team members.

CONCLUSION

In order to assess a team's collective performance without losing sight of the individual, we need to capture interdependent performances and characterise the nature of such interdependence. Moving away from a linear trajectory where independence is seen as the end goal can also help support efforts to measure an individual's competence as an interdependent member of a health care team.

Developing and evaluating a peer-based mental health literacy intervention with adolescent athletes

Widespread adolescent involvement in organized sport means that sport contexts are well-suited to 'actively' integrate prevention programs that may promote population-level change. This mixed methods study aimed to evaluate the feasibility and acceptability of a peer-based mental health literacy intervention. The intervention (i.e., Team Talk) was presented to eleven adolescent sport teams in the United States, with a total of 174 participants. Athlete participants completed surveys immediately before and after the intervention-including measures of workshop acceptability, social identity, and help-seeking behaviors. Semi-structured interviews were also conducted with a subset of five athletes, nine parents, and two coaches. With respect to recruitment as an indicator of feasibility, club-level adoption of the intervention was low, with difficulty recruiting clubs for intervention delivery. This signals that feasibility of the intervention-as it is currently designed and implemented by the research team-is low when considering similar competitive adolescent sport clubs and delivered as team-level workshops. Meanwhile, participants reported high acceptability of the intervention, and acceptability levels across participants was predicted by contextual factors related to implementation such as session duration. Regarding limited efficacy testing with measures completed before and after the intervention session: (a) social identity scores increased following the intervention, and (b) significant differences were not identified regarding efficacy to recognize symptoms of mental disorders. Athlete, coach, and parent interview responses also described potential adaptations to mental health programs. This research demonstrates the potential utility of peer-based mental health literacy interventions, while also revealing that further implementation research is necessary to adapt mental health literacy interventions to suit diverse adolescent sport contexts.

A scoping review of approaches for measuring 'interdependent' collaborative performances

INTRODUCTION

Individual assessment disregards the team aspect of clinical work. Team assessment collapses the individual into the group. Neither is sufficient for medical education, where measures need to attend to the individual while also accounting for interactions with others. Valid and reliable measures of interdependence are critical within medical education given the collaborative manner in which patient care is provided. Medical education currently lacks a consistent approach to measuring the performance between individuals working together as part of larger healthcare team. This review's objective was to identify existing approaches to measuring this interdependence.

METHODS

Following Arksey & O'Malley's methodology, we conducted a scoping review in 2018 and updated it to 2020. A search strategy involving five databases located >12 000 citations. At least two reviewers independently screened titles and abstracts, screened full texts (n = 161) and performed data extraction on twenty-seven included articles. Interviews were also conducted with key informants to check if any literature was missing and assess that our interpretations made sense.

RESULTS

Eighteen of the twenty-seven articles were empirical; nine conceptual with an empirical illustration. Eighteen were quantitative; nine used mixed methods. The articles spanned five disciplines and various application contexts, from online learning to sports performance. Only two of the included articles were from the field of Medical Education. The articles conceptualised interdependence of a group, using theoretical constructs such as collaboration synergy; of a network, using constructs such as degree centrality; and of a dyad, using constructs such as synchrony. Both descriptive (eg social network analysis) and inferential (eg multi-level modelling) approaches were described.

CONCLUSION

Efforts to measure interdependence are scarce and scattered across disciplines. Multiple theoretical concepts and inconsistent terminology may be limiting programmatic work. This review motivates the need for further study of measurement techniques, particularly those combining multiple approaches, to capture interdependence in medical education.

Network centrality, group density, and strength of social identification in college club sport teams

OBJECTIVE

With the underlying rationale that social identification is related to psychological health and well-being, we aimed to understand how social connections and group structure within college club sport teams relate to students' perceptions of social identification.

METHOD

We sampled 852 student-athletes from 35 intact same-sex college club sport teams. Using social network analyses derived from teammates' reports of connections with one another (i.e., time spent outside of sport, and teammate friendships), we computed: outdegree centrality (i.e., self-reported connections with teammates), indegree centrality (i.e., nominations from others), and group-level density. Multilevel models were fit to test the relative effects of outdegree centrality, indegree centrality, and group-level team density on athletes' social identification strength.

RESULTS

Outdegree centrality, indegree centrality, and team density were all positively related to the strength of athletes' social identification with their sport team. Examining model results step-by-step, incoming nominations of social connections (i.e., indegree) were associated with social identification beyond the effects of self-reported outdegree centrality. Furthermore, team-level density was significantly related to social identification after accounting for the individual-level effects of centrality.

CONCLUSION

Sport is a domain where participants can build social connections with peers, and sport groups offer a salient source for social identification. The current findings indicate that athletes who have greater social connections with teammates may form a stronger sense of social identification. Alongside theoretical contributions to a social identity approach to studying small groups, the current study highlights the utility of studying small groups using social network methodologies.

Congenital dyschromatopsia and school achievement

In 1993-94, in Liguria (a northwestern Italian region) a study was carried out on dyschromatopsia, a congenital sex-linked form of colour blindness. 3124 junior high school boys aged 10-15 years were tested using Ishihara plates (1973 edition) and Farnsworth's D-15 test (1947 edition). 152 students were identified as colour blind (4.87%), a value slightly below the Italian average of 5.3%. The school achievement of these students was assessed by means of the school marks of two randomised subsamples composed of 82 dyschromates and 82 orthochromates, paired homogeneously by age and class. Statistical analysis indicated significantly lower general school achievement for the 82 dyschromate subjects (except for art). The learning difficulties of dyschromate persons for whom colour is a basic didactic tool are discussed. Introduction of dyschromatopsia tests at preschool would be desirable.