Identifying, Alleviating Bias in VP&S Curriculum

During their first year as Columbia medical students, Christopher Travis’19 and Laura Benoit’19 started to notice a bias in the curriculum, particularly in lectures that describe normal as a limited range. They knew the bias was not intentional, but they decided it was their responsibility to draw attention to what they noticed. 

“The classic textbook definition of healthy gingivae is coral pink, but of course healthy gums of persons of color may be pigmented,” says Ms. Benoit. “There is a danger in incomplete medical knowledge,” adds Mr. Travis. “As a clinician I might mistakenly think that something is wrong with a patient when it isn’t necessarily so. One criterion to determine a newborn’s health is its pink appearance, yet what you care about isn’t specifically the color but an adequate oxygenated blood flow to the extremities. If the baby’s skin is darker you might not notice it as pink, but there will also be a difference between a dark arm that is dusky and one that is adequately oxygenated. Those differences add a level of complexity but also a level of completeness.” 

They were hesitant to say anything, but they wrote a letter to VP&S senior leadership to draw attention to the issue of biases that are often implicit and, therefore, hidden. The letter, while expressing a deep regard for their teachers, outlined plans to address the biases. The response was warm and receptive, and soon the two formed a diverse task force of students, faculty, and administrators to implement plans for a more inclusive curriculum. 

“We are recognizing that certain biases are baked into the way we’ve all learned medicine,” says Deepthiman Gowda, MD, associate professor of medicine and course director for Foundations of Clinical Medicine. “The lack of inclusion and the way we describe normal or the lack or careful recognition of damaging stereotypes, particularly in descriptions of diseases, are not necessarily purposeful. We have to be self-reflective and not take biases that might exist in the curriculum personally but see them as opportunities for improvement.”

The Task Force for a Bias-Free Curriculum, chaired by Dr. Gowda, drafted and disseminated guidelines for educators, identifying six areas for consideration when developing curricular material and teaching students. For example, the guidelines suggest having an inclusive representation of healthy or normal and avoiding stereotypes in representation of pathology. The guidelines were presented to and adopted by the school’s Curriculum and Education Policy Committee. 

“Our job as educators is to prepare our students to take care of the incredibly wide diversity of patients they are going to encounter throughout their careers,” says Dr. Gowda. “Therefore it is within our responsibility to make sure the curriculum is populated with cases, examples, and knowledge that represent that diversity.”

In support of the initiative, a web-based bias-free curriculum feedback portal was added to the learning environment reporting portal, where students can submit both positive and negative course feedback. Ms. Benoit and Mr. Travis stress the importance of the portal to keep the discussion going among students and faculty in the medical school. “For us, the most important goal, in addition to having the curriculum delivered, is that students will participate critically in its implementation,” says Mr. Travis.