Answer to "How are equality, diversity and inclusion defined in medical education?"
There are numerous definitions relating to the above terms. Often terms are used loosely and interchangeably. Colleagues may also be restricted to definitions used by their organisation. We suggest that, for transparency, it is important to be clear about the definitions you are using and, perhaps, also, why. In the section below, we define the major terms we have advocated and provide our justification. You may or may not agree with us, but we hope we demonstrate the value in being open about our perspectives.
There are many definitions of culture and diversity; none are value free and all arise within a certain context. We recommend the definition of culture as adopted by the Association of American Medical Colleges (AAMC) Task Force (1999):
“Culture is defined by each person in relationship to the group or groups with whom he or she identifies. An individual’s cultural identity may be based on heritage as well as individual circumstances and personal choice. Cultural identity may be affected by such factors as race, ethnicity, age, language, country of origin, acculturation, sexual orientation, gender, socioeconomic status, religious/spiritual beliefs, physical abilities, occupation, among others. These factors may impact behaviours such as communication styles, diet preferences, health beliefs, family roles, lifestyle, rituals and decision-making processes. All of these beliefs and practices, in turn can influence how patients and heath care professionals perceive health and illness and how they interact with one another.” (pp. 25)
As Dogra and Carter-Pokras (2018) discuss, this definition recognizes the patient as more than just a clinical presentation and, instead, as a person with many different layers. Seeing patients as people is a crucial factor in helping health providers to deliver patient-centred care that seeks to work with the patient in a collaborative way and enables practitioners to deliver high quality care to all patients. Individuals construct their own sense of identity and culture based on language, country, ethnicity, religion, etc. The AAMC Task Force definition provides a dynamic view of culture, allowing for change in how individuals view themselves in clinical contexts and at different life stages.
Equality is about ensuring that every individual has an equal opportunity to make the most of their lives and talents irrespective of their background.
Definitions of diversity are positively framed and argue that diversity itself means positive attitudes towards those who are different. For example, The University of Oregon (1999) states,
“The concept of diversity encompasses acceptance and respect. It means understanding that each individual is unique, and recognizing our individual differences… It is the exploration of these differences in a safe, positive, and nurturing environment. It is about understanding each other and moving beyond simple tolerance to embracing and celebrating the rich dimensions of diversity contained within each individual.”
Such assumptions are questionable, as irrespective of whether individuals respect or value diversity, it is still present. Diversity may perhaps be best viewed as the differing expressions of culture by individuals.
Inclusion attends to the interactions and relationships among individuals and the extent to which people feel valued and respected for who they are and what they contribute to a group or organisation. In inclusive cultures, people are engaged and feel valued as being essential to the success of the organisation. The Global Diversity Practice (2017) defines inclusion as ‘organisational efforts and practices in which different groups or individuals having different backgrounds are culturally and socially accepted and welcomed, and equally treated’.
An inclusive culture often requires organisational changes in mind‐set, practice, and physical space. In short, ‘diversity is the mix and inclusion is getting the mix to work well together” (The Global Diversity Practice, 2017).
A minority by definition is those that belong to a group with fewer members than another group when the two groups are considered as a whole group (American Heritage® Dictionary of the English Language, 2016).
The definition is then expanded to how the term is often socially used “when a minority is an ethnic, racial, religious, or other group having a distinctive presence within a larger society. Some people object to this term as negative or dismissive, and it should be avoided in contexts where a group's status with regard to the majority population is irrelevant. Thus we would normally say a poem celebrating the diversity of cultures (not minorities) in America, where the emphasis is cultural as opposed to statistical or political. But in the appropriate context, as when discussing a group from a social or demographic point of view, minority is a useful term that need not be avoided as offensive.”
Association of American Medical Colleges (1999) Contemporary Issues in Medicine: Communication in Medicine. III. Washington, DC: Association of American Medical Colleges. Available at: https://members.aamc.org/eweb/upload/Contemporary%20Issues%20In%20Med%20Commun%20in%20Medicine%20Report%20III%20.pdf (Accessed: 3 April 2019).
Definition of Diversity (1999) University of Oregon. Available at: https://gladstone.uoregon.edu/~asuomca/diversityinit/definition.html (Accessed: 4 March 2019).
Dogra, N. and Carter-Pokras, O. (2018) ‘Diversity in Medical Education’, in Understanding Medical Education: Evidence, Theory and Practice. 3rd edn. Wiley Blackwell, pp. 513–530.
‘minority’ (2011) American Heritage® Dictionary of the English Language, Fifth Edition. Available at: https://www.thefreedictionary.com/minority (Accessed: 4 March 2019).
What is Diversity & Inclusion? (2018) Global Diversity Practice. Available at: https://globaldiversitypractice.com/what-is-diversity-inclusion/ (Accessed: 4 March 2019).