Pharmacy students must understand the intricacies of culture and health, but they first need to be aware of their biases and prejudices.
Becoming a pharmacist and caring for patients is one of the most rewarding professions. From managing multitherapy regiments, to making recommendations on treatment plans, to dispensing and educating individuals on their medications, there is a plethora of knowledge that pharmacists yield. One often overlooked aspect of pharmacy practice is how to best serve our diverse patient population. Having a strong foundation on what diversity, equity, and inclusion (DEI) is and how it affects an individual’s practice as a pharmacist will allow them to perform at the top of their license.
Before getting into the nuances of how to deal with specific patient populations, it’s important to first know what DEI means. Diversity refers to the similarities and differences among individuals, accounting for all aspects of their personality and individual identity, according to the Society for Human Resource Management.1 Some common dimensions of diversity include race, ethnicity, nationality, religion, socioeconomic status, education, marital status, language, age, gender, sexual orientation, mental or physical ability, and learning styles. Inclusion describes the extent to which each individual in an organization feels welcomed, respected, supported, and valued as a team member. Inclusion is a 2-way accountability; each individual must grant and accept inclusion from others. Equity in the workplace refers to fair treatment in access, opportunity, and advancement for all individuals. Work in this area includes identifying and working to eliminate barriers to fair treatment for disadvantaged groups from the team level through systemic changes in organizations and industries. Academic pharmacy has a responsibility to educate and prepare pharmacists who are able to prepare care that is equitable, culturally competent, and responsive, and that challenges factors that drive racism, hate, and bias in health care.
Pharmacy students must understand the intricacies of culture and health, but they first need to be aware of their biases and prejudices. Black patients report fewer patient-centered behaviors from clinicians, with higher levels of implicit bias.2 This is an issue because patient-centered communication is associated with improved outcomes such as diabetes control and adherence to medication regimens. Integrating cultural diversity across the entire college of pharmacy curriculum,using committees to ensure consistency of these efforts, will challenge students to face these prejudices head-on. Once that is implemented, pharmacy students need to then make DEI patient centered, meaning patient-centered care must respect and reflect an individual patient’s preferences, needs, and values while ensuring these are what ultimately guide clinical decisions.3 Once that is achieved, the students must apply their learned clinical acumen, using their cultural competency as the other main decision-making tool. When implementing case-based learning, pharmacy school faculty should be intentional about adding cultural context and making it consistent throughout disease management. Having an awareness of social determinants of health forces students to think about the complete patient rather than isolated ailments.4 When introducing evidence-based research to students, call attention to the demographics tables embedded within the research. Educators have the ability to address students’ concerns regarding how valid the findings are as applied to patients whose data are missing from the original research. Another way that faculty can be intentional about organically integrating DEI practices in curriculum is to terminate stand-alone lectures on health equity. This typically “checks the box” and unfortunately reinforces that health equity and pharmacy practice are separate—but they are not. Although getting rid of stand-alone lectures is important, it is also pertinent to ensure that a single person is not speaking on behalf of an entire community; it is an unrealistic and unfair expectation that the thoughts of an entire group can be represented by a single member.
The social responsibility of health care professionals to address health inequities has been highlighted by the resurgence of student activism across the United States. Many of the current providers lack training that addresses interpersonal and structural dimensions of inequity, so it is even more pertinent that the next generation of pharmacy students and faculty be well equipped to deal with these inequities. Many DEI topics remain undertaught in colleges of pharmacy, perhaps because it disrupts the narrative that the providers are free from bias, which is far from the truth. Instead of deciding whether a specific topic should be taught, we must understand the reality: The United States is an extremely diverse country, and potential pharmacists will be caring for a wide array of patients. With this, every aspect of the patient needs to be taught in detail to ensure they are cared for in the best way possible—medically and culturally. Pharmacy students must continually be exposed to real-life examples of different scenarios so they are well equipped to treat patients once they are in practice. Colleges of pharmacy must create these opportunities and make sure they are available to all students through their curriculum to ensure that inclusivity is possible.
About the Author
Aaron Johnson, PharmD, is a health equity and DEI consultant and the founder and chairman of the Aaron Johnson Scholarship.
1. Toolkits. Society for Human Resource Management. 2023. Accessed February 9, 2023. https://www.shrm.org/ResourcesAndTools/toolsand-samples/toolkits/Pages/default.aspx
2. Blair IV, Steiner JF, Fairclough DL, et al. Clinicians’ implicit ethnic/racial bias and perceptions of care among Black and Latino patients. Ann Fam Med. 2013;11(1):43-52. doi:10.1370/afm.1442
3. Dogra N, Reitmanova S, Carter-Pokras O. Twelve tips for teaching diversity and embedding it in the medical curriculum. Med Teach. 2009;31(11):990-993. doi:10.3109/01421590902960326
4. Price EG, Gozu A, Kern DE, et al. The role of cultural diversity climate in recruitment, promotion, and retention of faculty in academic medicine. J Gen Intern Med. 2005;20(7):565-571. doi:10.1111/j.1525-1497.2005.0127.x