'I sound different, I look different, I am different': Protecting and promoting the sense of authenticity of ethnically minoritised medical students.

BACKGROUND: Being authentic can improve students' well-being and enhance the medical student-patient communication and patient safety. However, the underrepresentation of ethnically minoritised students in medical education can result in identity suppression, interfering with students' ability to succeed academically and professionally. METHODS: We conducted interviews with 20 ethnically minoritised medical students, which were analysed thematically, to explore the following: What facilitates and prevents students from being their authentic self during medical school? What learning and teaching strategies can enable students to be or become their authentic self? FINDINGS: Experiences of discrimination, microaggressions and/or racism were the main barriers to authenticity, leading to fear of being discriminated again if students expressed their true self. Lack of diversity, cultural awareness and staff representation were also fundamental barriers. Being authentic was often perceived as contradictory to being professional and a risk that could damage students' reputation. However, when students could express their true self, they felt happier, safer and developed a stronger sense of belonging. DISCUSSION: To enhance authenticity, students need to see better staff representation, role models they can relate and aspire to, such as Black professors. Equity/Diversity/Inclusion/Belonging (EDIB) training needs to become embedded throughout the curriculum and be delivered by facilitators with lived experiences. Other strategies to promote students' authenticity included mentoring, better signposting to complaints procedure and well-being resources and implementation of 'zero tolerance' policies. To our knowledge, this is one of the first studies on the concept of authenticity in medical education and the first study focusing on ethnically minoritised students.

The 'exotic other' in medical curricula: Rethinking cultural diversity in course manuals.

Introduction: Implementation of cultural diversity training in medical education faces challenges, including ambiguity about the interpretation of 'cultural diversity'. This is worrisome as research has demonstrated that the interpretation employed matters greatly to practices and people concerned. This study therefore explored the construction of cultural diversity in medical curricula.Methods: Using a constructivist approach we performed a content analysis of course materials of three purposefully selected undergraduate curricula in the Netherlands. Via open coding we looked for text references that identified differences labelled in terms of culture. Iteratively, we developed themes from the text fragments.Results: We identified four mechanisms, showing together that culture is unconsciously constructed as something or someone exotic, deviant from the standard Dutch or Western patient or disease, and therefore problematic.Conclusions: We complemented earlier identified mechanisms of othering and stereotyping by showing how these mechanisms are embedded in educational materials themselves and reinforce each other. We argue that the embedded notion of 'problematic stranger' can lead to a lack of tools for taking appropriate medical action and to insecurity among doctors. This study suggests that integrating more attention to biological and contextual differences in the entire medical curriculum and leaving out static references such as ethnicity and nationality, can enhance quality of medical training and care.