Enhancing equality, diversity, and inclusion in the undergraduate medicine curriculum: staff and student perspectives

Enhancing equality, diversity, and inclusion in the undergraduate medicine curriculum: staff and student perspectives | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Enhancing equality, diversity, and inclusion in the undergraduate medicine curriculum: staff and student perspectives Jo Seale, Eleanor M. Townsend, Vrinda Nayak This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7982081/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 7 You are reading this latest preprint version Abstract Introduction Incorporating equality, diversity, and inclusion (EDI) themes into medical curricula is essential for preparing students to support a diverse patient population. This study evaluated the representation of six predefined EDI themes in the Year 1 and 2 teaching content at the University of Exeter Medical School (UEMS) and explored student and staff perspectives on curriculum inclusivity with the aim of developing a guidance tool to support educators in integrating EDI topics into their teaching. Methods The views of year 1 and 2 students and staff were collected by questionnaires consisting of Likert items and open-ended questions. A student led curriculum review determined the representation of the six EDI themes in the written year 1 and 2 teaching material. Results The majority of students and staff felt confident discussing topics related to the six EDI themes except for religion and belief. Staff also requested more guidance on teaching gender identity, race/ethnicity, and disability. Analysis of 469 teaching sessions showed race/ethnicity was the most represented theme, while religion and belief had the least coverage. Student suggestions from the study informed the development of a guidance document for embedding EDI topics into the medical curriculum. Conclusion The finding that most EDI themes were not fully represented in the UEMS curriculum, in conjunction with a desire by students and staff for more teaching in this area, indicates the importance of further embedding EDI topics into the medical programme. The document developed from this study provides bespoke guidance for enhancing inclusivity in our curriculum. EDI inclusivity undergraduate medicine curriculum enhancement student perspectives Figures Figure 1 Figure 2 Figure 3 Introduction In alignment with guidelines set by the Medical Schools Council (MSC) and General Medical Council (GMC) ( 1 – 2 ), each medical curriculum in the UK requires adequate representation of diversity and inclusion to enable our future doctors to develop the knowledge, competence and skills required to care for patients from diverse backgrounds. The increasing diversity within the population, as evidenced in the 2021 census data for England and Wales ( 3 ), supports the importance of incorporating equality and diversity into medical education. Moreover, for the first time, the census counted people who identify as LGBTQ+, further demonstrating the changing social norms within the population ( 4 ). Widespread documentation of health disparities faced by minorities and people from marginalised communities, documented both in the UK and globally, indicates the need for healthcare professionals who are knowledgeable of the healthcare needs of our varied population. This is also highlighted by the National Health Service’s (NHS) long-term plan ( 5 ), underscoring the importance of providing foundational knowledge and skills in the early stages of medical education, which can subsequently be developed throughout an individual’s healthcare career. The undergraduate medical curriculum has a significant role in promoting the acquisition of knowledge and skills related to equality, diversity, and inclusion (EDI) in patient care and healthcare provision ( 6 – 9 ). In recent years, there has been a global effort in medical schools to enrich their curricula through inclusivity initiatives aimed at diversifying, decolonising, and internationalising/globalising the content ( 10 – 13 ). At the University of Exeter Medical School (UEMS), students enrolled in the Bachelor of Medicine and Bachelor of Surgery (BMBS) program primarily engage in problem-based learning (PBL) sessions, lectures, clinical skills, and interactive seminar sessions during the first two years. The subject matter of these activities is mapped to the guidance given by the MSC and GMC. However, the extent to which the teaching content is considered by students and staff involved in the medical program to be reflective of inclusivity is currently unclear. To address this uncertainty, the present study aimed to review the year 1 and 2 curriculum to determine the extent to which each teaching resource represents topics related to six predefined EDI themes: Race/ethnicity, Religion/beliefs, Disability, Gender identity, Sexual orientation and Socioeconomic status. In addition, the study sought to ascertain the views of year 1 and 2 students and staff about the inclusivity of the curriculum concerning the study themes. Ultimately, this study aims to address any gaps in the representation of the study themes by creating a guidance tool which can be utilised by both UEMS and other medical schools to enhance the inclusivity of medical curricula. Methods Study design Six themes were chosen to explore in the current study: Race/ethnicity, Religion/beliefs, Gender identity, Sexuality, Socioeconomic status, and Disability. Themes were selected following both a literature review on the EDI characteristics frequently identified in relation to healthcare and consultation with relevant stakeholders including the University of Exeter LGBTQ + network and members of the Racial Equality and Inclusion group at UEMS. To determine the representation of the study themes within the Year 1 and 2 BMBS curriculum, triangulation was employed through a curriculum review and surveys of staff and students. The study received ethical approval from the University of Exeter Medical School and Health and Care Professions Research Ethics Committee (Number: 030423). Participant recruitment Year 1 ( n = 238) and 2 ( n = 239) UEMS Students were recruited through an email invitation and advertisement posters on the campus between April and May 2023. Academic staff involved in year 1 and/or 2 BMBS teaching ( n = 100) were sent an email invitation to participate. Informed consent was obtained before participants proceeded with the study. Questionnaire To determine the views of students and staff regarding the representation of the study themes in the current year 1 and 2 BMBS curriculum the primary researchers created two questionnaires based on the aims of the study, one for staff and one for students. Each questionnaire consisted of a mixture of five-point Likert scale items and open-ended questions. The content of items in each questionnaire were predominantly similar, with some alterations being required to reflect the inevitable delivery versus receiving nature of the educator and student role respectively (Appendix S1). Prior to circulation, draft questionnaires were reviewed by academic colleagues and the ethics committee and alterations were made in response to their feedback. Curriculum review Ten Year 3 ( n = 7) and 4 ( n = 3) BMBS student interns were recruited using the Student Campus Partnership scheme to conduct a review of the year 1 and 2 BMBS written curriculum. The content consisted of PowerPoints and associated material used in 192 lectures, 206 interactive seminars in biomedicine/physiology/anatomy and 55 clinical skills teaching as well as 16 PBL sessions. Each student reviewed one-tenth of the programme which consisted of an average of 46 sessions. Theme representation was quantified using a previously published scoring system ( 14 ) wherein each session was given a score of 0 (no representation), 0.5 (partial representation) or 1 (full representation). If a score received 0 or 0.5, the reviewer was asked whether representation of any of the themes could be achieved and, if so, how. All responses were recorded on a Microsoft Form (Appendix S2) Data analysis Quantitative questionnaire responses and the curriculum review results were entered into Microsoft Excel 2024, version 2409 (Microsoft Corporation) to generate descriptive statistics. Qualitative data comprising of student suggestions from the curriculum review and responses to open-ended questionnaire items, were collated into a spreadsheet and categorised by theme across the four session types (lectures, seminars, clinical skills, and PBL) to inform the development of the guidance document. Creation of guidance document The three primary researchers independently reviewed the compiled suggestions from the qualitative data and generated a set of preliminary recommendations for each theme. These were then discussed in a group meeting to agree on a final selection of guidance options for educators. To ensure the information was applicable across different teaching formats and allowed educator autonomy, it was decided to create general guidance supplemented with links to relevant resources. A draft of the guidance document was subsequently reviewed by a volunteer group of staff members and the student interns involved in the curriculum review. Their feedback was used to further refine the guidance document. Results Student questionnaire Demographic data The response rate for the questionnaire was 48% (129 year 1; 102 year 2). The median age of respondents was 20.5 years (range 18–38 years). The majority of respondents were cisgender ( n = 227) and identified as a woman ( n = 134). The remainder of respondents identified as a man ( n = 87), non-binary ( n = 2) or did not provide an answer ( n = 7). Respondents described their ethnicity in their own terms, with the most common descriptors being White ( n = 138), British ( n = 112), Indian ( n = 17), Asian ( n = 15), Black ( n = 14), Pakistani ( n = 10), and Mixed ( n = 6). In total, there were 29 different terms used, and nine respondents declined to answer. For the religious belief system, nine different ideologies were supplied, with the most common response being atheism or no religion ( n = 81), followed by Christian ( n = 50). Most students described themselves as heterosexual ( n = 179), with the remaining respondents describing themselves as pansexual/bisexual ( n = 16) or homosexual ( n = 7). The majority of students said they did not have a disability ( n = 198), while 24 said they did, and nine students left blank or preferred not to say. Likert scale responses Quantitative analysis of the responses to the Likert item questions (Fig. 1 ) showed that the majority of students felt confident discussing the themes with their peers and were aware of the appropriate language to use, although this varied in accordance with the theme, with religion and beliefs having the least awareness. Similarly, 50–65% of students felt their knowledge was sufficient for their level of training in all of the themes except for religion and beliefs, where less than 50% considered themselves to have enough knowledge. In line with this, healthcare issues related to religion and beliefs were considered to be the least represented in the current curriculum. For all themes, the majority of students agreed that they would like further teaching about associated healthcare topics. Staff questionnaire The response rate for the questionnaire was 16%. Due to the low response rate, only the quantitative responses were analysed (Appendix S3). The majority (> 70%) of respondents felt confident discussing the themes with students and were aware of the appropriate language to use, except for gender identity where fewer respondents (< 60%) reported awareness and confidence. Over 60% of respondents felt that healthcare issues related to religion/beliefs, sexual orientation and disability were not fully represented in the curriculum and less than 50% of respondents considered themselves to have sufficient knowledge about health issues concerning gender identity and religion/beliefs. The majority of respondents (50–60%) requested more guidance on gender identity, religion/beliefs, race/ethnicity and disability. Curriculum review The representation of each theme in the written content of the four types of sessions (192 lectures, 206 seminars, 55 clinical skills, 16 PBL) is summarised in Fig. 2 . Race and ethnicity had the most representation in the sessions although this was predominantly partial and occurred in less than 20% of lectures, seminars and clinical skills sessions. Representation mostly occurred in PBL with 69% of the material showing either full or partial representation of the theme. Disability was the second most frequently represented theme, although the majority of lectures (84%), seminars (75%), PBL (69%) and clinical skills (73%) sessions did not feature the theme. For all session types, religion and beliefs had the lowest representation followed by sexual orientation and gender identity. For sessions without any current representation of a theme, a judgement was made by the reviewer as to whether the theme could be incorporated or not (Fig. 3 ). In a minority of lectures, seminars and clinical skills sessions, the reviewer felt that the theme could be included. In contrast, over 50% of PBL sessions were considered to be conducive to further incorporation of the race/equality, disability and/or socio-economic status themes. Guidance document The guidance document is a 5-page booklet with suggestions and resources to enhance inclusivity of the medicine curriculum. Following the title page, the second page of the document (Appendix S4) contains session specific suggestions, where opportunities for EDI theme inclusion was highlighted, for example in patient cases, lecture content, and seminar discussion. A main table on page 3 demonstrates how to incorporate EDI principles applicable to all 6 themes into teaching content, such as the use of diverse patient cases, images, and inclusive language, as well as the context of any colonial and historical legacies that have led to discriminatory practices in medicine (column 1). In addition, specific suggestions (columns 2–7) are provided for each of the six EDI themes. Pages 4–5 contain references to resources that providers can use to support the integration of topics into their teaching. The guidance document was internally disseminated through staff workshops and an online resource hub. Discussion The current study explored the representation of six EDI themes in the year 1 and 2 UEMS medical curriculum. Overall, the curriculum review found minimal representation of the themes in each type of teaching activity, except for race and ethnicity which showed the greatest level of representation in PBL. The finding that many lectures, seminars and clinical skills sessions were not deemed conducive to theme incorporation indicates a possible reason for their limited inclusion. In contrast, it was felt that there were opportunities to integrate the themes into PBL sessions which highlights a possible route for further curriculum development. Interestingly, there was a degree of uncertainty by the student reviewers as to whether some of the sessions would be able to include one or more themes. This is likely due to the subjective nature of the judgements being made by a sole reviewer. Student and staff questionnaire responses demonstrated that there was a noticeable ambiguity surrounding the representation of numerous themes as identified by the high number of respondents answering ‘neither agree or disagree’ to the relevant statement. In addition, despite the majority of students and staff feeling confident about discussing issues related to each theme, there was enthusiasm for more teaching on topics related to the EDI themes. As a result of these findings a guidance document containing advice on theme incorporation, many of which were highlighted by students involved in the curriculum review, was created. ‘Religion and belief’ was considered to be the least represented theme in the current analysis and an area in which students felt less confident. This is not unique to UEMS as a similar underrepresentation of spirituality has been identified in other UK medical schools ( 15 ). In continuing efforts to address this the GMC and MSC have both produced guidance documents ( 1 , 16 ). One issue highlighted in this study, and elsewhere ( 17 ), is the extent to which EDI themes can be incorporated into certain types of sessions such as those related to fundamental biomedical topics. In such teaching sessions it can often be challenging to introduce EDI themes without tokenism ( 18 ). In addition, certain styles of teaching, such as small group sessions, are more suited for integrating clinically relevant topics which can allow students to contextualise their learning ( 19 ). In light of this, advocating a ubiquitous inclusion of EDI into all facets of a medical curriculum is arguably unfeasible and likely to be ineffectual. Instead, the authors would argue that a more appropriate approach is for academics, alongside current students if possible, to reflect on each teaching session and come to a consensus as to whether any EDI issues can be incorporated in a meaningful way. As identified in this study, sessions which allow for student discussion and the exploration of clinical cases appear a useful medium by which students can explore the impact that EDI themes can have on an individual’s healthcare journey. While co-creation with students is well-established within medical curricula, this is especially pertinent when considering EDI topics. Students who are particularly attuned to social justice issues and eager to engage in advocacy can play a role in shaping the medical curricula with their perspectives ( 20 ). This not only allows us to hear the voices of students but also assists in addressing the power dynamics in determining the learning outcomes. The triangulation of two different methods (survey, and curriculum review) enabled the authors to gain a firm understanding of student and staff perspectives on the extent to which the six EDI themes have been represented in our curriculum as well as teaching and learning practices. In addition, student involvement in the review process allowed us to hear the voices of students. However, there are a number of limitations to this work. Specifically, due to time constraints and limited funding, only one student reviewed each session during the curriculum review. Time constraints also precluded piloting of the questionnaires. This prevented the calculation of reliability statistics which could have been used to inform further development of the questionnaire prior to its deployment. In addition, despite a good student questionnaire response rate staff questionnaire responses were low which limits the generalisation of these findings. Furthermore, all arms of this study will have been impacted by the respondents’ own lived experience and unconscious biases. It is also noted that a discrete set of themes were chosen as the focus of the current piece whilst other protected characteristics, such as age, were not explored. However, the six EDI themes used for this research have been used in similar studies ( 21 ) and it was felt that these offer a holistic perspective on underrepresented groups and those who encounter challenges in healthcare while avoiding an overwhelming analysis. Conclusion The present study determined the representation of six EDI themes in the current UEMS year 1 and 2 curriculum whilst also collecting the views of students and staff regarding both theme representation and their views about being taught/teaching these themes respectively. The demonstration that in the majority of sessions many themes were not fully represented, whilst also appreciating that a noticeable proportion of topics are not conducive to theme inclusion, indicates an area of curriculum development. Such findings highlight that a ‘one size fits all’ approach to EDI theme inclusion is not appropriate in this context. The keenness for increased teaching in relation to the EDI themes by both students and staff, alongside the need to ensure graduating students are adept at treating a diverse society, supports the importance of enhancing the inclusivity of our BMBS program. It is anticipated that the guidance document arising from this study will enable us to do this and will be a useful tool for others involved in medical education. Abbreviations BMBS Bachelor of Medicine Bachelor of Surgery Declarations Human Ethics and Consent to Participate Declaration The study received ethical approval from the University of Exeter Medical School and Health and Care Professions Research Ethics Committee (Number: 030423). Informed consent to participate in the study was collected by researchers, and all participants were given the opportunity to withdraw before anonymisation of the data. This study adhered to the Declaration of Helsinki. Consent for publication All participants in the study provided consent for publication. Competing Interests The authors have competing interests to declare Funding Declaration This work was funded by the Univeristy of Exeter Education Incubator. Author Contribution E.M.T, V.N, and J.S provided equal contributions to the conception and design of the work, as well as the acquisition of data. Production of figures was performed by J.S. All authors have drafted the work and contributed to revisions of the manuscript. Acknowledgement We would like to acknowledge the dedication, engagement and formidable work of the ten UEMS BMBS student interns tasked with reviewing the year 1 and 2 medical curriculum and for their valuable suggestions which provided the foundation of the resultant guidance document: Lara Andreski, Lily Chadwick, Ruggiero Di Lecce, Selorm Dzah, Maria Kamara, Phoebe Olabode, Heather Padley, Alice Sharp, Natasha Syed and Aysha Zaheer. We also wish to acknowledge the financial support in the form of a grant by the Exeter Education Incubator in 2022-23 and both Daniele Carrieri and the University of Exeter Health Professions Education & Wellbeing research group for their peer review of the ethics application and draft manuscript respectively. Finally we would like to thank the students and staff who responded to the survey and stakeholders who provided feedback at various stages of the research process. Data Availability The datasets supporting the conclusions of this article are included within the article (further details are available upon request). References General Medical Council. Religious and personal beliefs - GMC. [Internet]. n.d. [cited 2024 Nov 11]. Available from: https://www.gmc-uk.org/education/standards-guidance-and-curricula/guidance/religious-and-personal-beliefs General Medical Council. Promoting excellence - equality and diversity considerations. [Internet]. 2017 [cited 2024 Nov 11]. Available from: https://www.gmc-uk.org/-/media/documents/promoting-excellence-equality-and-diversity-considerations-pdf-72709944-updated-cover_pdf-108339650.pdf Office for National Statistics. Ethnic group, England and Wales. [Internet]. 2022 [cited 2024 Nov 11]. Available from: https://www.ons.gov.uk/peoplepopulationandcommunity/culturalidentity/ethnicity/bulletins/ethnicgroupenglandandwales/census2021 Catney G, Lloyd CD, Ellis M, Wright R, Finney N, Jivraj S, et al. Ethnic diversification and neighbourhood mixing: A rapid response analysis of the 2021 Census of England and Wales. Geogr J. 2023;189(1):63–77. 10.1111/geoj.12507 . NHS, The. NHS Long Term Plan. [Internet]. 2019 [cited 2024 Nov 11]. Available from: https://www.longtermplan.nhs.uk/wp-content/uploads/2019/08/nhs-long-term-plan-version-1.2.pdf Verbree AR, Isik U, Janssen J, Dilaver G. Inclusion and diversity within medical education: a focus group study of students' experiences. BMC Med Educ. 2023;23(1):61. 10.1186/s12909-023-04036-3 . Forrest D, George S, Stewart V, Dutta N, McConville K, Pope L, Kumar S. Cultural diversity and inclusion in UK medical schools. Clin Teach. 2022;19(3):213–20. 10.1111/tct.13472 . Brottman MR, Char DM, Hattori RA, Heeb R, Taff SD. Toward Cultural Competency in Health Care: A Scoping Review of the Diversity and Inclusion Education Literature. Acad Med. 2020;95(5):803–13. 10.1097/ACM.0000000000002995 . Roberts JH, Sanders T, Mann K, Wass V. Institutional marginalisation and student resistance: barriers to learning about culture, race and ethnicity. Adv Health Sci Educ Theory Pract. 2010;15(4):559–71. 10.1007/s10459-010-9218-7 . Green KA, Wolinsky R, Parnell SJ, Del Campo D, Nathan AS, Garg PS, Kaplan SE, Dasgupta S. Deconstructing Racism, Hierarchy, and Power in Medical Education: Guiding Principles on Inclusive Curriculum Design. Acad Med. 2022;97(6):804–11. 10.1097/ACM.0000000000004531 . Mbaki Y, Todorova E, Hagan P. Diversifying the medical curriculum as part of the wider decolonising effort: A proposed framework and self-assessment resource toolbox. Clin Teach. 2021;18(5):459–66. 10.1111/tct.13408 . Matthews NR, Davies B, Ward H. Global health education in UK medical schools: a review of undergraduate university curricula. BMJ Glob Health. 2020;5(12):e002801. 10.1136/bmjgh-2020-002801 . Gishen F, Lokugamage A. Diversifying the medical curriculum. BMJ. 2019;364:l300. 10.1136/bmj.l300 . PMID: 30674468. Wong SHM, Gishen F, Lokugamage AU. Decolonising the Medical Curriculum: Humanising medicine through epistemic pluralism, cultural safety and critical consciousness. LRE. 2021;19(1):1–22. 10.14324/LRE.19.1.16 . Neely D, Minford EJ. Current status of teaching on spirituality in UK medical schools. Med Educ. 2008;42(2):176–82. 10.1111/j.1365-2923.2007.02980.x . Medical Schools Council. Active Inclusion, Challenging Exclusions: Supporting students of different faiths. [Internet]. 2023 [cited 2024 Nov 11]. Available from: https://www.medschools.ac.uk/media/3049/active-inclusion-challenging-exclusions-supporting-students-of-faith.pdf Jeffrey DI. Barriers to empathy: The curriculum. Exploring Empathy Medical Students. London: Palgrave Macmillan Cham; 2019. pp. 151–83. Laughey WF, Atkinson J, Craig AM, Douglas L, Brown ME, Scott JL, Alberti H, Finn GM. Empathy in Medical Education: Its Nature and Nurture - a Qualitative Study of the Views of Students and Tutors. Med Sci Educ. 2021;31(6):1941–50. 10.1007/s40670-021-01430-8 . Dogra N, Bhatti F, Ertubey C, Kelly M, Rowlands A, Singh D, Turner M. Teaching diversity to medical undergraduates: Curriculum development, delivery and assessment. AMEE GUIDE 103 Med Teach. 2016;38(4):323–37. 10.3109/0142159X.2015.1105944 . Hirsh DA, Singh TA, Saravanan Y, Walters LK. A Practical Guide for Medical Teachers. In: Dent J, Harden R, Hunt D, editors. A practical guide for medical teachers (6th ed.) [e-book]. 2021 [cited 2024 Nov 11]. Available from: https://play.google.com/store/books/details/A_Practical_Guide_for_Medical_Teachers_E_Book_Edit?id=lBArEAAAQBAJ&hl=en_GB≷=MY Nolan N, Owen HA. Medical student experiences of equality, diversity, and inclusion: content analysis of student feedback using Bronfenbrenner's ecological systems theory. BMC Med Educ. 2024;24(1):5. 10.1186/s12909-023-04986-8 . Additional Declarations No competing interests reported. Supplementary Files AppendixS1.docx AppendixS2.docx AppendixS3.docx AppendixS4.pdf Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 11 Dec, 2025 Reviewers agreed at journal 05 Dec, 2025 Reviewers invited by journal 05 Dec, 2025 Editor assigned by journal 03 Dec, 2025 Editor invited by journal 10 Nov, 2025 Submission checks completed at journal 10 Nov, 2025 First submitted to journal 10 Nov, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7982081","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":556669639,"identity":"2350d13d-67b1-4122-864a-519f2b4e12ca","order_by":0,"name":"Jo Seale","email":"","orcid":"","institution":"University of Exeter Medical School, StLukès Campus","correspondingAuthor":false,"prefix":"","firstName":"Jo","middleName":"","lastName":"Seale","suffix":""},{"id":556669641,"identity":"149290aa-f477-4885-9f44-090c9a133fd7","order_by":1,"name":"Eleanor M. Townsend","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABCUlEQVRIiWNgGAWjYPADNhsUHm6FBxgMYIrSgAQzaVoOE9bCz8CdwPyB4Y+cwe32h48Lys7LGRzvP/i4gsFOnkEiLQGbFskG3g0gW4wN7pwxNp5x7raxZM9hZsMzDMmGDRJpB7BpMTgA0ZK47UYOmzRv2+3EfolkNskGBuYEBon0Bmxa7BFa0p//5m07V98m/5j9ZwNDPU4tBgxwLQlmzLxtBxL4JZjZGBsYDgO1YHeYxGHeDQfOGBgb29/IMZbmOZdsOLMn2ViyweC4YRvPM6ze52/v3figokJOTnJG+sPPPGV28gbHDz782FBRLc/PnmaATQsoEhDRguxgfBE5CkbBKBgFo4AAAAD51leSEmEo0AAAAABJRU5ErkJggg==","orcid":"","institution":"University of Exeter Medical School, StLukès Campus","correspondingAuthor":true,"prefix":"","firstName":"Eleanor","middleName":"M.","lastName":"Townsend","suffix":""},{"id":556669642,"identity":"fd4a1b9f-c61c-43a2-a593-94bda550da41","order_by":2,"name":"Vrinda Nayak","email":"","orcid":"","institution":"University of Exeter Medical School, StLukès Campus","correspondingAuthor":false,"prefix":"","firstName":"Vrinda","middleName":"","lastName":"Nayak","suffix":""}],"badges":[],"createdAt":"2025-10-29 16:38:25","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7982081/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7982081/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":97923529,"identity":"84146f24-b5c3-47ff-ac07-a829bd67af42","added_by":"auto","created_at":"2025-12-10 20:13:50","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":357461,"visible":true,"origin":"","legend":"","description":"","filename":"Manuscriptv9101125.docx","url":"https://assets-eu.researchsquare.com/files/rs-7982081/v1/51b4d871f6a0ff1637e2c6ec.docx"},{"id":98421345,"identity":"b6cc5334-95f4-48f1-bd02-8191f6b169bf","added_by":"auto","created_at":"2025-12-17 16:26:45","extension":"json","order_by":1,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":7593,"visible":true,"origin":"","legend":"","description":"","filename":"5bab046e4ab042c9b907a13a94fc0c3e.json","url":"https://assets-eu.researchsquare.com/files/rs-7982081/v1/2146751ddb14ce2471515874.json"},{"id":97923527,"identity":"a6ed9ff9-06fb-487d-bdd9-5f30392212a1","added_by":"auto","created_at":"2025-12-10 20:13:50","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":40258,"visible":true,"origin":"","legend":"","description":"","filename":"AppendixS1.docx","url":"https://assets-eu.researchsquare.com/files/rs-7982081/v1/e7f0ac5048a8e3bc885ee477.docx"},{"id":98421503,"identity":"4bd6acdf-b461-4580-9f5e-6265a8bd6ec8","added_by":"auto","created_at":"2025-12-17 16:27:59","extension":"docx","order_by":3,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":30737,"visible":true,"origin":"","legend":"","description":"","filename":"AppendixS2.docx","url":"https://assets-eu.researchsquare.com/files/rs-7982081/v1/dabd321e23b68d12d74e7ddf.docx"},{"id":97923535,"identity":"ca61b136-087b-475f-9e8b-c272ea68ceed","added_by":"auto","created_at":"2025-12-10 20:13:50","extension":"docx","order_by":4,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":106409,"visible":true,"origin":"","legend":"","description":"","filename":"AppendixS3.docx","url":"https://assets-eu.researchsquare.com/files/rs-7982081/v1/d23059731b47ee1d39997566.docx"},{"id":98421375,"identity":"7a9ac785-ea66-4330-a8d1-450c7852e4cc","added_by":"auto","created_at":"2025-12-17 16:26:55","extension":"pdf","order_by":5,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":337541,"visible":true,"origin":"","legend":"","description":"","filename":"AppendixS4.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7982081/v1/e33199ad0296009d90520c9f.pdf"},{"id":97923537,"identity":"4e55a3e2-0819-4941-94ef-2994f2660084","added_by":"auto","created_at":"2025-12-10 20:13:50","extension":"xml","order_by":6,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":68475,"visible":true,"origin":"","legend":"","description":"","filename":"5bab046e4ab042c9b907a13a94fc0c3e1enriched.xml","url":"https://assets-eu.researchsquare.com/files/rs-7982081/v1/883704e532088f84e691e510.xml"},{"id":98421041,"identity":"33025c4b-8e2b-4925-b72a-31063f8792c1","added_by":"auto","created_at":"2025-12-17 16:22:46","extension":"png","order_by":10,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":23827,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7982081/v1/12863ff03f2c5c56bb58edaa.png"},{"id":98421472,"identity":"67f45731-dae5-4a35-bf8c-e1d2e1d6d99e","added_by":"auto","created_at":"2025-12-17 16:27:42","extension":"png","order_by":11,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":27801,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-7982081/v1/462a1022494c5ed6a077618a.png"},{"id":97923541,"identity":"16095a69-8724-4f05-ad77-11efd99f3149","added_by":"auto","created_at":"2025-12-10 20:13:50","extension":"png","order_by":12,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":35470,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-7982081/v1/c1b40437613e4df3ae10b1fa.png"},{"id":98421499,"identity":"4fe2db87-d82b-4242-ab07-a3050eef9958","added_by":"auto","created_at":"2025-12-17 16:27:50","extension":"xml","order_by":13,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":63093,"visible":true,"origin":"","legend":"","description":"","filename":"5bab046e4ab042c9b907a13a94fc0c3e1structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7982081/v1/cd24607de8d75724987e55af.xml"},{"id":97923540,"identity":"0fb4b732-a5b4-451e-b25f-9c3451bc1cee","added_by":"auto","created_at":"2025-12-10 20:13:50","extension":"html","order_by":14,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":75104,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7982081/v1/076ebd4c4c056fedf4947776.html"},{"id":98421149,"identity":"df16d2e7-c22a-47da-afe9-e01e0dfd709d","added_by":"auto","created_at":"2025-12-17 16:24:19","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":143994,"visible":true,"origin":"","legend":"\u003cp\u003ePercentage of year 1 and 2 students who strongly agree/agree with questionnaire statements in relation to each theme. * Full statements in questionnaire: ‘Appropriate language’ = I am aware of the appropriate (i.e. not offensive/harmful) language to use in relation to [theme]; ‘Confident’ = I feel confident discussing with my peers health issues related to [theme]; ‘Sufficient knowledge’ = I feel I have sufficient knowledge about health issues related to [theme] for my stage of training; ‘Increased teaching’ = I would like more teaching about healthcare topics related to [theme]; ‘Fully represented’ = Healthcare issues related to [theme] are fully represented in the BMBS teaching content.\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7982081/v1/c951b6712e36efd2a35e9135.jpeg"},{"id":98422645,"identity":"1bb9bac4-a092-498a-bae6-6bdfe145d5b5","added_by":"auto","created_at":"2025-12-17 16:31:16","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":104750,"visible":true,"origin":"","legend":"\u003cp\u003ePercentage of sessions with full, partial or no representation of each study theme in year 1 and 2 BMBS lectures, seminars, PBL and clinical skills sessions\u003c/p\u003e","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7982081/v1/8411edb85977b11b47e4063b.jpeg"},{"id":97923533,"identity":"1d458a07-479c-4ad5-a06f-5a765201595c","added_by":"auto","created_at":"2025-12-10 20:13:50","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":40443,"visible":true,"origin":"","legend":"\u003cp\u003eExtent to which there was considered to be an opportunity to incorporate individual study themes into the year 1 and 2 BMBS lectures, seminars, PBL and clinical skills sessions which currently do not represent the theme. ‘Possible’ = session could incorporate the theme; ‘Not possible’ = session is not conducive to theme incorporation; ‘Uncertain’ = the reviewer was not certain whether the theme could be incorporated into the session\u003c/p\u003e","description":"","filename":"floatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-7982081/v1/b474b7b424ffa4abc20972d6.png"},{"id":98622382,"identity":"b78e6731-2379-4f3c-9230-e0006aef338c","added_by":"auto","created_at":"2025-12-19 16:53:25","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":855769,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7982081/v1/91a9bda9-e7a6-4f24-8d86-21ead921f9b2.pdf"},{"id":97923532,"identity":"676dca01-d4bb-4af0-97d3-193427b36c9f","added_by":"auto","created_at":"2025-12-10 20:13:50","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":40258,"visible":true,"origin":"","legend":"","description":"","filename":"AppendixS1.docx","url":"https://assets-eu.researchsquare.com/files/rs-7982081/v1/1d37c45875702e0ef0ba1c4c.docx"},{"id":97923543,"identity":"251bd937-e838-49cf-b8ed-7b2e176cf42a","added_by":"auto","created_at":"2025-12-10 20:13:51","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":30737,"visible":true,"origin":"","legend":"","description":"","filename":"AppendixS2.docx","url":"https://assets-eu.researchsquare.com/files/rs-7982081/v1/9f7a52b34eb554e2b640c8b0.docx"},{"id":97923542,"identity":"e1f3fe17-bcb5-4898-878e-194ac29c8351","added_by":"auto","created_at":"2025-12-10 20:13:50","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":106409,"visible":true,"origin":"","legend":"","description":"","filename":"AppendixS3.docx","url":"https://assets-eu.researchsquare.com/files/rs-7982081/v1/dbc576eec8c6073dc5757eba.docx"},{"id":98421396,"identity":"a6ba1078-27a0-4806-88ca-8430bdd7194a","added_by":"auto","created_at":"2025-12-17 16:27:07","extension":"pdf","order_by":3,"title":"","display":"","copyAsset":false,"role":"supplement","size":337541,"visible":true,"origin":"","legend":"","description":"","filename":"AppendixS4.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7982081/v1/e9b491d8434db9eb3b709c38.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eEnhancing equality, diversity, and inclusion in the undergraduate medicine curriculum: staff and student perspectives\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eIn alignment with guidelines set by the Medical Schools Council (MSC) and General Medical Council (GMC) (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e), each medical curriculum in the UK requires adequate representation of diversity and inclusion to enable our future doctors to develop the knowledge, competence and skills required to care for patients from diverse backgrounds. The increasing diversity within the population, as evidenced in the 2021 census data for England and Wales (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e), supports the importance of incorporating equality and diversity into medical education. Moreover, for the first time, the census counted people who identify as LGBTQ+, further demonstrating the changing social norms within the population (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Widespread documentation of health disparities faced by minorities and people from marginalised communities, documented both in the UK and globally, indicates the need for healthcare professionals who are knowledgeable of the healthcare needs of our varied population. This is also highlighted by the National Health Service\u0026rsquo;s (NHS) long-term plan (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e), underscoring the importance of providing foundational knowledge and skills in the early stages of medical education, which can subsequently be developed throughout an individual\u0026rsquo;s healthcare career.\u003c/p\u003e\u003cp\u003eThe undergraduate medical curriculum has a significant role in promoting the acquisition of knowledge and skills related to equality, diversity, and inclusion (EDI) in patient care and healthcare provision (\u003cspan additionalcitationids=\"CR7 CR8\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). In recent years, there has been a global effort in medical schools to enrich their curricula through inclusivity initiatives aimed at diversifying, decolonising, and internationalising/globalising the content (\u003cspan additionalcitationids=\"CR11 CR12\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). At the University of Exeter Medical School (UEMS), students enrolled in the Bachelor of Medicine and Bachelor of Surgery (BMBS) program primarily engage in problem-based learning (PBL) sessions, lectures, clinical skills, and interactive seminar sessions during the first two years. The subject matter of these activities is mapped to the guidance given by the MSC and GMC. However, the extent to which the teaching content is considered by students and staff involved in the medical program to be reflective of inclusivity is currently unclear. To address this uncertainty, the present study aimed to review the year 1 and 2 curriculum to determine the extent to which each teaching resource represents topics related to six predefined EDI themes: Race/ethnicity, Religion/beliefs, Disability, Gender identity, Sexual orientation and Socioeconomic status. In addition, the study sought to ascertain the views of year 1 and 2 students and staff about the inclusivity of the curriculum concerning the study themes. Ultimately, this study aims to address any gaps in the representation of the study themes by creating a guidance tool which can be utilised by both UEMS and other medical schools to enhance the inclusivity of medical curricula.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStudy design\u003c/h2\u003e\u003cp\u003eSix themes were chosen to explore in the current study: Race/ethnicity, Religion/beliefs, Gender identity, Sexuality, Socioeconomic status, and Disability. Themes were selected following both a literature review on the EDI characteristics frequently identified in relation to healthcare and consultation with relevant stakeholders including the University of Exeter LGBTQ\u0026thinsp;+\u0026thinsp;network and members of the Racial Equality and Inclusion group at UEMS. To determine the representation of the study themes within the Year 1 and 2 BMBS curriculum, triangulation was employed through a curriculum review and surveys of staff and students. The study received ethical approval from the University of Exeter Medical School and Health and Care Professions Research Ethics Committee (Number: 030423).\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eParticipant recruitment\u003c/h3\u003e\n\u003cp\u003eYear 1 (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;238) and 2 (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;239) UEMS Students were recruited through an email invitation and advertisement posters on the campus between April and May 2023. Academic staff involved in year 1 and/or 2 BMBS teaching (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;100) were sent an email invitation to participate. Informed consent was obtained before participants proceeded with the study.\u003c/p\u003e\n\u003ch3\u003eQuestionnaire\u003c/h3\u003e\n\u003cp\u003eTo determine the views of students and staff regarding the representation of the study themes in the current year 1 and 2 BMBS curriculum the primary researchers created two questionnaires based on the aims of the study, one for staff and one for students. Each questionnaire consisted of a mixture of five-point Likert scale items and open-ended questions. The content of items in each questionnaire were predominantly similar, with some alterations being required to reflect the inevitable delivery versus receiving nature of the educator and student role respectively (Appendix S1). Prior to circulation, draft questionnaires were reviewed by academic colleagues and the ethics committee and alterations were made in response to their feedback.\u003c/p\u003e\n\u003ch3\u003eCurriculum review\u003c/h3\u003e\n\u003cp\u003eTen Year 3 (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;7) and 4 (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;3) BMBS student interns were recruited using the Student Campus Partnership scheme to conduct a review of the year 1 and 2 BMBS written curriculum. The content consisted of PowerPoints and associated material used in 192 lectures, 206 interactive seminars in biomedicine/physiology/anatomy and 55 clinical skills teaching as well as 16 PBL sessions. Each student reviewed one-tenth of the programme which consisted of an average of 46 sessions. Theme representation was quantified using a previously published scoring system (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e) wherein each session was given a score of 0 (no representation), 0.5 (partial representation) or 1 (full representation). If a score received 0 or 0.5, the reviewer was asked whether representation of any of the themes could be achieved and, if so, how. All responses were recorded on a Microsoft Form (Appendix S2)\u003c/p\u003e\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\u003ch2\u003eData analysis\u003c/h2\u003e\u003cp\u003eQuantitative questionnaire responses and the curriculum review results were entered into Microsoft Excel 2024, version 2409 (Microsoft Corporation) to generate descriptive statistics. Qualitative data comprising of student suggestions from the curriculum review and responses to open-ended questionnaire items, were collated into a spreadsheet and categorised by theme across the four session types (lectures, seminars, clinical skills, and PBL) to inform the development of the guidance document.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eCreation of guidance document\u003c/h2\u003e\u003cp\u003eThe three primary researchers independently reviewed the compiled suggestions from the qualitative data and generated a set of preliminary recommendations for each theme. These were then discussed in a group meeting to agree on a final selection of guidance options for educators. To ensure the information was applicable across different teaching formats and allowed educator autonomy, it was decided to create general guidance supplemented with links to relevant resources. A draft of the guidance document was subsequently reviewed by a volunteer group of staff members and the student interns involved in the curriculum review. Their feedback was used to further refine the guidance document.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\u003ch2\u003eStudent questionnaire\u003c/h2\u003e\u003cdiv id=\"Sec11\" class=\"Section3\"\u003e\u003ch2\u003eDemographic data\u003c/h2\u003e\u003cp\u003eThe response rate for the questionnaire was 48% (129 year 1; 102 year 2). The median age of respondents was 20.5 years (range 18\u0026ndash;38 years). The majority of respondents were cisgender (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;227) and identified as a woman (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;134). The remainder of respondents identified as a man (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;87), non-binary (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;2) or did not provide an answer (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;7). Respondents described their ethnicity in their own terms, with the most common descriptors being White (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;138), British (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;112), Indian (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;17), Asian (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;15), Black (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;14), Pakistani (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;10), and Mixed (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;6). In total, there were 29 different terms used, and nine respondents declined to answer. For the religious belief system, nine different ideologies were supplied, with the most common response being atheism or no religion (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;81), followed by Christian (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;50). Most students described themselves as heterosexual (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;179), with the remaining respondents describing themselves as pansexual/bisexual (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;16) or homosexual (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;7). The majority of students said they did not have a disability (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;198), while 24 said they did, and nine students left blank or preferred not to say.\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003eLikert scale responses\u003c/h2\u003e\u003cp\u003eQuantitative analysis of the responses to the Likert item questions (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e) showed that the majority of students felt confident discussing the themes with their peers and were aware of the appropriate language to use, although this varied in accordance with the theme, with religion and beliefs having the least awareness. Similarly, 50\u0026ndash;65% of students felt their knowledge was sufficient for their level of training in all of the themes except for religion and beliefs, where less than 50% considered themselves to have enough knowledge. In line with this, healthcare issues related to religion and beliefs were considered to be the least represented in the current curriculum. For all themes, the majority of students agreed that they would like further teaching about associated healthcare topics.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003eStaff questionnaire\u003c/h2\u003e\u003cp\u003eThe response rate for the questionnaire was 16%. Due to the low response rate, only the quantitative responses were analysed (Appendix S3). The majority (\u0026gt;\u0026thinsp;70%) of respondents felt confident discussing the themes with students and were aware of the appropriate language to use, except for gender identity where fewer respondents (\u0026lt;\u0026thinsp;60%) reported awareness and confidence. Over 60% of respondents felt that healthcare issues related to religion/beliefs, sexual orientation and disability were not fully represented in the curriculum and less than 50% of respondents considered themselves to have sufficient knowledge about health issues concerning gender identity and religion/beliefs. The majority of respondents (50\u0026ndash;60%) requested more guidance on gender identity, religion/beliefs, race/ethnicity and disability.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003eCurriculum review\u003c/h2\u003e\u003cp\u003eThe representation of each theme in the written content of the four types of sessions (192 lectures, 206 seminars, 55 clinical skills, 16 PBL) is summarised in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. Race and ethnicity had the most representation in the sessions although this was predominantly partial and occurred in less than 20% of lectures, seminars and clinical skills sessions. Representation mostly occurred in PBL with 69% of the material showing either full or partial representation of the theme. Disability was the second most frequently represented theme, although the majority of lectures (84%), seminars (75%), PBL (69%) and clinical skills (73%) sessions did not feature the theme. For all session types, religion and beliefs had the lowest representation followed by sexual orientation and gender identity.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eFor sessions without any current representation of a theme, a judgement was made by the reviewer as to whether the theme could be incorporated or not (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). In a minority of lectures, seminars and clinical skills sessions, the reviewer felt that the theme could be included. In contrast, over 50% of PBL sessions were considered to be conducive to further incorporation of the race/equality, disability and/or socio-economic status themes.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\u003ch2\u003eGuidance document\u003c/h2\u003e\u003cp\u003eThe guidance document is a 5-page booklet with suggestions and resources to enhance inclusivity of the medicine curriculum. Following the title page, the second page of the document (Appendix S4) contains session specific suggestions, where opportunities for EDI theme inclusion was highlighted, for example in patient cases, lecture content, and seminar discussion. A main table on page 3 demonstrates how to incorporate EDI principles applicable to all 6 themes into teaching content, such as the use of diverse patient cases, images, and inclusive language, as well as the context of any colonial and historical legacies that have led to discriminatory practices in medicine (column 1). In addition, specific suggestions (columns 2\u0026ndash;7) are provided for each of the six EDI themes. Pages 4\u0026ndash;5 contain references to resources that providers can use to support the integration of topics into their teaching. The guidance document was internally disseminated through staff workshops and an online resource hub.\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe current study explored the representation of six EDI themes in the year 1 and 2 UEMS medical curriculum. Overall, the curriculum review found minimal representation of the themes in each type of teaching activity, except for race and ethnicity which showed the greatest level of representation in PBL. The finding that many lectures, seminars and clinical skills sessions were not deemed conducive to theme incorporation indicates a possible reason for their limited inclusion. In contrast, it was felt that there were opportunities to integrate the themes into PBL sessions which highlights a possible route for further curriculum development. Interestingly, there was a degree of uncertainty by the student reviewers as to whether some of the sessions would be able to include one or more themes. This is likely due to the subjective nature of the judgements being made by a sole reviewer. Student and staff questionnaire responses demonstrated that there was a noticeable ambiguity surrounding the representation of numerous themes as identified by the high number of respondents answering \u0026lsquo;neither agree or disagree\u0026rsquo; to the relevant statement. In addition, despite the majority of students and staff feeling confident about discussing issues related to each theme, there was enthusiasm for more teaching on topics related to the EDI themes. As a result of these findings a guidance document containing advice on theme incorporation, many of which were highlighted by students involved in the curriculum review, was created.\u003c/p\u003e\u003cp\u003e\u0026lsquo;Religion and belief\u0026rsquo; was considered to be the least represented theme in the current analysis and an area in which students felt less confident. This is not unique to UEMS as a similar underrepresentation of spirituality has been identified in other UK medical schools (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). In continuing efforts to address this the GMC and MSC have both produced guidance documents (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eOne issue highlighted in this study, and elsewhere (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e), is the extent to which EDI themes can be incorporated into certain types of sessions such as those related to fundamental biomedical topics. In such teaching sessions it can often be challenging to introduce EDI themes without tokenism (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). In addition, certain styles of teaching, such as small group sessions, are more suited for integrating clinically relevant topics which can allow students to contextualise their learning (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). In light of this, advocating a ubiquitous inclusion of EDI into all facets of a medical curriculum is arguably unfeasible and likely to be ineffectual. Instead, the authors would argue that a more appropriate approach is for academics, alongside current students if possible, to reflect on each teaching session and come to a consensus as to whether any EDI issues can be incorporated in a meaningful way. As identified in this study, sessions which allow for student discussion and the exploration of clinical cases appear a useful medium by which students can explore the impact that EDI themes can have on an individual\u0026rsquo;s healthcare journey.\u003c/p\u003e\u003cp\u003eWhile co-creation with students is well-established within medical curricula, this is especially pertinent when considering EDI topics. Students who are particularly attuned to social justice issues and eager to engage in advocacy can play a role in shaping the medical curricula with their perspectives (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). This not only allows us to hear the voices of students but also assists in addressing the power dynamics in determining the learning outcomes.\u003c/p\u003e\u003cp\u003e The triangulation of two different methods (survey, and curriculum review) enabled the authors to gain a firm understanding of student and staff perspectives on the extent to which the six EDI themes have been represented in our curriculum as well as teaching and learning practices. In addition, student involvement in the review process allowed us to hear the voices of students. However, there are a number of limitations to this work. Specifically, due to time constraints and limited funding, only one student reviewed each session during the curriculum review. Time constraints also precluded piloting of the questionnaires. This prevented the calculation of reliability statistics which could have been used to inform further development of the questionnaire prior to its deployment. In addition, despite a good student questionnaire response rate staff questionnaire responses were low which limits the generalisation of these findings. Furthermore, all arms of this study will have been impacted by the respondents\u0026rsquo; own lived experience and unconscious biases. It is also noted that a discrete set of themes were chosen as the focus of the current piece whilst other protected characteristics, such as age, were not explored. However, the six EDI themes used for this research have been used in similar studies (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e) and it was felt that these offer a holistic perspective on underrepresented groups and those who encounter challenges in healthcare while avoiding an overwhelming analysis.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe present study determined the representation of six EDI themes in the current UEMS year 1 and 2 curriculum whilst also collecting the views of students and staff regarding both theme representation and their views about being taught/teaching these themes respectively. The demonstration that in the majority of sessions many themes were not fully represented, whilst also appreciating that a noticeable proportion of topics are not conducive to theme inclusion, indicates an area of curriculum development. Such findings highlight that a \u0026lsquo;one size fits all\u0026rsquo; approach to EDI theme inclusion is not appropriate in this context. The keenness for increased teaching in relation to the EDI themes by both students and staff, alongside the need to ensure graduating students are adept at treating a diverse society, supports the importance of enhancing the inclusivity of our BMBS program. It is anticipated that the guidance document arising from this study will enable us to do this and will be a useful tool for others involved in medical education.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eBMBS\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eBachelor of Medicine\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eBachelor of Surgery\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003c/div\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003ch2\u003eHuman Ethics and Consent to Participate Declaration\u003c/h2\u003e\u003cp\u003eThe study received ethical approval from the University of Exeter Medical School and Health and Care Professions Research Ethics Committee (Number: 030423). Informed consent to participate in the study was collected by researchers, and all participants were given the opportunity to withdraw before anonymisation of the data. This study adhered to the Declaration of Helsinki.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003ch2\u003eConsent for publication\u003c/h2\u003e\u003cp\u003eAll participants in the study provided consent for publication.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003ch2\u003eCompeting Interests\u003c/h2\u003e\u003cp\u003eThe authors have competing interests to declare\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e\u003cp\u003eDeclaration\u003c/p\u003e\u003cp\u003eThis work was funded by the Univeristy of Exeter Education Incubator.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eE.M.T, V.N, and J.S provided equal contributions to the conception and design of the work, as well as the acquisition of data. Production of figures was performed by J.S. All authors have drafted the work and contributed to revisions of the manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003e We would like to acknowledge the dedication, engagement and formidable work of the ten UEMS BMBS student interns tasked with reviewing the year 1 and 2 medical curriculum and for their valuable suggestions which provided the foundation of the resultant guidance document: Lara Andreski, Lily Chadwick, Ruggiero Di Lecce, Selorm Dzah, Maria Kamara, Phoebe Olabode, Heather Padley, Alice Sharp, Natasha Syed and Aysha Zaheer. We also wish to acknowledge the financial support in the form of a grant by the Exeter Education Incubator in 2022-23 and both Daniele Carrieri and the University of Exeter Health Professions Education \u0026amp; Wellbeing research group for their peer review of the ethics application and draft manuscript respectively. Finally we would like to thank the students and staff who responded to the survey and stakeholders who provided feedback at various stages of the research process.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe datasets supporting the conclusions of this article are included within the article (further details are available upon request).\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eGeneral Medical Council. Religious and personal beliefs - GMC. [Internet]. n.d. [cited 2024 Nov 11]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.gmc-uk.org/education/standards-guidance-and-curricula/guidance/religious-and-personal-beliefs\u003c/span\u003e\u003cspan address=\"https://www.gmc-uk.org/education/standards-guidance-and-curricula/guidance/religious-and-personal-beliefs\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGeneral Medical Council. Promoting excellence - equality and diversity considerations. [Internet]. 2017 [cited 2024 Nov 11]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.gmc-uk.org/-/media/documents/promoting-excellence-equality-and-diversity-considerations-pdf-72709944-updated-cover_pdf-108339650.pdf\u003c/span\u003e\u003cspan address=\"https://www.gmc-uk.org/-/media/documents/promoting-excellence-equality-and-diversity-considerations-pdf-72709944-updated-cover_pdf-108339650.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eOffice for National Statistics. Ethnic group, England and Wales. [Internet]. 2022 [cited 2024 Nov 11]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.ons.gov.uk/peoplepopulationandcommunity/culturalidentity/ethnicity/bulletins/ethnicgroupenglandandwales/census2021\u003c/span\u003e\u003cspan address=\"https://www.ons.gov.uk/peoplepopulationandcommunity/culturalidentity/ethnicity/bulletins/ethnicgroupenglandandwales/census2021\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCatney G, Lloyd CD, Ellis M, Wright R, Finney N, Jivraj S, et al. Ethnic diversification and neighbourhood mixing: A rapid response analysis of the 2021 Census of England and Wales. Geogr J. 2023;189(1):63\u0026ndash;77. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/geoj.12507\u003c/span\u003e\u003cspan address=\"10.1111/geoj.12507\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNHS, The. NHS Long Term Plan. [Internet]. 2019 [cited 2024 Nov 11]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.longtermplan.nhs.uk/wp-content/uploads/2019/08/nhs-long-term-plan-version-1.2.pdf\u003c/span\u003e\u003cspan address=\"https://www.longtermplan.nhs.uk/wp-content/uploads/2019/08/nhs-long-term-plan-version-1.2.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eVerbree AR, Isik U, Janssen J, Dilaver G. Inclusion and diversity within medical education: a focus group study of students' experiences. BMC Med Educ. 2023;23(1):61. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s12909-023-04036-3\u003c/span\u003e\u003cspan address=\"10.1186/s12909-023-04036-3\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eForrest D, George S, Stewart V, Dutta N, McConville K, Pope L, Kumar S. Cultural diversity and inclusion in UK medical schools. Clin Teach. 2022;19(3):213\u0026ndash;20. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/tct.13472\u003c/span\u003e\u003cspan address=\"10.1111/tct.13472\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBrottman MR, Char DM, Hattori RA, Heeb R, Taff SD. Toward Cultural Competency in Health Care: A Scoping Review of the Diversity and Inclusion Education Literature. Acad Med. 2020;95(5):803\u0026ndash;13. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1097/ACM.0000000000002995\u003c/span\u003e\u003cspan address=\"10.1097/ACM.0000000000002995\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRoberts JH, Sanders T, Mann K, Wass V. Institutional marginalisation and student resistance: barriers to learning about culture, race and ethnicity. Adv Health Sci Educ Theory Pract. 2010;15(4):559\u0026ndash;71. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s10459-010-9218-7\u003c/span\u003e\u003cspan address=\"10.1007/s10459-010-9218-7\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGreen KA, Wolinsky R, Parnell SJ, Del Campo D, Nathan AS, Garg PS, Kaplan SE, Dasgupta S. Deconstructing Racism, Hierarchy, and Power in Medical Education: Guiding Principles on Inclusive Curriculum Design. Acad Med. 2022;97(6):804\u0026ndash;11. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1097/ACM.0000000000004531\u003c/span\u003e\u003cspan address=\"10.1097/ACM.0000000000004531\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMbaki Y, Todorova E, Hagan P. Diversifying the medical curriculum as part of the wider decolonising effort: A proposed framework and self-assessment resource toolbox. Clin Teach. 2021;18(5):459\u0026ndash;66. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/tct.13408\u003c/span\u003e\u003cspan address=\"10.1111/tct.13408\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMatthews NR, Davies B, Ward H. Global health education in UK medical schools: a review of undergraduate university curricula. BMJ Glob Health. 2020;5(12):e002801. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1136/bmjgh-2020-002801\u003c/span\u003e\u003cspan address=\"10.1136/bmjgh-2020-002801\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGishen F, Lokugamage A. Diversifying the medical curriculum. BMJ. 2019;364:l300. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1136/bmj.l300\u003c/span\u003e\u003cspan address=\"10.1136/bmj.l300\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. PMID: 30674468.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWong SHM, Gishen F, Lokugamage AU. Decolonising the Medical Curriculum: Humanising medicine through epistemic pluralism, cultural safety and critical consciousness. LRE. 2021;19(1):1\u0026ndash;22. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.14324/LRE.19.1.16\u003c/span\u003e\u003cspan address=\"10.14324/LRE.19.1.16\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNeely D, Minford EJ. Current status of teaching on spirituality in UK medical schools. Med Educ. 2008;42(2):176\u0026ndash;82. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/j.1365-2923.2007.02980.x\u003c/span\u003e\u003cspan address=\"10.1111/j.1365-2923.2007.02980.x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMedical Schools Council. Active Inclusion, Challenging Exclusions: Supporting students of different faiths. [Internet]. 2023 [cited 2024 Nov 11]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.medschools.ac.uk/media/3049/active-inclusion-challenging-exclusions-supporting-students-of-faith.pdf\u003c/span\u003e\u003cspan address=\"https://www.medschools.ac.uk/media/3049/active-inclusion-challenging-exclusions-supporting-students-of-faith.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJeffrey DI. Barriers to empathy: The curriculum. Exploring Empathy Medical Students. London: Palgrave Macmillan Cham; 2019. pp. 151\u0026ndash;83.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLaughey WF, Atkinson J, Craig AM, Douglas L, Brown ME, Scott JL, Alberti H, Finn GM. Empathy in Medical Education: Its Nature and Nurture - a Qualitative Study of the Views of Students and Tutors. Med Sci Educ. 2021;31(6):1941\u0026ndash;50. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s40670-021-01430-8\u003c/span\u003e\u003cspan address=\"10.1007/s40670-021-01430-8\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDogra N, Bhatti F, Ertubey C, Kelly M, Rowlands A, Singh D, Turner M. Teaching diversity to medical undergraduates: Curriculum development, delivery and assessment. AMEE GUIDE 103 Med Teach. 2016;38(4):323\u0026ndash;37. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3109/0142159X.2015.1105944\u003c/span\u003e\u003cspan address=\"10.3109/0142159X.2015.1105944\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHirsh DA, Singh TA, Saravanan Y, Walters LK. A Practical Guide for Medical Teachers. In: Dent J, Harden R, Hunt D, editors. A practical guide for medical teachers (6th ed.) [e-book]. 2021 [cited 2024 Nov 11]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://play.google.com/store/books/details/A_Practical_Guide_for_Medical_Teachers_E_Book_Edit?id=lBArEAAAQBAJ\u0026amp;hl=en_GB≷=MY\u003c/span\u003e\u003cspan address=\"https://play.google.com/store/books/details/A_Practical_Guide_for_Medical_Teachers_E_Book_Edit?id=lBArEAAAQBAJ\u0026amp;hl=en_GB≷=MY\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNolan N, Owen HA. Medical student experiences of equality, diversity, and inclusion: content analysis of student feedback using Bronfenbrenner's ecological systems theory. BMC Med Educ. 2024;24(1):5. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s12909-023-04986-8\u003c/span\u003e\u003cspan address=\"10.1186/s12909-023-04986-8\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"EDI, inclusivity, undergraduate medicine, curriculum enhancement, student perspectives","lastPublishedDoi":"10.21203/rs.3.rs-7982081/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7982081/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eIntroduction\u003c/h2\u003e\u003cp\u003eIncorporating equality, diversity, and inclusion (EDI) themes into medical curricula is essential for preparing students to support a diverse patient population. This study evaluated the representation of six predefined EDI themes in the Year 1 and 2 teaching content at the University of Exeter Medical School (UEMS) and explored student and staff perspectives on curriculum inclusivity with the aim of developing a guidance tool to support educators in integrating EDI topics into their teaching.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eThe views of year 1 and 2 students and staff were collected by questionnaires consisting of Likert items and open-ended questions. A student led curriculum review determined the representation of the six EDI themes in the written year 1 and 2 teaching material.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eThe majority of students and staff felt confident discussing topics related to the six EDI themes except for religion and belief. Staff also requested more guidance on teaching gender identity, race/ethnicity, and disability. Analysis of 469 teaching sessions showed race/ethnicity was the most represented theme, while religion and belief had the least coverage. Student suggestions from the study informed the development of a guidance document for embedding EDI topics into the medical curriculum.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eThe finding that most EDI themes were not fully represented in the UEMS curriculum, in conjunction with a desire by students and staff for more teaching in this area, indicates the importance of further embedding EDI topics into the medical programme. The document developed from this study provides bespoke guidance for enhancing inclusivity in our curriculum.\u003c/p\u003e","manuscriptTitle":"Enhancing equality, diversity, and inclusion in the undergraduate medicine curriculum: staff and student perspectives","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-10 20:13:45","doi":"10.21203/rs.3.rs-7982081/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2025-12-11T15:30:47+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"840560904916633269240765675951313224","date":"2025-12-05T12:50:32+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-12-05T11:17:23+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-12-03T09:59:47+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-11-10T18:27:30+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-11-10T11:41:13+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Medical Education","date":"2025-11-10T11:38:14+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"a360ccd0-3272-4990-8220-a6babf11720a","owner":[],"postedDate":"December 10th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-12-10T20:13:45+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-10 20:13:45","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7982081","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7982081","identity":"rs-7982081","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}