ArticlePDF Available

Twelve tips for designing an inclusive curriculum in medical education using Universal Design for Learning (UDL) principles

Authors:

Abstract

An inclusive curriculum anticipates and provides strategies to support a diverse range of learners. Universal Design for Learning (UDL) offers medical educators three core principles, which can be used to design curriculum objectives, activities, instructional materials, and assessments with embedded flexibility, equitability, and representation to support diverse learners. Drawing on the available literature and author experience, this article presents twelve tips based on UDL principles for designing and implementing an inclusive curriculum in medical education. This article also questions the purpose of medical curricula and makes recommendations for fostering inclusivity within and beyond the curriculum setting.
Luke K
MedEdPublish
https://doi.org/10.15694/mep.2021.000118.1
Page | 1
Practical tips and/or guidelines Open Access
Twelve tips for designing an inclusive curriculum in
medical education using Universal Design for
Learning (UDL) principles
Karl Luke[1]
Corresponding author: Mr Karl Luke lukek1@cardiff.ac.uk
Institution: 1. Cardiff University
Categories: Curriculum Planning, Educational Strategies, Teaching and Learning, Technology
Received: 12/10/2020
Published: 10/05/2021
Abstract
An inclusive curriculum anticipates and provides strategies to support a diverse range of learners. Universal Design
for Learning (UDL) offers medical educators three core principles, which can be used to design curriculum
objectives, activities, instructional materials, and assessments with embedded flexibility, equitability, and
representation to support diverse learners. Drawing on the available literature and author experience, this article
presents twelve tips based on UDL principles for designing and implementing an inclusive curriculum in medical
education. This article also questions the purpose of medical curricula and makes recommendations for fostering
inclusivity within and beyond the curriculum setting.
Keywords: Universal Design for Learning; inclusive curriculum; curriculum design; inclusivity; medical education;
systemic barriers
Introduction
Widening access initiatives seek to increase the diversity of learners studying medicine and subsequently
diversifying the medical profession (Patterson and Price, 2017). With such diversification it is essential that
measures are introduced to ensure that curriculum design does not produce unnecessary barriers or discriminate
against learners with diverse characteristics, backgrounds, circumstances, and preferences. Moreover, designing
inclusive and equitable learning experiences is critical to mitigating the predicted global worsening of equity gaps in
higher education as a result of the COVID-19 pandemic (Marinoni, van’t Land and Jensen, 2020; Montacute, 2020).
Curriculum refers to the body of knowledge-content, subjects and/or skills taught in a particular programme, often
informed by government, societal, regulatory, and institutional requirements. Curriculum is also concerned with
Luke K
MedEdPublish
https://doi.org/10.15694/mep.2021.000118.1
Page | 2
‘when’ and ‘how’ the overall content will be transmitted or ‘delivered’ to learners (Smith, 2000). Various
interdependent components are involved in the curriculum design process, including the development of learning
outcomes, alignment to competence standards, and implementation through teaching, learning and assessment
activities (Morgan and Houghton, 2011). An inclusive curriculum anticipates the diverse needs of learners and aims
to provide all learners, regardless of their background and immutable characteristics, with equal opportunities to
participate fully and achieve the learning outcomes of a programme. Designing an inclusive curriculum should be
grounded by the principles of anticipatory, flexibility, collaboration, transparency, and equitability (McLoughlin,
2001; Morgan and Houghton, 2011).
Principles from Universal Design for Learning (UDL) (CAST, 2018) provide a useful framework for assisting
medical educators in designing programmes with integrated scaffolding of support for learners and flexibility of
access to learning with regards to space-time configurations and modality (Dickinson and Gronseth, 2020).
Curriculum designed in conjunction with UDL principles provides flexibility and allows learners to customise their
learning experiences to meet their individual needs.
The tips outlined in this article are not presented in any hierarchical order but provide a framework for designing
and implementing an inclusive curriculum in medical education. The guidance also explores the important issue of
social inequality in relation to curriculum design and makes recommendations for fostering inclusivity using UDL
principles.
Tip 1: Embed inclusive design from the start
Many countries have equality legislation in place which requires educators to make reasonable accommodations or
adjustments to ensure that learners are not discriminated in relation to disability and protected characteristics.
However, inclusive curriculum design should anticipate and reduce the need for individual adjustments (Bunbury,
2020). Where individual accommodations remain necessary, it is recommended they are designed and implemented
in partnership with the learner. Moreover, engaging learners throughout the curriculum design process can help
educators anticipate potential adjustments and help evaluate whether such accommodations could benefit a larger
population of learners and become mainstreamed (Morgan and Houghton, 2011).
Universal Design for Learning (UDL) (CAST, 2018) is a set of principles, grounded by cognitive neuroscience, for
designing curriculum that aims to provide all individuals with equal learning opportunities, regardless of (dis)ability,
gender, age, or cultural background. The three principles of UDL are:
Multiple means of representation: Using a variety of strategies to present information; providing a1.
range of methods to support perception and comprehension.
Multiple means of action and expression: Providing diverse learners with alternative ways to act2.
competently; providing alternatives for demonstrating what learners have learned.
Multiple means of engagement: Aligning to learners’ interests by offering choices of modality,3.
content, and tools; optimising relevance, value, and authenticity; motivating learners by offering
variable levels of challenge and effective feedback.
UDL is significantly different from other curriculum design approaches as it encourages educators to undertake the
design process by expecting the curriculum to be accessed by diverse learners with varying abilities and skills. This
anticipatory design approach encourages educators to design curriculum that recognises and embraces diversity in
learners’ needs and preferences (Sanger, 2020).
Luke K
MedEdPublish
https://doi.org/10.15694/mep.2021.000118.1
Page | 3
Tip 2: Define clear and achievable learning outcomes
In establishing curriculum objectives it is important that they are aligned to professional competence standards and
are also designed to allow learners multiple ways to demonstrate goal achievement. This advocated by the UDL
principle of multiple means of action and expression.
Effective inclusive curriculum design, including the teaching strategies, materials, and assessment design, involves
flexibility and strong constructive alignment with the intended learning outcomes (McLoughlin, 2001). Learning
outcomes should be non-discriminatory by design and reflect a genuine measure of achievable competence (Morgan
and Houghton, 2011). As an example, it is important to design goals and strategies within the medical curriculum
that will enable all learners to have equitable and flexible opportunities to develop and express pre-clinical
knowledge, competencies, and attributes. Simulated, virtual, or augmented activities potentially provide a safe
environment for learners to practise, acquire, and enhance skills required during clinical practice (McLean and
Gibbs, 2010; Dickinson and Gronseth, 2020). Whilst such methods are likely to benefit a range of learners, they may
be particularly helpful for the unconfident learner or those with restricted opportunities to acquire skills before
practical training starts (Morgan and Houghton, 2011). This is a particularly important consideration given the
restrictions forced upon some training opportunities by the COVID-19 pandemic. Therefore, when designing
learning outcomes carefully consider how a diverse cohort of learners can achieve and express these.
Learning outcomes should be clearly presented to learners within the syllabus. A syllabus is typically presented as a
document which outlines the topic or concept areas that may be assessed and examined and is often developed by
the educator. It provides learners with the required elements of a course or programme and can shape learner
expectations (Harnish and Bridges, 2011). For educators, it serves as an instrument to help plan and organise the
content and activities that learners must engage with during a course (Slattery and Carlson, 2005). Language used
with the syllabus can influence learners’ initial impressions of educators. Incorporating friendly language and a
pleasant tone within the syllabus can foster learner motivation and positive relationships between faculty and
learners (Harnish and Bridges, 2011).
Tip 3: Diversify the curriculum
A goal of inclusive curriculum design is to recognise, value, and integrate the diverse identities within a programme,
which is supported by the UDL principles of multiple means of representation and engagement. Particularly
important when teaching diverse learners from different backgrounds, countries, or cultural traditions, proactively
diversifying the curriculum will help learners feel that they belong, which can be a powerful motivator for
engagement and learning (Sanger, 2020).
Review the curriculum so it does not perpetuate stereotypes and explore if bias is evident within the content and
activities. Does the curriculum preference certain groups, contexts, mindsets, or cultures? For example, the UK
medical curriculum has been criticised for lacking cultural diversity and offering traditionally white, androcentric,
Eurocentric content (Gishen and Lokugamage, 2019). Curriculum designers should actively explore unconscious
biases within the curriculum and prevailing forms of privilege (McIntosh, 1989).
Importantly, there is growing concern that the medical curricula offered by UK Universities marginalises and
alienates minority learners. In recent years, calls have intensified for UK universities to "decolonise" the curriculum
and rebalance the dominance of western values and beliefs (Nazar et al., 2015; Lokugamage, Ahillan and Pathberiya,
2020). Educators should endeavour to remove colonial references and design a curriculum which allows learners to
see themselves and others exhibited in positive ways. There are recent examples of medical schools in the UK
actively widening the curriculum to include teaching on racial bias within medical trials and the historical
Luke K
MedEdPublish
https://doi.org/10.15694/mep.2021.000118.1
Page | 4
exploitation of black people in medical research, and training on topics such as spotting unconscious bias and racism
(Mundasad, 2020). Verdonk and Janczukowicz (2018) observe that as patient populations become increasingly
varied and complex, educators need to equip medical students with the attributes, knowledge, and skills to treat
diverse patients fairly and non-judgmentally. Gishen and Lokugamage (2019) also argue that by introducing
diversity related topics into the medical curriculum increases medical students’ confidence, communication skills,
and potentially improves future patient care.
Tip 4: Co-design with learners
The UDL principle of providing multiple means of engagement centres around the concept of varying learner
motivations and educators should provide a variety of ways to focus and engage learners. To help foster learner
engagement, medical educators can actively involve learners in aspects of curriculum design by offering
opportunities to inform the development of learning outcomes, the types of resources used, the subjects studied, or
the modalities of assessment.
Learners can act as powerful change agents through co-producing medial curricula (Burk-Rafel et al., 2020).
Engaging learners as authentic partners in the curriculum design process allows greater ownership, accountability,
and understanding about the purpose and context of the learning experience (Morgan and Houghton, 2011).
Engaging learners as curricula co-creators may produce more learner-centred and equitable educational programs,
whereby more diverse voices are represented (Burk-Rafel et al., 2020). There is evidence of medical educators
actively engaging learners as stakeholders in curricula reforms, whereby learners are provided opportunities to
critically question and challenge inequalities and gaps inherent in their curriculum and develop innovative
approaches to address such challenges (Krishnan et al., 2019; Moss et al., 2020). Within the curriculum, educators
could also explore principles of allyship (Ng, Ware and Greenberg, 2017) and encourage learners to co-design
practical strategies for enacting equitable relationships with peers inside and beyond the curriculum setting
(Ackerman-Barger et al., 2020; Roberts, 2020).
Tip 5: Present diverse voices and perspectives
Educators can promote a sense of belonging for learners by considering learner diversity and offering
underrepresented scholarly perspectives. This could be achieved by ensuring diversity of perspectives within reading
lists, by promoting authors of different gender identities, or incorporating case studies from a variety of regions and
countries (Sanger, 2020). Doing so supports the UDL principle of providing multiple means of engagement by
aligning to learners’ interests and motivations, as well as providing authentic experiences. If offering broad and
diverse representation is challenging within a discipline, acknowledge imbalances and encourage critique. If a
seminal text only uses male pronouns, or stereotypical case studies, acknowledge this and give learners an
opportunity to discuss and critique. This can help learners see how and why particular materials or case scenarios are
selected. For example, if all essential texts are androcentric and produced in Europe or North America, discuss this
with the learners and explain the rationale behind their inclusion. Some key medical concepts may be strongly
associated with white males, which could be addressed by arranging seminar speakers from diverse backgrounds to
present content and to provide learners with positive role models from marginalised communities.
Where possible, underrepresented communities, such as the LGBT+ community and black, Asian and minority
ethnic (BAME) groups, should be visible within the curriculum, which will enable learners and educators to feel less
marginalised (Gishen and Lokugamage, 2019). Ensure a range of examples from diverse communities are provided
in lecture content, reading lists, and problem-based scenarios. For example, LGBT+ case inclusion and providing
illustrative photos of clinical signs on both light and dark skin tones. It is important to present diverse communities
Luke K
MedEdPublish
https://doi.org/10.15694/mep.2021.000118.1
Page | 5
positively, equally, and avoid stereotyping; this is particularly important as stereotyping can have a profound
negative impact on learning and performance (Steele and Aronson, 1995). To promote an environment of belonging
and respectful inclusion, develop a mutually agreed charter - or ground rules - between learners and educators
outlining expected behaviours and responsibilities within all learning spaces (including virtual spaces). To further
support a sense of belonging, in discussions - whether online or in-person - apply the preferred names and pronouns
used by learners.
Tip 6: Review the timetable and delivery
When considering the UDL principle of action and expression, educators should provide learners with multiple
means to interact with the curriculum, including the resources, materials, tools, technologies, and peers. Review the
curriculum timetable and critically consider if the timing of the teaching and learning activities might negatively
impact some learners (e.g. religious or cultural holidays and celebrations). Using an online diversity and inclusion
calendar can be helpful in planning activities.
Where possible, curricula should provide opportunities for flexible delivery using both asynchronous and
synchronous online activities, which removes some of the barriers associated with developing a fixed timetable and
conflicts with clinical responsibilities and rotas (McLean and Gibbs, 2010; Dickinson and Gronseth, 2020).
Synchronous learning refers to learner engagement with materials, instructors, and peers in real-time, although not
necessarily in the same place, such as through the use of virtual classroom technologies. This contrasts to
asynchronous learning, which does not involve learners in the same place or at the same time (e.g. a task to gather
information on a topic individually by a set date).
Tip 7: Design opportunities for cooperative learning
Creating peer learning opportunities helps exploit the advantages offered by a diverse cohort of learners and supports
the UDL principles of providing multiple means of engagement and expression/action. Learners often value
opportunities to share their background and perspectives, therefore design activities and assessments that encourage
peer working and support. Design opportunities within the curriculum which allow learners to bring together their
unique voices for shared enterprise, for example through cooperative learning which prioritises collaboration to
achieve learning goals. Techniques, such as the Jigsaw method, can be a successful strategy in which small groups,
with mixed levels of ability, use a variety of activities to develop joint understandings of a topic area or subject
(Walker, Olvet and Chandran, 2015; Eachempati, KS and Ismail, 2017). Creating space within the curriculum for
learners to share personal experiences can support learner motivation and sets an inclusive tone by encouraging each
learner to share understandings. When designing small group work activities, ensure that the allocation of learners
enables the formation of ethnically diverse groups from various educational backgrounds.
Tip 8: Consider effective teaching strategies
There is some evidence to suggest that learner-centred strategies may have a negative impact on learners from lower
socio-economic backgrounds and may perpetuate some inequalities in education (Andersen and Andersen, 2017).
Furthermore, as the majority of medical students may have relatively similar pre-entry qualifications, there can be an
implicit assumption that these learners will share similar learning experiences, approaches, and preferences (Morgan
and Houghton, 2011). However, this is unlikely to be the case and learners deploy a range of strategies depending on
their abilities, needs, and preferences. The UDL principle of representation advocates that educators should guide
information processing and engage learners by activating prior knowledge. Incorporating different teaching
strategies and varying activities will offer a more inclusive experience for learners with different prior knowledge,
Luke K
MedEdPublish
https://doi.org/10.15694/mep.2021.000118.1
Page | 6
experiences, and learning needs. Therefore, when designing opportunities for self-directed learning or collaborative
learning, medical educators have an important role in providing direct instruction, which involves providing clear and
detailed instructions, guiding learners as they begin independent practice, and offering examples and explanations
(Kirschner and Hendrick, 2020).
UDL principles advocate that medical educators should avoid or explain culturally specific references, clarify
medical vocabulary and symbols, and provide cognitive supports in instruction. Giving learners organising clues can
be an effective strategy, for example: "we have explored four risk factors associated with disease progression, which I
will now summarise." Provide background or framing information for new concepts using artefacts such as images,
articles, and videos, which can be explored independently outside of a teaching session. Scaffold learning (offer
guidance to reduce the complexity of a task) by providing access to resources (e.g. syllabus, summaries, study
guides, PowerPoint slides) and tutor support (e.g. formative assessment feedback, tutorials) (Sanger, 2020). Clearly
segment teaching sessions and activities into chunks, which will help learners to organise content into coherent
cognitive structures (Mayer, 2010). Design learner activities that require retrieval practice and provide worked
examples, demonstrating how to solve a specific problem or modelling expected outcomes, which can be effective
for optimising germane load (Collins et al., 2020).
Tip 9: Offer multiple strategies to present information
The UDL principle of representation advocates that educators should provide instruction through multiple forms of
media and provide a variety of ways to interact with educational content to generate new understandings. Enhance
instruction through a range of activities, such as the use of case studies, poetry, patient stories, stimulations, role
play, practical activities, guest speakers, virtual communications, and educational software. Within the curriculum
offer alternative learning contexts by designing opportunities for individual and collaborative working, as well as
distance learning, peer learning, and clinical work.
Teaching and learning materials should be presented in a range of modalities, such as online resources, digital
learning objects, videos, articles, podcasts, PowerPoint presentations, and e-books. When designing multimedia
artefacts and presentations critically consider effective design principles (Pate and Posey, 2016). Mayer’s (2010)
multimedia design principles offer practical guidance for reducing extraneous information, such as decorative
images, and optimising the presentation of multimodal aspects for efficient cognitive processing and learning.
Where possible, provide instructional material in alternative formats. For example, provide access to both physical
and electronic versions of key textbooks, capture lectures using recording software, and provide a digital document
version of online learning packages (e.g. a downloadable PDF file). Providing captions to videos and podcasts, or
enabling live captions within online synchronous tools (e.g. Microsoft Teams), serves the dual purpose of enhancing
accessibility for learners with hearing impairments and supporting multiple options for perception, which aligns with
the UDL principle of representation and can be particularly beneficial for second language learners (Dickinson and
Gronseth, 2020). This offers an example of how adjustments can become mainstreamed to benefit a wider group of
learners.
Tip 10: Use technology appropriately
Whilst not an inherent solution, if used appropriately technology can be used to facilitate enhancements within
inclusive curriculum design and is highlighted throughout the three core principles of UDL. For example, the use of
touch-sense haptic technologies and stimulations can replicate learning experiences that might otherwise be
inappropriate for learners to undertake on real patients, for example based on training stage or issues with access to
assessors for appraisal (Morgan and Houghton, 2011). Such technologies also allow greater flexibility with regards to
Luke K
MedEdPublish
https://doi.org/10.15694/mep.2021.000118.1
Page | 7
the space-time dimensions of learning. UDL principles have also been successfully deployed in clinical practice with
the support of technologies (Martyn, Pace and Gee, 2015). In practice environments, mobile technologies and
assistive applications have been used to provide feedback (e.g. mini-CEX) and electronic note-taking whilst on ward
rounds (Morgan and Houghton, 2011). Developing clear policies and processes (e.g. data protection and
confidentiality) that break down the barriers to using technology, including the use of mobile devices and assistive
applications in clinical environments, helps foster an enabling learning experience (Martyn, Pace and Gee, 2015).
To ensure the inclusive use of technology, potential barriers - such as skills, ability, equipment access, financial, and
accessibility - need consideration prior to implementation. Importantly, the use of technology should not be a barrier
for learners with disabilities (Hersh and Mouroutsou, 2019). For example, medical educators can make simple
adjustments when designing resources and multimedia content by using consistent page titles and headings, and
images should be relevant to the content and include alt text (alternative text descriptions). This is crucial for
learners who rely on assistive technologies, such as screen readers, to interact with content. Consistent and clear page
titles provides clarity and structure to assist learners with orientation and navigation, and alt text within images are
used by applications to describe images to learners with visual impairments.
Tip 11: Provide flexible opportunities for assessment and feedback
UDL principles advocate that the curriculum should provide multiple means of learner action and expression,
whereby learners are offered alternative means to demonstrate what they have learned (Sanger, 2020). Medical
educators should design different assessment options to demonstrate learning, such as oral presentations (individual
or team-based), written assignments (e.g. essays, fictional, creative), or visual representations (e.g. posters, videos).
Where summative assessments, such as traditional essays or exams, are obligatory due to professional body
requirements, different formative assessment options should be offered, such as more personalised submissions (e.g.
reflective commentaries, online discussion forums, blogs) (Morgan and Houghton, 2011).
Feedback is an essential component of learning and its value is widely recognised within medical education (Bing-
You et al., 2017; Kornegay et al., 2017). Within the curriculum, design opportunities for formative feedback based
on group and individual activity. When considering effective feedback in diverse contexts, ensure feedback is
timely, honest, direct, and constructive. Recommend concrete steps for improvement and signpost additional
resources and services which can be accessed flexibly. Support learner motivation by providing feedback, setting
goals, and providing rewards for completing tasks. Importantly, the UDL engagement principle also recommends that
educators support learners in developing self-regulatory skills and provide opportunities for learner self-assessment
and self-reflection.
Tip 12: Evaluate curricula using an inclusive design checklist
As discussed, an inclusive curriculum anticipates and provides strategies to support a diverse range of learners.
While UDL itself is not a list of strategies that must be implemented, the UDL Guidelines (CAST, 2018) offer a set
of practical suggestions that can be applied to any discipline and provides ideas for UDL implementation. To help
with the implementation of UDL principles, many UDL checklists can be found online, such as those designed by
Iowa State University (2019) and West Virginia Department of Education (Unknown). Such UDL checklists can be
a useful starting point in evaluating the current level of inclusively with programmes or for planning curriculum
changes (Bartholomew and Griffin, 2018).
Many UK Universities have also designed general inclusive curriculum checklists. Whilst not explicitly aligned to
the UDL principles, many of the checklists offer important aspects covered by UDL. Examples of inclusive
curriculum checklists can be found from University of Dundee (2017), University College London (2018), and
Luke K
MedEdPublish
https://doi.org/10.15694/mep.2021.000118.1
Page | 8
Manchester Metropolitan University (2020). Importantly, inclusive curriculum checklists can be completed as part
of the development and design of new programmes and the periodic review of existing programmes.
Conclusion
Medical curricula are not static and continues to evolve to reflect new ideas, practices, and knowledge. Designing an
inclusive curriculum extends to critically exploring the ideological assumptions underpinning the purpose of the
curricula (Smith, 2000). Within medical education, outcomes‐based curricula, which is heavily dependent on the
setting of behavioural objectives, has been challenged by educators who argue that learning outcomes are unable to
accurately specify educational achievements and the true effects of learning (Rees, 2004). Scholars have advocated a
paradigm shift from curriculum as product to emancipatory models, known as curriculum as praxis, which focuses on
the domains of knowledge, critical reflection, and committed action (Ford and Profetto-McGrath, 1994). The
curriculum as praxis model is concerned with the development of a critical consciousness, and actively seeks to
challenge inequalities through action. For example, Shahvisi (2019) reports on teaching UK medical students of the
significant social status and privilege they will have as doctors, and the importance of collective action against
damaging agendas and social injustices. Moreover, it is essential that medical curricula attend to the current political,
economic, and societal issues we face, including global pandemics, social injustices, technological advances, and
climate change (Verdonk and Janczukowicz, 2018; Finkel, 2019; Goh and Sandars, 2020).
Implementing curriculum changes poses numerous challenges such as stakeholder resistance, lack of skills and
knowledge, time pressures, lack of desire or damaging conflicts, and issues with communication and planning (Luke,
2021). Adopting a methodological approach to managing curriculum change is essential and awareness of the need
for change is a key foundation in the change process (Luke, 2021). This paper has aimed to raise awareness of the
importance of inclusivity within medical education and explored how UDL principles can be used to develop a
flexible curriculum, which embeds opportunities for learners to be active participants in the curriculum design and
delivery. The three core UDL principles offer medical educators opportunities to design curriculum outcomes,
activities, instructional materials, and assessments with embedded flexibility, equitability, and representation to
support diverse learners in any context. In turn, an inclusive curriculum may help in tackling systemic barriers that
produce inequitable learning opportunities and outcomes. Inclusive curriculum design may also provide learners with
the critical skills and competencies to positively contribute to diverse workplaces and wider society.
Take Home Messages
Use UDL principles when (re)designing curriculum. Flexibility, variation, and engagement are key principles
for universal design.
Recognise, incorporate, and celebrate diversity in the curriculum. Demonstrate the cultural and social
relevance of course concepts.
Design opportunities for personalising activities and allow learners to co-design elements of the curriculum.
Use technology appropriately and digitise resources. Present content in alternative formats (text, audio, and/or
visual). For example, record lectures where possible.
Use varied teaching methods and provide learners with active learning opportunities. Use alternative
strategies for assessing learning.
Notes On Contributors
Luke K
MedEdPublish
https://doi.org/10.15694/mep.2021.000118.1
Page | 9
Karl Luke is a lecturer in Medical Education at Cardiff University, United Kingdom. Karl is a Senior Fellow of the
Higher Education Academy (SFHEA) and Certified Member of the Association of Learning Technology (CMALT).
Karl's research interests include digital education, multimodality and sociomateriality. ORCiD:
https://orcid.org/0000-0002-7765-6126
Acknowledgements
None.
Bibliography/References
Ackerman-Barger, K., Boatright, D., Gonzalez-Colaso, R., Orozco, R., et al. (2020) ‘Seeking Inclusion Excellence:
Understanding Racial Microaggressions as Experienced by Underrepresented Medical and Nursing Students’,
Academic Medicine, 95(5), pp. 758–763. https://doi.org/10.1097/ACM.0000000000003077.
Andersen, I. G. and Andersen, S. C. (2017) ‘Student-centered instruction and academic achievement: Linking
mechanisms of educational inequality to schools’ instructional strategy’, British Journal of Sociology of Education,
38(4), pp. 533–550. https://doi.org/10.1080/01425692.2015.1093409.
Bartholomew, A. L. and Griffin, N. (2018) ‘Using a Universal Design for Learning Checklist to Teach Secondary
Transition Skills’, Career Development and Transition for Exceptional Individuals, 41(4), pp. 245–251.
https://doi.org/10.1177/2165143417742895.
Bing-You, R., Hayes, V., Varaklis, K., Trowbridge, R., et al. (2017) ‘Feedback for learners in medical education:
What is known? A scoping review’, Academic Medicine, 92(9), pp. 1346–1354.
https://doi.org/10.1097/ACM.0000000000001578.
Bunbury, S. (2020) ‘Disability in higher education–do reasonable adjustments contribute to an inclusive
curriculum?’, International Journal of Inclusive Education, 24(9), pp. 964–979.
https://doi.org/10.1080/13603116.2018.1503347.
Burk-Rafel, J., Harris, K. B., Heath, J., Milliron, A., et al. (2020) ‘Students as catalysts for curricular innovation: A
change management framework’, Medical Teacher, 42(5), pp. 572–577.
https://doi.org/10.1080/0142159X.2020.1718070.
CAST. (2018) Universal Design for Learning Guidelines version 2.2, CAST. Available at: http://udlguidelines.cast.org
(Accessed: 02 October 2020).
Collins, B., Day, R., Hamilton, J., Legris, K., et al. (2020) ‘12 Tips for Pivoting to Teaching in a Virtual
Environment’, MedEdPublish, 9. https://doi.org/10.15694/mep.2020.000170.1.
Dickinson, K. J. and Gronseth, S. L. (2020) ‘Application of Universal Design for Learning (UDL) Principles to
Surgical Education During the COVID-19 Pandemic’, Journal of Surgical Education, 77(5), pp. 1008–1012.
https://doi.org/10.1016/j.jsurg.2020.06.005.
Eachempati, P., KS, K. K. and Ismail, A. (2017) 'Cooperative learning through jigsaw classroom technique for
designing cast partial dentures - a comparative study', MedEdPublish, 6(2), p. 26.
https://doi.org/10.15694/mep.2017.000088.
Finkel, M. L. (2019) ‘A call for action: integrating climate change into the medical school curriculum’, Perspectives
Luke K
MedEdPublish
https://doi.org/10.15694/mep.2021.000118.1
Page | 10
on Medical Education, 8(5), pp. 265–266. https://doi.org/10.1007/s40037-019-00541-8.
Ford, J. S. and Profetto-McGrath, J. (1994) ‘A model for critical thinking within the context of curriculum as
praxis’, Journal of Nursing Education, 33(8), pp. 341–344.
Gishen, F. and Lokugamage, A. (2019) ‘Diversifying the medical curriculum’, BMJ, 364.
https://doi.org/10.1136/bmj.l300.
Goh, P. S. and Sandars, J. (2020) ‘A vision of the use of technology in medical education after the COVID-19
pandemic’, MedEdPublish, 9. https://doi.org/10.15694/mep.2020.000049.1.
Harnish, R. J. and Bridges, K. R. (2011) ‘Effect of syllabus tone: Students’ perceptions of instructor and course’,
Social Psychology of Education, 14(3), pp. 319–330. https://doi.org/10.1007/s11218-011-9152-4.
Hersh, M. and Mouroutsou, S. (2019) ‘Learning technology and disability – Overcoming barriers to inclusion:
Evidence from a multicountry study’, British Journal of Educational Technology, 50(6), pp. 3329–3344.
https://doi.org/10.1111/bjet.12737.
Iowa State University. (2019) Universal Design Checklist for Your Online Course, Center for Excellence in Learning
and Teaching (CELT), Iowa State University. Available at:
https://www.celt.iastate.edu/wp-content/uploads/2018/10/UDL-QM-accessibilitychecklist.pdf (Accessed: 02
October 2020).
Kirschner, P. A. and Hendrick, C. (2020) How Learning Happens: Seminal Works in Educational Psychology and
what They Mean in Practice. Oxon: Routledge.
Kornegay, J. G., Kraut, A., Manthey, D., Omron, R., et al. (2017) ‘Feedback in medical education: a critical
appraisal’, AEM Education and Training, 1(2), pp. 98–109. https://doi.org/10.1002/aet2.10024.
Krishnan, A., Rabinowitz, M., Ziminsky, A., Scott, S. M., et al. (2019) ‘Addressing race, culture, and structural
inequality in medical education: a guide for revising teaching cases’, Academic Medicine, 94(4), pp. 550–555.
https://doi.org/10.1097/ACM.0000000000002589.
Lokugamage, A. U., Ahillan, T. and Pathberiya, S. D. C. (2020) ‘Decolonising ideas of healing in medical
education’, Journal of Medical Ethics, 46(4), pp. 265–272. https://doi.org/10.1136/medethics-2019-105866.
Luke, K. (2021) ‘Twelve tips for managing change in medical education’, MedEdPublish, 10(1).
https://doi.org/10.15694/mep.2021.000053.1.
Manchester Metropolitan University. (2020) The Inclusive Curriculum Toolkit, University Teaching Academy (UTA),
Manchester Metropolitan University. Available at: https://www.celt.mmu.ac.uk/inclusion/toolkit.php (Accessed: 02
October 2020).
Marinoni, G., van’t Land, H. and Jensen, T. (2020) The impact of Covid-19 on higher education around the world,
IAU Global Survey Report. Available at:
https://www.iau-aiu.net/IAU-releases-Global-Survey-Report-on-Impact-of-Covid-19-in-Higher-Education
(Accessed: 02 October 2020).
Martyn, K., Pace, K. and Gee, N. (2015) ‘Application of UDL principles to Practice Environments: Getting it
right?’, Universal Design for Learning: A License to Learn - Ahead Ireland, (March), pp. 21–23. Available at:
https://www.ahead.ie/userfiles/files/Conference/2015/Conference%202015%20Publication.pdf (Accessed: 02
October 2020).
Luke K
MedEdPublish
https://doi.org/10.15694/mep.2021.000118.1
Page | 11
Mayer, R. E. (2010) ‘Applying the science of learning to medical education’, Medical Education, 44(6), pp. 543–549.
https://doi.org/10.1111/j.1365-2923.2010.03624.x.
McIntosh, P. (1989) ‘White privilege: Unpacking the invisible knapsack’, in McGoldrick, M. (ed) Re-visioning
family therapy: Race, culture, and gender in clinical practice. New York, NY: Guilford, pp. 147–152.
McLean, M. and Gibbs, T. (2010) ‘Twelve tips to designing and implementing a learner-centred curriculum:
prevention is better than cure’, Medical Teacher, 32(3), pp. 225–230. https://doi.org/10.3109/01421591003621663.
McLoughlin, C. (2001) ‘Inclusivity and alignment: Principles of pedagogy, task and assessment design for effective
cross‐cultural online learning’, Distance Education, 22(1), pp. 7–29. https://doi.org/10.1080/0158791010220102.
Montacute, R. (2020) Social mobility and Covid-19. Implications of the covid-19 crisis for educational inequality, The
Sutton Trust. Available at:
https://www.suttontrust.com/wp-content/uploads/2020/04/COVID-19-and-Social-Mobility-1.pdf (Accessed: 02
October 2020).
Morgan, H. and A. Houghton. (2011) Inclusive Curriculum Design in Higher Education, Advance HE. Available at:
https://www.advance-he.ac.uk/knowledge-hub/inclusive-curriculum-design-higher-education (Accessed: 02 October
2020).
Moss, J. L., Hardy, E. C., Cooley, K. A., Cuffe, S. N., et al. (2020) ‘Students Advocating for Diversity in Medical
Education’, MedEdPublish, 8. https://doi.org/10.15694/mep.2019.000159.2
Mundasad, S. (2020) The medical school trying to become anti-racist, BBC. Available at:
https://www.bbc.co.uk/news/health-53465113 (Accessed: 02 October 2020).
Nazar, M., Kendall, K., Day, L. and Nazar, H. (2015) ‘Decolonising medical curricula through diversity education:
lessons from students’, Medical Teacher, 37(4), pp. 385–393. https://doi.org/10.3109/0142159X.2014.947938.
Ng, W., Ware, S. M. and Greenberg, A. (2017) ‘Activating diversity and inclusion: A blueprint for museum
educators as allies and change makers’, Journal of Museum Education, 42(2), pp. 142–154.
https://doi.org/10.1080/10598650.2017.1306664.
Pate, A. and Posey, S. (2016) ‘Effects of applying multimedia design principles in PowerPoint lecture redesign’,
Currents in Pharmacy Teaching and Learning, 8(2), pp. 235–239. https://doi.org/10.1016/j.cptl.2015.12.014.
Patterson, R. and Price, J. (2017) ‘Widening participation in medicine: what, why and how?’, MedEdPublish, 6.
https://doi.org/10.15694/mep.2017.000184.
Rees, C. E. (2004) ‘The problem with outcomes‐based curricula in medical education: insights from educational
theory’, Medical Education, 38(6), pp. 593–598. https://doi.org/10.1046/j.1365-2923.2004.01793.x.
Roberts, L. W. (2020) ‘Belonging, Respectful Inclusion, and Diversity in Medical Education’, Academic Medicine,
95(5), pp. 661–664. https://doi.org/10.1097/ACM.0000000000003215.
Sanger, C. S. (2020) ‘Inclusive Pedagogy and Universal Design Approaches for Diverse Learning Environments’, in
Sanger, C. S. and Gleason, N. W. (eds) Diversity and Inclusion in Global Higher Education. Singapore: Palgrave
Macmillan, pp. 31–71.
Shahvisi, A. (2019) ‘Coloniality in the NHS: training medical students to resist’, in Moncrieffe, M., Asare, Y.,
Dunford, R. and Youssef, H. (eds) Decolonising the Curriculum: Teaching and Learning about Race Equality.
Brighton: University of Brighton, p. 13.
Luke K
MedEdPublish
https://doi.org/10.15694/mep.2021.000118.1
Page | 12
Slattery, J. M. and Carlson, J. F. (2005) ‘Preparing an effective syllabus: Current best practices’, College Teaching,
53(4), pp. 159–164. https://doi.org/10.3200/CTCH.53.4.159-164.
Smith, M. K. (2000) What is curriculum? Exploring theory and practice, infed.org. Available at:
https://infed.org/curriculum-theory-and-practice/ (Accessed: 02 October 2020).
Steele, C. M. and Aronson, J. (1995) ‘Stereotype threat and the intellectual test performance of African Americans’,
Journal of Personality and Social Psychology, 69(5), pp. 797–811. https://doi.org/10.1037/0022-3514.69.5.797.
University College London. (2018) New checklist helps staff rate inclusivity of their programmes, University College
London. Available at:
https://www.ucl.ac.uk/teaching-learning/news/2018/may/new-checklist-helps-staff-rate-inclusivity-their-programmes
(Accessed: 02 October 2020).
University of Dundee. (2017) Inclusive curriculum checklist, guidance and good practice example, University of
Dundee. Available at:
https://www.dundee.ac.uk/qf/documents/details/inclusive-curriculum-checklist-guidance-and-good-practice-exampl
e.php (Accessed: 02 October 2020).
Verdonk, P. and Janczukowicz, J. (2018) 'Editorial: Diversity in Medical Education', MedEdPublish, 7(1).
https://doi.org/10.15694/mep.2018.000001.1.
Walker, S., Olvet, D. M. and Chandran, L. (2015) ‘The jigsaw technique of peer teaching and learning: An efficient
and enjoyable teaching strategy in medicine’, MedEdPublish, 6(14). http://doi.org/10.15694/mep.2015.006.0014.
West Virginia Department of Education. (Unknown) UDL Guidelines Checklist, West Virginia Department of
Education. Available at: https://wvde.state.wv.us/osp/UDL/7.%20UDL%20Guidelines%20Checklist.pdf (Accessed:
02 October 2020).
Appendices
None.
Declarations
The author has declared that there are no conflicts of interest.
This has been published under Creative Commons "CC BY 4.0" (https://creativecommons.org/licenses/by-sa/4.0/)
Ethics Statement
This is a Personal Opinion and does not require ethical approval.
External Funding
This article has not had any External Funding
Luke K
MedEdPublish
https://doi.org/10.15694/mep.2021.000118.1
Page | 13
MedEdPublish: rapid, post-publication, peer-reviewed articles on healthcare professions’ education. For more
information please visit www.mededpublish.org or contact mededpublish@dundee.ac.uk.
Article
Introduction: There is an increasing need to facilitate enhanced student engagement in anatomy education. Higher education students differ in academic preferences and abilities and so, not all teaching strategies suit all students. Therefore, it is suggested that curricula design and delivery adapt to sustain learner engagement. Enhanced learner engagement is a fundamental feature of Universal Design for Learning (UDL). The aim of this study is to determine if anatomy educators in the Republic of Ireland (ROI) and United Kingdom (UK) are aware of UDL and to assess if, and to what extent, it has been implemented in the design and delivery of anatomy curricula for healthcare students. Materials and methods: An anonymous online questionnaire was administered to anatomy educators in higher level institutions in the ROI and UK. Inductive content analysis was used to identify the impact of UDL on student learning, engagement and motivation, as perceived by the participants. Results: The response rate was 23% (n= 61). Nineteen participants stated they knew of UDL. Of these, 15 had utilized UDL in their teaching of anatomy. Analysis indicated that the perception of UDL was mixed. However, the majority of responses relating to UDL were positive. Conclusions: The majority of the respondents were unaware of UDL but identified the frameworks' checkpoints within their curriculum, suggesting they have unknowingly incorporated elements of UDL in their curriculum design and delivery. There is a lack of information on the benefits of explicit utilization of UDL for engagement and motivation to learn anatomy in healthcare programs in the ROI and UK. This article is protected by copyright. All rights reserved.
Article
Full-text available
Healthcare systems and organisations are continually exposed to change, and medical educators are increasingly expected to manage change, such as curriculum transformations and educational reforms. However, leading change can often be challenging, and medical educators often lack the resources, knowledge, and skills to successfully manage change initiatives. In managing change, it is important to recognise that organisations do not change, rather it is people that change, one person at a time. However, change can have a destabilising effect on individuals and an approach to support individuals through change is strongly advocated. This article offers twelve tips for managing change using the Prosci ADKAR model for achieving individual change. The article explores how ADKAR can be used as a systematic framework to guide the formulation of change management plans. Finally, the article considers the current context of the COVID-19 pandemic and offers an appraisal of such frameworks and models during a time of unprecedented change and transform.
Article
Full-text available
COVID-19 has necessitated a rapid shift to teaching in virtual environments across the educational spectrum. In this respect, instructors previously unfamiliar, or under-familiar, with virtual teaching environments need to learn quickly and effectively how these environments work and how they can be used to successfully deliver courses, especially within health professions education contexts. These twelve tips provide insight on the practice of teaching in virtual environments, from course design, to student engagement, to assessment practices, to maximising the potential that technology can provide for both the instructor and the students. Moreover, these tips inform virtual pedagogical practices in the health professions for all levels of experience.
Article
Full-text available
Objective: During the COVID-19 pandemic in 2020, we have faced unprecedented challenges in the delivery of surgical education. At the time of writing, changes to the structure and nature of the surgical workforce are occurring rapidly, even daily. Surgical educators are utilizing remote learning solutions, including flipped classroom approaches, online educational materials, telemedicine, and simulations, to continue education for surgical residents despite cancelations of face-to-face instruction. Our objective is to delineate an interdisciplinary strategy, utilizing the principles of Universal Design for Learning (UDL), by which we can optimize learning during this pandemic. Design: This perspective describes the UDL framework which can be used to situate solutions to issues with delivery of surgical education during this pandemic within the broader view of strategic inclusive instructional design to meet diverse learning needs.. Conclusion: The principles of UDL can inform curricular and pedagogical changes in surgical education that may be employed during a time of social distancing, isolation, and quarantine. UDL involves planning flexibility into curricular design from the outset, recognizing that learners are varied in their learning preferences and capabilities, motivational characteristics, and environmental constraints. Viewing the design of remote learning opportunities through the UDL lens aims to remove barriers to learning during this pandemic by targeting three areas: expansion of the means that information is communicated, ways that learners are supported and motivated, and approaches to assessing learning through available distance learning technologies.
Article
Full-text available
Medical education across the world has experienced a major disruptive change as a consequence of the COVID-19 pandemic and technology has been rapidly and innovatively used to maintain teaching and learning. The future of medical education is uncertain after the pandemic resolves but several potential future scenarios are discussed to inform current decision-making about the future provision of teaching and learning. The use of emergent technology for education, such as artificial intelligence for adaptive learning and virtual reality, are highly likely to be essential components of the transformative change and the future of medical education. The benefits and challenges of the use of technology in medical education are discussed with the intention of informing all providers on how the changes after the pandemic can have a positive impact on both educators and students across the world.
Article
Full-text available
The legacy of colonial rule has permeated into all aspects of life and contributed to healthcare inequity. In response to the increased interest in social justice, medical educators are thinking of ways to decolonise education and produce doctors who can meet the complex needs of diverse populations. This paper aims to explore decolonising ideas of healing within medical education following recent events including the University College London Medical School’s Decolonising the Medical Curriculum public engagement event, the Wellcome Collection ’s Ayurvedic Man: Encounters with Indian Medicine exhibition and its symposium on Decolonising Health, SOAS University of London’s Applying a Decolonial Lens to Research Structures, Norms and Practices in Higher Education Institutions and University College London Anthropology Department’s Flourishing Diversity Series. We investigate implications of ‘recentring’ displaced indigenous healing systems, medical pluralism and highlight the concept of cultural humility in medical training, which while challenging, may benefit patients. From a global health perspective, climate change debates and associated civil protests around the issues resonate with indigenous ideas of planetary health , which focus on the harmonious interconnection of the planet, the environment and human beings. Finally, we look further at its implications in clinical practice, addressing the background of inequality in healthcare among the BAME (Black, Asian and minority ethnic) populations, intersectionality and an increasing recognition of the role of inter-generational trauma originating from the legacy of slavery. By analysing these theories and conversations that challenge the biomedical view of health, we conclude that encouraging healthcare educators and professionals to adopt a ‘ decolonising attitude ’ can address the complex power imbalances in health and further improve person-centred care.
Article
Full-text available
Problem: Innovations within the medical education system often come from administration and leadership, in the traditional top-down approach to preparing students for the actualities of medical practice. There is a dearth of literature showing the power of students to design and advance innovations in this same arena. As incoming classes of students are increasingly more diverse, student efforts for diversity and inclusion initiatives must be explored as avenues to effect positive change within the system. Approach: Medical students at the University of South Carolina School of Medicine Greenville (UofSC SOM Greenville) formed the committee known as Student Advocates for Diversity and Inclusion (SADI) in Fall 2017, with the goals of enhancing the curriculum, increasing the visibility of diverse peoples within the medical school and the healthcare system, and supporting the experience of these peoples. Outcomes: The report herein describes the formation of the Student Advocates for Diversity and Inclusion and its initial steps, including the modification of curricular practices and the development of extracurricular programs. Conclusion: SADI may serve as one example of the power of students to transform medical education. Other students and schools can use the committee and its successes and challenges to implement similar programs at their respective institutions, with the goal of achieving diversity and inclusion more broadly across the medical education system.
Article
Introduction: The role of medical students in catalyzing and leading curricular change in US medical schools is not well described. Here, American Medical Association student and physician leaders in the Accelerating Change in Medical Education initiative use qualitative methods to better define student leadership in curricular change. Methods: The authors developed case studies describing student leadership in curricular change efforts. Case studies were presented at a national medical education workshop; participants provided worksheet reflections and were surveyed, and responses were transcribed. Kotter’s change management framework was used to categorize reported student roles in curricular change. Thematic analysis was used to identify barriers to student engagement and activators to overcome these barriers. Results: Student roles spanned all eight steps of Kotter’s change management framework. Barriers to student engagement were related to faculty (e.g. view student roles narrowly), students (e.g. fear change or expect faculty-led curricula), or both (e.g. lack leadership training). Activators were: (1) recruiting collaborative faculty, staff, and students; (2) broadening student leadership roles; (3) empowering student leaders; and (4) recognizing student successes. Conclusions: By applying these activators, medical schools can build robust student–faculty partnerships that maximize collaboration, moving students beyond passive educational consumption to change agency and curricular co-creation.
Chapter
For educators in diverse contexts, it is not only socially virtuous but also pedagogically valuable to proactively anticipate and incorporate students’ heterogeneous backgrounds, abilities, and interests into teaching and course design. This chapter highlights two educational frameworks—Inclusive Pedagogy and Universal Design for Learning (UDL)—that emphasize the educational importance of imbuing all students with a sense of belonging in the classroom and curriculum. Drawing from these approaches, the chapter suggests a series of concrete strategies for educators to enthusiastically harness diversity and amplify student learning. The chapter is designed as a detailed and practical introduction to Inclusive Pedagogy and UDL for educators at all career stages, and particularly those operating in very diverse higher education contexts.