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Taking Difference Into Account


What kind of diversity education have you received in your medical education?

Was this a core part of the curriculum or a 'special session'?


What was attendance like?

Would you consider the cultural sensitivity of those in attendance to be high or low?

What about the people who were not in attendance?


How much value do you feel that your medical school places on understanding difference?

How is this conveyed to you?

In our effort to raise awareness and promote sensitivity to a variety of cultures we have taken what time in the curriculum we have been able to wrestle away and created educational experiences that are incidental, "one off"  and more often than not optional, rather than providing something that is intentionally and meaningfully integrated into all aspects of the curriculum.


These session betray a belief that "we" must learn about "them", that we are somehow the "norm" and they are "other" (For a further exploration of these terms please refer to the humanities perspective on difference). This approach leads to a reductionist matching of traits to groups and the memorization of how to alter ones approach for specific ’groups’ without ever really evaluating ones own assumptions and biases and thinking about how our education and systems privilege some over others and asking why we who benefit the most get to make the rules. Despite our best intentions we may have actually been reinforcing stereotypes (and health disparities) by superficial and noncritical diversity education.[2]

Blye Frank and Anna MacLeod propose that we move away from approaches to multiculturalism that have been referred to as "the Four Ds of multiculturalism" - dress, diet, dialect, dance.[1]  This approach "may contribute to the reproduction of cultural stereotypes. As a result, difficult issues such as discrimination, health disparities, and structural inequities are overlooked."[1]

Frank and MacLeod propose instead a "critical approach which considers inequities, including health disparities, and institutional products." thus encouraging "learners to become reflective practitioners who identify and respond to, unfairness and discrimination within the patient-doctor relationship, medical education, and health care delivery". [1]

We can change the climate of our institutions by taking difference into account in the following spheres:

  • language -  is our language inclusive?

  • pedagogy - who is being heard and why are some not being heard?

  • curriculum - what messages are we sending with the formal and the unstated or hidden curriculum?

  • policy - how is critical diversity education supported?[3]

Taking action 

How can you change the climate of your medical school right now in the things that you do every day?


How can you use more inclusive language and encourage others to do the same?


How can you be more inclusive in the information sources you use and the voices you listen to?


How can you support and encourage under represented voices?

What opportunities do you have that you can give or share with someone or a group that is under-represented or absent?


How can you make explicit some of the messages of the hidden curriculum and effectively challenge them to be better?


Who are other students and faculty who share your interests and concerns?

How can you encourage your class and your school to engage in critical diversity education?

"the acknowledgement and thoughtful consideration of difference is a fundamental component of doctor education and professional development."[1][3]


1. Frank B. MacLeod A Beyond the 'four Ds of Multiculturalism': taking difference into account in medical education. Medical Education 2005; 39:1178-1179

2. Hunt LM and de Voogd KB. Clinical Myths of the Cultural "Other": Implications for Latino Patient Care. Academic Medicine 2005; 80:918- 924.

3. Special thanks to Dr. Blye Frank,Professor and Director of Faculty Development in the Division of Medical Education, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia for his contribution to this section

All references for this section