The Case for Change: A Student-Staff Partnership to Decolonise a Medical School’s Case-Based Learning Curriculum

Abstract

Context Over the last few years, there has been increasing work across higher education (HE) on the attainment gap (Universities UK and NUS, 2019), anti-racism pedagogy (Ono-George, 2019) and the need for decolonisation of curricula (Liyanage, 2020). Decolonisation is the process of reviewing and changing the HE curricula of post-colonial countries so that they become diverse, inclusive and representative of minority ethnicities (Mbaki and Todorova, 2020). In our graduate entry programme, black, Asian and minority ethnic (BAME) students were awarded fewer merits and distinctions despite fulfilling the same entrance requirements as their peers (Sorinola et al ., 2019). A survey of medical students for the University’s Student Union Decolonise Project confirmed the need to decolonise our medical curriculum (Akojie and Seth, 2019). Therefore, as we use a case-based learning (CBL) curriculum, we formed a student-staff partnership to review it. Work A group of approximately ten students from The Warwick Medical School Black and Minority Ethnic Student Network volunteered to work together with the academic lead for CBL on decolonising the content and delivery of CBL sessions. Methodology The student members of the group examined the diversity of fictitious patients used in CBL cases and identified those from a minority ethnic background; they edited any that stereotyped patients or that might encourage misconceptions. They also reviewed the images used and suggested alternatives with appropriate skin tones. For example, the group expanded one CBL case of a jaundiced British Asian patient to include new content on signs of jaundice in all skin tones. After discussion, the group also changed the stereotypical fictional name of this CBL patient. The group has also been working on additional content to improve awareness about important issues disproportionately affecting people with minority ethnic backgrounds, issues such as higher risk of adverse outcomes in pregnancy or inadequate pain management. One member of the group with a special interest in sickle cell disease has also contributed additional material to several relevant cases, in order to raise awareness of this condition. The group’s members have considered student feedback and their own experiences when planning training for CBL facilitators on how to combat bias and direct or indirect racism encountered during CBL sessions. Results Initial verbal feedback from CBL groups on the changed content has been very favourable. Importantly, this partnership has also resulted in positive impacts on the course as a whole: Firstly, students from ethnic minority backgrounds are now driving change in CBL at our medical school. Secondly, it has provided an unmissable opportunity to work alongside and in partnership with our students who, as graduate-entry students, bring a vast array of knowledge, experience and skills to the course. Thirdly, despite the fact that CBL is a learner-led process, all CBL cases, historically, were written and edited solely by the medical school staff and so this move to involving students in the writing or editing of cases is a step forward to student ownership of their learning and therefore to improved engagement with the course. Conclusion This venture is intended not to be a single project, but a permanent and continuing process of reviewing and updating CBL in our curriculum, remaining for the future as a partnership of students and staff.