Inclusion in the clinical learning environment: Building the conditions for diverse human flourishing

Abstract

Aim: While diversity, equity, and inclusion are much proclaimed aspirational goals in education programs, the clinical learning environment (CLE) frequently falls short of meaningful incorporation of these concepts in processes, policies, and local culture. In this paper, we explore how inclusion, diversity, and equity can and should be defined and operationalized within medical education.

Methods: Three cases, organized around Hafferty’s curricular framework (formal, informal, and hidden), we illustrate lapses and potential best practices in inclusion in the CLE.

Results: The essential “best-practice” of programs inclusive of diverse individuals is the design of policies, processes, and behavioral norms co-creatively with all community members. Potential pitfalls to greater inclusion include nostalgic reference to “the past”, a neutrality that is operationalized without the rudder of explicit values and not recognizing that ethical obligations between teachers, learners, and programs are at the heart of the discussion of how inclusive learning and work environments are built.

Conclusion: Inclusive CLE’s provide space for co-creation, understand the need to ensure the voices of the vulnerable (i.e. learners) are heard and valued and through this promote the flourishing of diverse human capital, in keeping with a model that views diversity as a key attribute or organizational excellence.

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article.

Acknowledgments

This work was originally presented in a workshop format at the International Conference on Residency Education, Halifax, Nova Scotia, Canada on October 17, 2018. The author acknowledges the discussions had there with the conference attendees: Linda Snell, Nicolette Caccia, Elizabeth Elsey, Ric Almond, Andrew Warren, Anne Matlow, and Kelly Caverzagie.

Additional information

Notes on contributors

Saleem Razack

Saleem Razack, MD, is a Professor of Pediatrics, Member of the Centre for Medical Education, and Director of the Office of Social Accountability and Community Engagement, Faculty of Medicine, McGill University, Montreal, Canada.

Ingrid Philibert

Ingrid Philibert, PhD, is a writer and editor in medical education and the former Senior Vice President, Field Activities, Accreditation Council for Graduate Medical Education, Chicago, IL.