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Dr Lucy Desmond on Diversifying Medical Education

Dec 8, 2020

Written by Noa Kolkovski

Noa is a third year medical student at the University of Melbourne.

Dr Lucy Desmond is passionate about pushing for more inclusive and diverse medical education. Dr Desmond is a resident at Western Health in Victoria and an educator at the University of Melbourne. She has structured her career around a love for learning and the core belief that medical education is socially out-dated.

Dr Desmond is also the founder of beauty within medicine, a medical education platform delivering online content that is both high-yield and beautifully illustrated. Dr Desmond has also been writing an inclusive infographic medical textbook, entitled beauty within: Respiratory (to be released early 2021). Also in the pipeline is Dr Desmond’s surface anatomy book, Destigmatise, which celebrates beauty within diversity across all spectrums of age, biological sex (including intersex), ethnicity, size and physical difference. 

I spoke with Dr Desmond about medical education and how she challenges the status quo.

What are the key issues regarding diversity in medical education and how do they impact medical practice? 

Ableism & Medical School Admission
Whether medical students know it or not, they are taught on their very first day that we are not all equal. The entrance criteria for acceptance into medical school is socially outdated. Many universities outline a specific level of physical ability required for candidates, often stating something along the lines of “independent mobility” and “at least one fully functional arm” as requirements. Disability refers to an impairment of the body and/or mind that may limit participation and engagement in certain activities if the social environment is not accommodating. The medical environment is not currently accommodating and this needs to change. Physical impairment does not mean cognitive impairment and just because someone can’t do everything, doesn’t mean they can’t do anything.

Eurocentric- & Androcentric Medical Education
Once you start medical school, you learn that some bodies are inferior to others. Surface anatomy is habitually depicted on a young slender white male. Similarly, physical examination videos used to teach students how to detect pathological signs are commonly completed by an older white clinician examining a healthy young white male, without signs.  Despite over 50% of the population having breasts, some universities still tell medical students that they don’t need to worry about having to examine a female during their marked clinical exams. They tell them that the patient or the actor will be male. Apparently, this alleviates a lot of stress due to the increased degree of difficulty caused by manoeuvring such inconvenient appendages!

Furthermore, in some medical courses, a whole biological sex may be completely disregarded and referred to as “ambiguous genitalia”. This is atrocious given it is estimated that up to 2% of the population are intersex.

Once you commence clinical placement, you learn that some groups of people have been completely ignored and excluded in research. Basic examination findings used to determine health status such as waist and neck circumference do not consider body diversity. It has only been recently discovered that those assigned female at birth experiencing an acute myocardial infarction typically present with atypical chest pain. This is likely just the tip of the iceberg for sex-specific differences in presentations.

Cultural Safety
Transitioning to the bedside is made even more difficult by the fact that students are not educated about communicating with and examining a wide variety of people. During medical school we are taught to be ‘culturally aware’, but we are not taught specific nuances relevant to different religions and ethnicities.

These key issues above regarding the lack of diversity in medical education can all be linked back to one thing: a lack of recognition of the power of diversity and the talents and skills that those who are different can provide. This severely impacts how medical practice can be effective because the world is not homogenous. We cannot expect to serve a diverse community with an outdated, uniform strategy. The challenge is being able to teach in shades of grey in a world that is often presented in black and white.

How have you and beauty within medicine sought to address some of the issues around diversity in medicine?

beauty within medicine has not only provided a space to express myself creatively and educate others, but has also provided a platform for others to do the same, and to address the issues around diversity in medicine, or what I like to refer to as ‘socially outdated medical education’.

Speaking engagements have enabled me to advocate for change and creating infographics have allowed those views to be translated into socially inclusive medical education content. Our inclusivity infographic created in conjunction with the incredible A/Prof McNair is one that I feel the most proud of.

I am really excited to say that we have had over 500 people that have expressed their interest in being involved in our surface anatomy photoshoot. These magical images will be used in our upcoming surface anatomy book called, Destigmatise, which will assist students to learn about surface anatomy through the lens of a diverse range of people.

This is a start, but that is all it is. I strongly believe that to really shake things up, medical schools need to stop teaching in black and white which creates unconscious bias, and instead start exploring the shades of grey. Students are currently taught to think in terms of what is normal vs. abnormal, rather than ‘variations’ that land somewhere on a broad spectrum which can be applied to everything.

As a young female doctor, how do you seek to challenge the status quo?

As a young female doctor, I feel incredibly grateful for all the female doctors who graduated before me. Those in previous generations have worked extremely hard to forge a path and establish themselves in what was previously (and in some areas of medicine still is) a male dominated field. Now, with the majority of graduates being female, change is happening from the bottom up. It is so wonderful to be part of this movement.

Within the clinical environment currently, I think rather than just focusing on gendered inequality, the focus should also be on professional inequality. Doctors are often seen to be at the top of the hospital hierarchy, however, every individual who works within a hospital has a specific skill set and is a critical cog in the healthcare machine. Doctors see patients, provide a plan and then await that plan to be actioned. The people that work to make that plan possible and those who prepare for the next patient to arrive are so often overlooked.

The importance of personally acknowledging all of those who work to help execute your patient’s plan and express gratitude for all that they do cannot be underestimated.

What are 3 nuggests of wisdom you could impart to help medical students and junior doctors make actionable changes in regards to making medical education and practice more diverse, inclusive and supportive?

I can’t give you three but I can give you four…

  1. There are no rules: Your career progression can and will be fluid as your priorities in life shift. Don’t be afraid to step off the tram-tracks of career progression because you are concerned that it will be frowned upon. Life is too short to be miserable, so do things you enjoy while balancing becoming a well-rounded doctor in your own time.
  2. Identify your unconscious stereotypes and prejudices: Ideally, internal belief systems and unconscious stereotypes held by individuals should be questioned during their medical training. To really understand others, we must first understand ourselves. People will only tell you what you specifically ask for unless they feel comfortable with you as their doctor.
  3. Speak thoughtfully: To ensure that everyone feels like an equal within the walls of our medical institutions, the language we use as doctors needs to be deliberate, specific and considered. Female breast checks and male prostate checks are disrespectful to those who do not identify with their gender assigned at birth or who are intersex. Menstruation does not apply to females but to “females assigned at birth” and some individuals who are intersex. Be considerate of pronouns. If you don’t know something ask the patient but do so with care and only if there is a need to know.
  4.     Question everything: Do not believe everything you are told. As a medical student you are taught by a wide range of people. They are all human and therefore their beliefs may not align with yours and they can also make errors. Actively listen, research and come to your own conclusions about everything. Then educate those around you.

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