EyeInclude: A qualitative feasibility study utilising staff-student partnership to create a diverse and inclusive postgraduate taught ophthalmology curriculum

Abstract

Introduction / Aims

In many ophthalmic diseases, patient ethnicity impacts prevalence, hospital non-attendance, access to treatment, type of treatment offered, and response to treatment. Such variation in outcomes has been linked to a number of reasons, one of which is clinician unconscious biases engendered during education. Some postgraduate ophthalmic curricula lack purposeful and structured diversity pedagogy theory, despite the need to sustain behavioural change that actively addresses inequalities in patient care.

The EyeInclude project established a staff-student partnership from the onset. This study aimed to understand the lived experiences of students and co-create a diverse and inclusive curriculum for a postgraduate module, with the potential for application to external postgraduate courses and international ophthalmic curriculum design.

Aim: Curriculum Redesign

Methods

The study redesigned the curriculum in collaboration with two student ambassadors from minoritized groups. Collectively, a literature review was conducted and discussions with different UCL EDI leads took place to understand the work being done in this area. Paired pre- and post-module student surveys were co-created with students and adapted from focus group thematic analysis and the UCL Curriculum Inclusivity Health Check. Surveys and semi-structured focus groups were conducted with a diverse cohort of domestic and international students. Changes recommended by students were implemented into the curriculum and evaluated by the same cohort. Student recommendations included low stakes activities, group work, diverse case studies, revision of reading lists and nuances in management of patients from different ethnic backgrounds.

Results

A total of thirteen (87%) students responded to surveys and focus groups. The median age of participants was 24 years (range 21-47). There was a preponderance of female participants 64%, Asian descent 77% (East, South, and Central Asia), home students 54%. Professional backgrounds of participants included junior doctors (46%), intercalating medical students (31%), and allied ophthalmic professionals (23%). Thematic analysis elicited health inequalities, representation of teaching materials, faculty values and method of delivery as pertinent to curriculum diversification and inclusion.

After curriculum re-design, students agreed or strongly agreed that the module contextualised ophthalmic health inequalities (100%), raised cultural awareness (100%), and considered age (100%), race (100%), disability (92%), pregnancy/maternity (85%), studies beyond Europe/USA (85%), gender (85%), and religion/belief (54%) in the context of managing ophthalmic patients. There was marked improvement of students’ reported confidence in knowledge of ophthalmic health inequalities, from 38% (agree) to 92% (agree or strongly agree). Student awareness of under-representation of patient populations underpinning investigational and diagnostic algorithms (54% to 100%) and in clinical trial literature (31% to 85%) increased.

All students agreed or strongly agreed that diversity in the curriculum is important to them (100%). Students perceived their cultural needs were considered (8% to 46%). There were increases in students who strongly agreed that they felt connected to the staff (62%) and that others on the programme understood them as a person (54%). The majority of students (92%) would like more opportunities to discuss health inequalities.

Conclusion

A staff-student partnership created and implemented a diverse and inclusive ophthalmic postgraduate module curriculum. The multi-stakeholder pedagogical approach contextualised practice-influencing evidence, emphasised health inequalities, and engaged with all faculty. Our curriculum changes enhanced students’ sense of belonging, increased their confidence in managing multi-background patients, and has the potential for transforming postgraduate and international ophthalmic curriculum design.