Public Oral Defense: Bethany Schowengerdt

Embodying Diversity, Equity, and Inclusion (DEI): Experiences of Student Advocates for Curricular Change in a United States Medical School Committing to Antiracism

Advisors: Dr. Joan DeJaeghere & Dr. Meixi

Burton Hall 205 & Online via Zoom

This dissertation examines a tacit assumption in medical school statements and accreditation standards that medical students will come to embody diversity, equity, and inclusion (DEI) in medical care through a learning experience imbued with DEI. Despite this pervasive assumption, it is unclear what it means for a given medical student to act out such commitments to DEI, especially antiracism, and what in their environment should stimulate their DEI-informed professional practice. Without dismissing the importance of outcome (e.g., cultural competence) achievement, I raise the concern that superficial, performative DEI can emerge if medical schools do not acknowledge how curriculum and students reciprocally come to embody a contextualized sense of DEI. 

A phenomenological inquiry informed by post-intentional thinking positioned DEI as enacted, through its embodiment by students. Student advocates, who are particularly sensitive to the nature of change demanded of them by their school, provided first-hand accounts of learning that challenged the acquisitive and bounded nature of DEI-informed curriculum of a medical school committed to antiracism. The study compared student advocates’ emerging sensemaking of DEI over time and in different places (e.g., classrooms, clinical immersion sites). The juxtaposition of what students were able to imagine as DEI-informed care and what they experienced as DEI-informed curricula revealed three critical findings. One finding is a generally shared journey among six student advocates of varying identities (racial/ethnic, gender, educational/professional backgrounds) as they come to understand DEI as a practice-grounded advocacy for and attunement to patients so they can define and maintain good health. A second finding is, to different degrees, that student advocates experienced tension with the utility of “DEI-informed” materials as group work prompts, group formations, and patient case vignettes both formed and challenged mental schema of DEI-informed practice. The complex mediation of these material artifacts was evident in students’ wrestling with whether activities were too structured or not structured enough. This complexity was visible when patient case vignettes and group work took on a new form —and an affective dynamic— during the physical encounters of the clinical education phase. Finally, due to a feeling of underpreparedness, these students attempted to change the conditions of power, time, and place through their advocacy activities. I contend this shift may be an alternative imaginary of DEI informed by care and epistemic openness beyond mastery of specific communication skills and knowledge about population-level health disparities, which felt unintegrated to students. The findings suggest more affectively attuned pedagogies could support students to embody both a rights-based and advocacy practice-based sense of DEI. The dissertation concludes that scholars and practitioners, particularly in medical education, should consider and scope the limitations in terms of power, place, and time dynamics of schoolwide commitments to DEI-informed curriculum given the distributed, intersubjective way in which students learn and then practice in a DEI-informed way.