Towards a more inclusive curriculum

Research worldwide also shows that diversity within medicine improves its quality. And when we see that there is still a considerable imbalance between the physician population and society, there is still a lot to be gained.One of the studies recently conducted at the GP training programs has formulated a so-called DEI (Diversity, Equity, and Inclusivity) strategy. This consists of 7 very concrete strategies, of which these are the most important:

• DEI expertise promotion for all those involved in GP training using training programs;
• Appointment of DEI ambassadors in all teams of GP training, who contribute to knowledge transfer, reflection on possible prejudices;
• Participation in DEI networks; Giving an active voice to trainees from ethnic minority groups in developments within GP training.

Despite the fact that there is a lot of attention and a number of initiatives have already been started within medicine, there are still plenty of challenges remaining. To address these challenges, it is essential that medical education actively works towards a more inclusive curriculum. In general, the following aspects are often mentioned as supporting the process towards more ‘DEI’:

• Awareness of implicit biases
• Knowledge about health issues specific to particular groups
• Skills to communicate effectively with a diverse patient population

The role of digital tools in inclusivity

Digital tools, including e-portfolios, can make a modest but potentially valuable contribution to promoting inclusivity in medical education. For example, we see in studies on biasing and the transfer of graduated doctors to the practical work environment as residents (learner handovers), the influence of negative feedback has a major impact on how the learner continues the learning path. A student who carries negative feedback consistently receives lower grades. And often this happens unconsciously or at least out of sight.

A number of very practical tools to promote diversity are:

• Personalized learning: E-portfolios allow students to follow their own learning path and reflect on their experiences. This can help recognize and value the unique perspectives and backgrounds of students.
• Equal opportunities for feedback: Digital platforms can provide a more structured and objective way of giving feedback, reducing the chance of unconscious biases.
• Accessibility: Online tools can increase the accessibility of education for students with physical limitations or other challenges.
• Cultural competence: E-portfolios can contain specific modules aimed at developing cultural competence, better preparing students to work with diverse patient populations.

Conclusion

Although digital tools such as e-portfolios may contribute more positively to more inclusive medical education than we think, they are only part of the solution. Real change requires a holistic approach, where all aspects of the training are critically examined and adjusted. Instruments or concepts such as ‘workplace-based assessment’, programmatic assessment, multi-source feedback, OSCE, where the origin of a decision can always be clear for the learner and the assessor, can be very useful in this regard. That’s why we believe these are also important elements of a good digital portfolio. Especially now that algorithms and AI support are increasingly being applied in such tools.

Creating an inclusive learning environment in medical education is not only a matter of justice for students but also an investment in better healthcare for everyone. By embracing diversity and promoting inclusivity, we train doctors who are better able to provide care to an increasingly diverse society.

Sources

1. https://www.huisartsopleiding.nl/kwaliteit-innovatie/opleidingsinnovatie/bevorderen-van-diversiteit-inclusie-en-gelijke-kansen-tijdens-de-opleiding/
2. https://www.revalidatie.nl/ntr/diversiteit-en-inclusie-in-de-opleiding-tot-revalidatiearts/
3. https://dejongedokter.nl/djd-schrijft/hoe-ver-zijn-we-al-diversiteit-en-inclusie-in-het-medisch-onderwijs/
4. Naar een inclusieve opleiding in de zorg: Diversiteit en inclusie onder artsen (Obihara & Maarse 2024)
5. Lee HW, Kim E. Workforce diversity and firm performance: Relational coordination as a mediator and structural empowerment and multisource feedback as moderators. Hum Resour Manage. 2019;1–19

Challenges and solutions

One of the biggest challenges in implementing holistic assessment is ensuring the objectivity and comparability of the assessments. Standardized assessment tools and regular training of instructors can help minimize subjective influences. Moreover, it is important that the assessment tools are regularly reviewed and updated according to new scientific findings and societal needs.

Conclusion

The introduction of holistic assessment in medical education is a necessary step to improve the quality of medical care. It ensures that future physicians not only possess the required specialized knowledge but are also capable of applying this knowledge in practice and addressing the needs of patients. However, such an education requires continuous adaptation and development of curricula, as well as close cooperation among all stakeholders in the healthcare system.

Sources used for this article

1. PDF: Bildungskonzepte für_das Gesundheitswesen
2. TOP XI Ankündigung des 129. Deutschen Ärztetages 2025 in Leipzig (bundesaerztekammer.de)
3. PDF: Berufsbildung und Beschäftigung im personenbezogenen Diensleistungssektor
4. PDF: Zwischen Licht und Schatten – eine explorative Studie zum Ausbildungserleben von Auszubildenden in der Pflege unter besonderer
   Betrachtung von Migrationshintergründen

Digital Portfolios: Empowering Learners

Digital portfolio platforms, like Scorion, can be powerful tools to support integrated learning and programmatic assessment. They provide students with a central hub to document achievements, reflect on their progress, and showcase their developing competencies ⁽⁴⁾.

Benefits of digital portfolios include:

• Centralized collection of work samples and assessments
• Opportunities for self-reflection and metacognition
• Longitudinal tracking of competency development
• Flexible, anytime access to promote self-directed learning

Navigating Challenges and Opportunities

While these approaches offer tremendous potential, implementing them requires careful consideration. Medical schools must adapt existing curricula, assessment structures, and technological infrastructure. Faculty development is also crucial to ensure educators can effectively leverage these new methodologies ⁽⁵⁾.

Conclusion

Integrated learning and programmatic assessment, supported by digital portfolios, have the power to transform medical education fundamentally. By fostering critical thinking, practical skills, and lifelong learning habits, these approaches prepare future physicians to thrive in an ever-evolving healthcare landscape. As medical schools worldwide embrace these innovations, they pave the way for a new generation of doctors equipped to meet the complex challenges of 21st-century medicine.

Sources used for this article

1. Integrated Courses – The Medic Portal
2. Vertical integration in medical education: the broader perspective | BMC Medical Education | Full Text (biomedcentral.com)
3. Integrated Medical Curriculum: Advantages and Disadvantages – PMC (nih.gov)
4. ROLE OF INTEGRATED CURRICULUM IN MEDICAL EDUCATION | American University of Barbados (aubmed.org)
5. Integrated Learning: Need of the Hour in Medical Education (apibpj.com)

How do you assess EPAs?

And to assess this properly, Prof Dr Ten Cate has developed a toolkit that actually consists of two parts. The first are the different levels of supervision which are a very useful tool to get a good idea of the level at which someone is performing. 

The second is a palette of assessment tools used. This is because it depends on the activity which assessment tool is appropriate. For example, one activity may be better assessed by ‘direct observation’ and another by a more longitudinal methodology of multiple measurements or a case discussion. It is therefore important to use the right measurement tools.

Working with EPAs

Developing EPAs is still an art. There are a number of tips and roadmaps for this too (Ten Cate, 2015; Pool & Ten Cate 2018). The steps to take are: Identify EPAs, describe them, validate and develop assessment instruments.

And applying EPAs in practice means that, as an educational institution or medical university or hospital, you ensure that prospective professionals work a lot in practice with or without supervision. Learning in the workplace, in other words.

But in addition, it is also important that these learning activities are recorded in some way, so that you can see what the progress is or to link an ‘entrustment descision’ to it.

And so it is important to convert EPAs into a measurement toolkit that does justice to teaching practice. And then Scorion often comes into the picture. This is now used by most universities, colleges and a large number of hospitals to work with EPAs. Good registration and recording of progress and feedback and assessments is very important when working with EPAs. In many cases, this is done using an e-portfolio. But not every portfolio is suitable for this. Traditional document-oriented portfolios are not able to properly record EPAs in a programmatic way. This is because it is about capturing feedback and assessments in data points and thus being able to present them clearly to the student, as well as to supervisors.

And furthermore, the portfolio should not interfere too much with the learning process. It should fit seamlessly with the programme and give the student something to hold on to. Ultimately, this way, the data points and the data help both the programme and the student to become an ‘entrustable’ professional.

EPAs worldwide

We find that there is currently a lot of interest worldwide in working with EPAs. We are therefore active with the Scorion team in seven different countries and notice that the demand for EPA knowledge is growing rapidly. EPAs also provide a particularly good framework for a national standard for a number of countries.

If you would like to know more about how to properly record EPAs in practice and set up a digital toolkit, please feel free to contact us. We will be happy to help you!

Author

Drs Roel Smabers, Scorion

Sources

Pool, Inge & Aantjes, Tineke & Kleijer, Wilma & ten Cate, Olle. (2018). Entrustable professional activities (EPA’s)- wat zijn dat en hoe ontwikkel je die?

ten Cate, Olle & Chen, Huiju & Hoff, Reinier & Peters, Harm & Bok, Harold. (2015). Curriculum development for the workplace using Entrustable Professional Activities (EPAs): AMEE Guide No. 99. Medical Teacher. 37. 1-20. 10.3109/0142159X.2015.1060308.