When we think about inclusivity, we often think about medicine as a whole, or diversity in skin tones. Many people think that skin tone does not matter in anatomy because it only shows what the inside looks like, but surface anatomy makes up a huge amount of anatomy teaching and is something students rely on for their future practice.
Implicit bias can be influenced based on the resources that students are exposed to. An implicit bias towards White people is further emphasised by the lack of representation in typical anatomy resources, such as textbooks, which have an over-representation of light skin tones (Louie and Wilkes, 2018). If students are mostly exposed to light skin tones, then they may develop implicit biases towards those who are not White, impacting patient care. This highlights the importance of diverse resources in the anatomical curriculum, as it is likely the first exposure a lot of students get to a plethora of images that show skin, namely in surface anatomical imagery.
Students want to be taught about inclusivity (Nazar et al, 2015). They are receptive to these conversations and challenging of internal bias, however, the receptivity to this decreases as their career develops and so needs to be addressed early in the curriculum (Nazar et al, 2015). At medical schools, 85% of anatomical teaching is done in the first two years of the undergraduate curriculum and so would be an ideal place for conversations about inclusivity to occur (Gogalniceanu et al, 2009). Moreover, most anatomical teaching occurs before students are well underway with their clinical placements. It is at these clinical placements where students may be most exposed to the ‘hidden curriculum’, which is the teaching and learning that students experience outside of the taught curriculum, such as interactions of clinicians with patients, or lecturers with students (Marcelin et al, 2019). Students identified that there are issues of bias and racial stereotypes in this hidden curriculum, which may influence or contribute to their own implicit biases (Nazar et al, 2015). While students are enthusiastic about inclusivity, they may not want to or have the extra time to go out of their way to find diverse resources, and because of this, it is so important that medical students receive these in their anatomical teaching (Nazar et al, 2015).
Furthermore, the GMC does not offer medical schools guidance on what should be minimum anatomical knowledge, and it is the onus of the anatomical staff to provide students with a diverse and inclusive curriculum that properly prepares students for practice (Turney, 2007). Outside of the GMC, the Anatomical Society’s syllabus, which many medical schools use as a guideline for anatomical teaching, makes no mention of ethnic minorities and the importance of this to be a focus in teaching (Smith et al, 2015). Because of a lack of guidance around this, it is important to evaluate how inclusive anatomical teaching is and where improvements can be made. Diversity in anatomy is important as to many students it may carry a particular significance - it may be the first opportunity they have to truly learn about the human body in such an immersive and hands-on way. Dissection will likely be something that students remember for their entire career, so it is of such high importance that these memories are not tainted with reduced inclusivity and diversity.
To conclude, it’s also important to note that ethnic inclusivity is just one aspect of inclusivity in both medical and anatomical education. Advancements need to be made with regard to the diversity and inclusion of a plethora of body types that more accurately display the population that our future doctors will be treating.
References:
Gogalniceanu, P., O'Connor Fitzgerald, E., Raftery, A., (2009) 'Undergraduate Anatomy Teaching in the UK', Annals of the Royal College of Surgeons of England, 91, pp. 102-106, available at: https://publishing-rcseng-ac-uk.nottingham.idm.oclc.org/doi/pdf/10.1308/147363509X407506 (Accessed 13/10/22).
Louie, P. and Wilkes, R. (2018) 'Representations of Race and Skin Tone in Medical Textbook Imagery', Social Science & Medicine, 202, pp. 38-42.
Marcelin, J.R., Siraj, D.S, Victor, R., Kotadia, S. Maldonado, Y.A., (2019) 'The Impact of Unconscious Bias in Healthcare: How to Recognize and Mitigate It', The Journal of Infectious Diseases, 220(2), pp. S62-S73.
Nazar, M., Kendall, K., Day, L., Nazar, H., (2015) 'Decolonising medical curricular through diversity education: lessons from students', Medical Teacher, 37(4), pp. 385-93.
Smith, C.F., Finn, G.M., Stewart, J., Atkinson, M.A., Davies, D.C, Dyball, R., Morris, J., Ockleford, C., Parkin, I., Standring, S., Whiten, S., Wilton, J., McHanwell, S., (2015) ‘The Anatomical Society core regional anatomy syllabus for undergraduate medicine’, Journal of Anatomy, 228(1), pp. 15-23.
Turney, B.W (2007) 'Anatomy in a Modern Medical Curriculum', Annals, 89(2), pp. 104-107.
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