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

Integration with the Digital Learning Environment

A digital portfolio should never stand alone. It must be seamlessly integrated with the institution’s existing digital learning environment. Students and teachers need a single, connected ecosystem where learning, assessment, and feedback come together.

Smooth integration with learning management systems, scheduling tools, and assessment software is essential. Only when these systems work together can the portfolio truly function as a powerful instrument for personalized learning (2,3).

That may sound obvious — and it is — but in practice, integration often falls short. Sometimes systems simply can’t connect. As a result, data ends up scattered across platforms, making it harder to get a complete picture of a student’s progress. When that happens, students may not receive the right support at the right time.

What functionalities are needed for personalized learning?

Research has shown that the chances of success increase significantly if certain conditions are met:

1. Adjusting learning goals and activities
   Teachers can adapt learning goals and associated learning activities per student in the portfolio to their specific level, interest, and learning needs.
2. Formative evaluation and tailored feedback
   By closely monitoring students’ portfolio submissions and progress, teachers can provide targeted, personal feedback that aligns with each individual student’s learning needs.
3. Choices for students
   A powerful aspect is that students make choices within the curriculum in their learning activities, work forms, and ways of learning.
4. Flexible learning routes and paths
   With the flexibility of a digital portfolio, universities can easily set up different learning paths and choice trajectories, tailored to the preferences, talents, ambitions, and learning speeds of individual students.
5. Live monitoring and adjustment
   The clear dashboard gives teachers current insight into the progress, development, and bottlenecks of each individual student.
6. Individual timing and location of learning activities
   In addition, in our own practice and especially in medical education, we see the importance of being able to do learning activities individually in time and place as opposed to classical classroom learning. After all, in practice, you don’t often have a say in what will happen. And certainly in a healthcare facility or hospital this is the case. So for setting up the portfolio, it is then necessary that the actions or assignments with the corresponding feedback or assessment form can be easily changed by the institution.
7. Flexibility at the process level
   Finally, in order to facilitate all of the above points at the process level, you must also be able to be very flexible. For example, the programmatic testing concept works with many different forms such as low-stake and high stake assessments, self-reflections, group feedback, 360 degree feedback and many other processes. This is because the specific learning situation requires a specific feedback form, content and process.

Conclusion

Through these extensive functionalities for differentiation and personalization, an advanced digital portfolio makes it possible to shape higher education around the individual student. Students gain more control over their own learning process and can follow a learning path that seamlessly aligns with their personal needs, possibilities, and ambitions.

Thus, a well-implemented digital portfolio optimally supports universities in realizing personalized learning. A promising development for high-quality and future-oriented higher education, in which customization and talent development are central.

Sources to this article

1. Invoeren van een digitaal portfolio in het hoger beroepsonderwijs (utwente.nl)
2. https://www.surf.nl/files/2023-09/sf-e-portfolio_def.pdf
3. surf-rapport-herijking-van-de-visie-op-de-digitale-leeromgeving_webversie_0.pdf
4. Surfen over glad ijs; ICT-implementatiestrategieën in het hoger onderwijs vanuit veranderkundig perspectief (hal.science)