GUMC Tool: Inclusive Pedagogy
Georgetown University Medical Center is committed to promoting and supporting diversity, equity and inclusion across all its research, education, and clinical care activities. A core aspect of this is providing faculty with access to resources and tools that enable them to ensure their instructional materials reflect these principles.
Instructional materials are a key component of how students engage with new learning content. Materials that contain examples of misrepresentation or biases can cause substantial damage to students’ perceptions and attitudes to themselves, other people, their learning environment, and the subject matter. Conversely, materials that demonstrate concepts of respect, fairness, and positive power balances can not only enhance learning outcomes among students, but will contribute to reducing inequity and disparities.
The short list below provides a simple set of guidelines for faculty, as well as staff or students assisting with teaching (or otherwise presenting their work), to use either when updating existing materials or creating new ones, to avoid biases and promote an inclusive, diverse and representative learning environment. These principles apply across all ways in which content is disseminated, including research presentations and scientific manuscripts, so we encourage you to consider using these guidelines more broadly in your research, service, and instructional endeavors.
The “Top Tips” provided at the end of each section are recommendations for advancing diversity, inclusivity and representation beyond the baseline guidance, and which we hope will be useful for thinking more broadly about ways in which instructional practices can be used to create a positive and inclusive learning environment.
If you have questions, or would like to contribute examples to this list, please contact: firstname.lastname@example.org.
More great resources can be found in the CNDLS Inclusive Pedagogy Toolkit.
Attributes and identities that can result in bias, discrimination, or mis-/underrepresentation in instructional materials include:
Age, Ethnicity, Immigration status, Religion, Appearance, Gender, Mental health, and Sexual orientation, Diet, Gender equity, National origin, Socioeconomic status, Disability, Height, Primary language, Substance use, Education level, Housing status, Race, Weight
Content and Language
- Example: Terms relating to disease or other type health conditions that end in “-ic” frame the affected person solely in the context of that disease, implicitly implying no other facets to their identity or self. So, in a lecture about mental health, instead of the term “Schizophrenic”, frame the person first: “a person living with Schizophrenia”.
- Example: It is easy to overlook that many of the common terms we use to discuss biological and social processes can result in microinvalidations or even triggers for individuals. For example, conflating “mother” with provision of an egg for conception can invalidate the experiences of, and thus exclude, trans women, adoptive parents, and egg donors, among others.
- Hales (2020) provides a comprehensive set of examples of more inclusive language related to genetics and physiology
Does your content provide opportunities, as appropriate, to acknowledge sensitively that learners may have a personal experience with the topic?
- Example: Discussion of certain conditions or events which are commonly associated with stigma (e.g., addiction, self-harm) may be upsetting for some students, especially those with direct experience. Providing clear outlines of the topics to be discussed, and expressing that students may disengage from the class if needed, can help navigate these situations sensitively.
Do your materials question assumptions related to different groups, and/or include examples in which people vulnerable to exclusion are made visible and represented positively?
- Example: Use your materials to challenge assumptions! For example, when discussing malnutrition and food insecurity, consider including examples from high-income countries, many of which face substantial challenges related to micronutrient deficiencies; likewise, include examples of how obesity affects millions of people in lower- and middle-income countries, to counter expectations and stereotypes around access to food and nutrition.
Does your content mention race appropriately, or examine the implications of diversity as part of the theory or practice of the topic area, to the extent this would be relevant?
- Example: Consider removing race as a detail from cases, history of patient illness (HPI), and one liners, unless it is relevant for patient care. If included, an explanation as to why race is important to the teaching example, with respect to provision of care, should be provided.
- Example: When discussing healthcare, explain that the race of the attending physician impacts outcomes, as a way to demonstrate how diversity in medicine can have tangible impacts on individual and population health. For example, a 2020 study showed a 50% reduction in the “mortality penalty” when Black newborns were cared for by Black physicians.
- Example: In clinical practice, conflict between types of healthcare professionals can undermine team cohesion and negatively impact the quality of patient care. Educational materials that reflect respectful interprofessional dynamics can help foster positive relationships. For example, medical student curricula can describe the extensive responsibilities placed on nurses, and the wide variety of roles they play in clinical care.
- Example: Be aware that your trainees may have backgrounds or interests related to other approaches to health, and consider their views with respect and deliberate discourse. US medical, public health, and health sciences education often focuses exclusively on “Western” biomedical concepts of health and medicine. However, many non-European and Indigenous cultures place strong emphasis on spirituality or connection to community as a source of well-being, equal in importance to physical and mental health.
Top Tip: Racism and discrimination are determinants of health. In this way, medical and public health education present ideal forums for exploring issues of diversity, openness, and cultural relativity, both in the context of health outcomes but also in their own right. Consider explicitly including these themes throughout your training materials, to acknowledge the significant impact they have on our society and individuals within it. For example, when discussing racial concordance (as seen in the example with Black newborns), consider spending time on why a doctor’s race makes a difference to health outcomes, and what that reveals about the inequities in our society.
Top Tip: Consider including group assignments and other collaborative projects in your instructional approach, and encourage other aspects of “community building” within your classroom. Research has shown that first generation college students in the US perform better when community and interdependence are emphasized as core aspects of the higher education experience; conversely, they fall behind relative to continuing-gen students when independence or “finding your own path” are the dominant approaches. (Stephens et al., 2012)
Research and References
Do you acknowledge limitations in the cited literature or research with respect to sampled populations or bias?
- Example: Many aspects of research under-sample from minority populations, even when the health condition or disease being studied is more prevalent in an underrepresented group. For example, research in 2015 showed that fewer than 5% of US federally-funded research studies on lung diseases since 1995 had focused on people of color, despite Black Americans being over 3 times more likely to die from asthma, a known risk factor, than White counterparts. Ensure that these types of limitations are clearly described in your materials.
Are the research studies and references cited in your materials up to date with respect to terminology, classifications of populations and individuals, equitable methods, and/or sampling bias?
- Example: Consider how to enhance your examples to include new approaches and methodologies that explicitly focus on advancing equity. For example, co-production of knowledge is increasingly recognized as a powerful tool for rebalancing power within research initiatives, with potential important impacts on the quality and sustainability of health and biomedical research.
- More information on this topic provided in the BMJ Collection of Papers
- Example: The following resources highlight issues around racist and biased citation, promote the academic work of underrepresented groups, and may help you identify new citations or examples:
Top Tip: Studies have shown that racial biases exist, even implicitly, in citation patterns, contributing to under-citation of scholars of color and silencing the intellectual production of researchers from underrepresented groups. In global health, this extends to underrepresentation of authors from the Global South in highly cited publications, especially in lead/senior authorship positions. Try to expand your citation list, or showcase the work of a wider diversity of researchers, to help overcome these persistent and damaging biases.
Top Tip: If you come across biased or racist research, report it! A group of scientists have launched the Anti-Racist Science initiative (@AntiRacist_sci), dedicated to fighting against peer-reviewed racism, one paper at a time. They maintain a Google form where you can report pre-prints and peer-reviewed papers that propagate racist and/or race science misinformation
Images & Media
- Example: Be deliberate about selecting images that, collectively across your materials, represent the diversity of the broader community and provide students from all backgrounds and identities to connect with the material.
- Extensive list of stock photography that includes diverse populations, including many open access, free resources
- Example: Black patients, especially men, are over-diagnosed with schizophrenia or schizoaffective mood disorder relative to non-Hispanic whites, which in some settings, has led to misconceptions related to race and likelihood of mental illness among the general public. Consistently using images of Black men in discussions of mental illness can reinforce implicit biases and contribute to stigma.
- References related to Top Tip (below):
Top Tip: For topic areas where known stereotypes or stigma exist, consider explicitly acknowledging and discussing the origins and impacts of these stereotypes. For example, a discussion about alcoholism in Indigenous populations could look at the causes of addiction in these communities (including racism, intergenerational trauma, residential schools, etc.); debunk insidious and damaging myths about the biological or cultural bases for alcoholism among Indigenous peoples; and look closely at the epidemiology of alcohol (ab)use, to understand that Indigenous individuals are actually more likely to abstain from alcohol than Whites, have similar levels of binge drinking, but are more likely to die from alcohol-related causes, and think critically about how and why those disparities persist.
Resources used for this guide
Various sources were used to compile this checklist, beyond those referenced directly in the text, including:
- UMass DRIVE Worksheet for Curriculum Approval
- La Trobe Inclusive Curricula Checklist
- University of Michigan Inclusive Pedagogy Checklist
- Irving Medical Center Guidelines for Promoting a Bias-Free Curriculum
Further Readings and References
Ambrose, S., Bridges, M.W., DiPietro, M., Lovett, M.C., & Norman, M.K. (2010). How Learning Works: Seven Research-Based Principles for Smart Teaching. San Francisco: Jossey-Bass. Chapter 6: “Why do Student Development and Course Climate Matter for Student Learning?”
Aronson, J., Fried, C., & Good, C. (2002). Reducing the effects of stereotype threat on African American college students by shaping theories of intelligence. Journal of Experimental Social Psychology 38: 113–125.
Gurin, P., Dey, E.L., Hurtado, S., & Gurin, G. (2002). Diversity and higher education: Theory and impact on educational outcomes. Harvard Educational Review, 72(3), 330-366.
Stephens, N. M., Fryberg, S. A., Markus, H. R., Johnson, C. S., & Covarrubias, R. (2012). Unseen disadvantage: how American universities’ focus on independence undermines the academic performance of first-generation college students. Journal of personality and social psychology, 102(6), 1178.
Steele, C. (2011). Whistling Vivaldi: How Stereotypes Affect Us and What We Can Do. Reprinted. New York: Norton.Woodruff, J.N., Vela, M.B., Zayyad, Z., Johnson, T.A., Kyalwazi, B., Amegashie, C., Silverman, R., Levinson, D., Blythe, K., Lee, W.W., Thomas, S., Parrish, W., & Humphrey, H. J. (2020). Supporting Inclusive Learning Environments and Professional Development in Medical Education Through an Identity and Inclusion Initiative. Academic Medicine 95(12S): S51-S57