“Increased global attention to diversity, equity, and inclusion necessitates inclusive teaching in health professions education.” The opening line of this article by Jeremy Amayo and team set the scene for a wide-ranging discussion of principle and practical strategies to help teachers be more inclusive – in the classroom, in the clinical environment, and in the online learning environment.

Jeremy Amayo is an Assistant Professor and the Director of Ultrasound Education at the Emory University School of Medicine. He is also a Physician Assistant in the Division of Critical Care Medicine at Emory Healthcare.

As a radiologist, I am a physician whose responsibility and expertise is to carefully review medical imaging (e.g. radiographs, CT, ultrasound, MRI, PET) to detect abnormal findings or deem a medical imaging test “normal.” Since high school, my love of science and technology has been intertwined with appreciation for, creation of, and education in the visual arts. Radiology has been the perfect career combining visual skills, deductive reasoning, and understanding the intersections of anatomy, physiology, and disease. Participating in the Harvard Macy Institute Art Museum-based Health Professions Education Fellowship has not only exposed me to techniques highlighting similar skills that are cultivated in radiology practice but also to push emotional boundaries farther. This experience has also introduced me to my co-fellows - other passionate educators connecting, innovating, and working together to change the future of medicine and medical education.

Several years ago, while precepting 3^rd year medical students, I realized I was trying very hard to minimize their exposure to the parts of the job that can be cheerless. I wanted to protect them. I wanted them to have the most positive interaction with medicine they could during medical school. Unfortunately, however, from the moment we start our path to becoming physicians, it is easy to find ourselves dwelling on the negative. Whether it is bad feedback, a low score on an exam, a tough interaction with a patient, or hearing about patients’ lack of access to care, the negative experiences tend to carry more weight than the positive. Recently, after attending a particularly discouraging lecture, I knew it was time to put a plan into play that had been brewing in my mind for years.

With encouragement and collaboration from colleagues, we began an evening storytelling session which a colleague appropriately titled “For the Love of Medicine.” This is a para-curricular, voluntary activity for medical students where physicians on our faculty and in our community share brief but specific stories from their careers. This purpose of each story is to highlight why choosing a career in medicine is so rewarding.

Now, in 2022, I am a second-year medical student at Wayne State University School of Medicine. Diversity, in both patient population and medical school student body, is one of Wayne’s strengths. Still, I recognize that I fall within a uniquely well-represented but seemingly under-supported group of outliers: the non-traditional medical students.

Who is a non-traditional medical student? 

Anecdotally, we may be known as “the weird ones who always sit in the front row and never come to social events.” Generally, students are considered non-traditional if there was at least a two-year gap between completing an undergraduate degree and medical school matriculation. First-generation medical students or students who come from low socioeconomic backgrounds often self-identify as non-traditional as well. The average age of medical school matriculants is 24 years old, suggesting a shift towards more non-traditional student acceptances.

What value do non-traditional students bring to medical education?

Non-traditional students bring valuable life experience to medical school. For example, students with prior career experience may exemplify team spirit and a growth mindset that all students can learn from. Older medical students may have the lived experience of navigating the healthcare system that can be valuable for all learners.  

How do we do this? One solution is to recalibrate “performance reviews” as future-focused, collaborative, goal-setting conversations—those that will motivate individuals (humans) to envision a future beyond traditional outcomes measures—to wonder and dream. Modernizing the performance review “system” is an important step for taking our organizations to a new level from the ground up.   This may mean elevating and redefining metrics for performance, beyond strictly business or work-related units of measure like RVU calculations or faculty work load.

What could this look like? Scholars are increasingly examining the psychological needs of workers including, autonomy, competence, and relatedness, among others, and during a pandemic, these needs were heightened, yet often blurry. So now, more than ever before, we have an opportunity to pay attention to the messages we send, or don’t send, in our performance conversations.

Asking better questions during our reviews is an investment that helps people feel and be seen. Bringing better questions to performance conversations is also “power agnostic”—anyone can enrich performance outcomes through questions and conversations that matter. 

Connecting as humans, not machines or cogs, we can interrupt our everyday biases, and pursue clarity and focus around additional needs, roles, and dialogues--such as mentor, advisor, sponsor, or coach--which only expands the possibilities of promising results.