Skip to main content
NCBI home page
MedEdPublish logoLink to MedEdPublish
. 2021 May 10;10:118. [Version 1] doi: 10.15694/mep.2021.000118.1

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

Karl Luke 1,a
PMCID: PMC10939519  PMID: 38486517

Abstract

This article was migrated. The article was marked as recommended.

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 ‘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:

  • 1.

    Multiple means of representation: Using a variety of strategies to present information; providing a range of methods to support perception and comprehension.

  • 2.

    Multiple means of action and expression: Providing diverse learners with alternative ways to act competently; providing alternatives for demonstrating what learners have learned.

  • 3.

    Multiple means of engagement: Aligning to learners’ interests by offering choices of modality, 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).

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 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 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, 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 UDLprinciple 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 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 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

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

[version 1; peer review: This article was migrated, the article was marked as recommended]

Declarations

The author has declared that there are no conflicts of interest.

Ethics Statement

This is a Personal Opinion and does not require ethical approval.

External Funding

This article has not had any External Funding

Bibliography/References

  1. 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. 10.1097/ACM.0000000000003077 [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. 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. 10.1080/01425692.2015.1093409 [DOI] [Google Scholar]
  3. 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. 10.1177/2165143417742895 [DOI] [Google Scholar]
  4. 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. 10.1097/ACM.0000000000001578 [DOI] [PubMed] [Google Scholar]
  5. 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. 10.1080/13603116.2018.1503347 [DOI] [Google Scholar]
  6. 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. 10.1080/0142159X.2020.1718070 [DOI] [PubMed] [Google Scholar]
  7. CAST . (2018) Universal Design for Learning Guidelines version 2.2, CAST. Available at: http://udlguidelines.cast.org( Accessed: 02 October 2020). [Google Scholar]
  8. Collins B., Day R., Hamilton J., Legris K., et al. (2020) 12 Tips for Pivoting to Teaching in a Virtual Environment. MedEdPublish. 9. 10.15694/mep.2020.000170.1 [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. 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. 10.1016/j.jsurg.2020.06.005 [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. 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. 10.15694/mep.2017.000088 38406417 [DOI] [Google Scholar]
  11. Finkel M. L.(2019) A call for action: integrating climate change into the medical school curriculum. Perspectives on Medical Education. 8(5), pp.265–266. 10.1007/s40037-019-00541-8 [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. 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. [DOI] [PubMed] [Google Scholar]
  13. Gishen F. and Lokugamage A.(2019) Diversifying the medical curriculum. BMJ. 364. 10.1136/bmj.l300 [DOI] [PubMed] [Google Scholar]
  14. Goh P. S. and Sandars J.(2020) A vision of the use of technology in medical education after the COVID-19 pandemic. MedEdPublish. 9. 10.15694/mep.2020.000049.1 [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. 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. 10.1007/s11218-011-9152-4 [DOI] [Google Scholar]
  16. 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. 10.1111/bjet.12737 [DOI] [Google Scholar]
  17. 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). [Google Scholar]
  18. Kirschner P. A. and Hendrick C.(2020) How Learning Happens: Seminal Works in Educational Psychology and what They Mean in Practice. Oxon: Routledge. [Google Scholar]
  19. 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. 10.1002/aet2.10024 [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. 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. 10.1097/ACM.0000000000002589 [DOI] [PubMed] [Google Scholar]
  21. 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. 10.1136/medethics-2019-105866 [DOI] [PubMed] [Google Scholar]
  22. Luke K.(2021) Twelve tips for managing change in medical education. MedEdPublish. 10(1). 10.15694/mep.2021.000053.1 [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. 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). [Google Scholar]
  24. 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). [Google Scholar]
  25. 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). [Google Scholar]
  26. Mayer R. E.(2010) Applying the science of learning to medical education. Medical Education. 44(6), pp.543–549. 10.1111/j.1365-2923.2010.03624.x [DOI] [PubMed] [Google Scholar]
  27. 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. [Google Scholar]
  28. 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. 10.3109/01421591003621663 [DOI] [PubMed] [Google Scholar]
  29. 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. 10.1080/0158791010220102 [DOI] [Google Scholar]
  30. 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). [Google Scholar]
  31. Morgan H. and Houghton A.. (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). [Google Scholar]
  32. Moss J. L., Hardy E. C., Cooley K. A., Cuffe S. N., et al. (2020) Students Advocating for Diversity in Medical Education. MedEdPublish. 8. 10.15694/mep.2019.000159.2 [DOI] [PMC free article] [PubMed] [Google Scholar]
  33. 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). [Google Scholar]
  34. 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. 10.3109/0142159X.2014.947938 [DOI] [PubMed] [Google Scholar]
  35. 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. 10.1080/10598650.2017.1306664 [DOI] [Google Scholar]
  36. 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. 10.1016/j.cptl.2015.12.014 [DOI] [Google Scholar]
  37. Patterson R. and Price J.(2017) Widening participation in medicine: what, why and how? MedEdPublish. 6. 10.15694/mep.2017.000184 [DOI] [PMC free article] [PubMed] [Google Scholar]
  38. Rees C. E.(2004) The problem with outcomes‐based curricula in medical education: insights from educational theory. Medical Education. 38(6), pp.593–598. 10.1046/j.1365-2923.2004.01793.x [DOI] [PubMed] [Google Scholar]
  39. Roberts L. W.(2020) Belonging, Respectful Inclusion, and Diversity in Medical Education. Academic Medicine. 95(5), pp.661–664. 10.1097/ACM.0000000000003215 [DOI] [PubMed] [Google Scholar]
  40. 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. [Google Scholar]
  41. 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. [Google Scholar]
  42. Slattery J. M. and Carlson J. F.(2005) Preparing an effective syllabus: Current best practices. College Teaching. 53(4), pp.159–164. 10.3200/CTCH.53.4.159-164 [DOI] [Google Scholar]
  43. 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). [Google Scholar]
  44. 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. 10.1037/0022-3514.69.5.797 [DOI] [PubMed] [Google Scholar]
  45. 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). [Google Scholar]
  46. 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-example.php( Accessed: 02 October 2020). [Google Scholar]
  47. Verdonk P. and Janczukowicz J.(2018) Editorial: Diversity in Medical Education. MedEdPublish. 7(1). 10.15694/mep.2018.000001.1 [DOI] [PMC free article] [PubMed] [Google Scholar]
  48. 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). 10.15694/mep.2015.006.0014 [DOI] [Google Scholar]
  49. 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).
MedEdPublish (2016). 2021 Oct 9. doi: 10.21956/mep.18913.r27032

Reviewer response for version 1

Anita Samuel

This review has been migrated. The reviewer awarded 4 stars out of 5 This is a practical and informative article that is relevant as we address issues of equity in medical education. It is nice to see UDL being introduced to medical education curriculum. You have provided some practical strategies that can be immediately implemented. Below are some suggestions to strengthen this article:• Framing UDL as a part of curriculum (re)design can be a daunting undertaking. It might be helpful to mention that UDL principles can be incorporated into existing curricula. This makes it much more accessible for meded programs. • The last paragraph of Tip 2 focuses on syllabus. It is important information but is not really connected to the theme of the tip. • The first sentence in Tip 6 also appears out of place.

Reviewer Expertise:

NA

No decision status is available

MedEdPublish (2016). 2021 Oct 6. doi: 10.21956/mep.18913.r27031

Reviewer response for version 1

Richard Hays 1

This review has been migrated. The reviewer awarded 3 stars out of 5 I found this a difficult article to review. The author has used a curriculum development framework developed in California and has applied this to undergraduate medical curriculum design in the UK context, offering 12 tips for that may improve curriculum inclusivity and diversity. I will come back to the tips but first, I have two concerns that I would like to discuss with the author, but will have to do this the slow way via this review. The first is that I am not sure that the case for such a potentially major change in overall curriculum design and delivery is made. Whenever I have been involved in curriculum design, I have stuck by the rule that for something else to go in, something must come out. Medical curricula are already so overcrowded in both content and delivery that I would not support adding to it. It is difficult to argue for a further reduction in scientific content and there already are curriculum domains that include communication skills, and personal and professional behaviours. There may be scope to develop further those domains and I know that many medical programs are moving in that direction. The second concern is that I am not sure that the UDL framework is valid for tertiary professional education. It seems more relevant to primary and secondary education for populations where there are substantial minority groups that face substantial disadvantage. Widening participation is an important and necessary strategy, but the frameworks may be best applied in precursor programs and pathways so that medical school applicants are better prepared and more likely to be successful in medical programs. Following the UDL principles may be even more important early in the education system to bring and retain more people from minority populations in the high achiever group that might consider medical careers. Coming back to the 2 tips, I think that these are sensible, because the dual aim of curriculum design is to ensure that graduates meet community expectations. These expectations are high wrt knowledge, skills and professional behaviours, but can underlying attitudes be changed by simple inclusion strategies? Adult behaviours are a product of their family background and life experience (with some genetics in there somewhere) and so the content of a medical curriculum may be only a small influence on the end product. More important is role modelling, and there is already evidence that the health system has many poor role models who may normalise poor behaviours. Overall I found this a really thought-provoking article, although feel that more work needs to be done on why and how to to apply important contemporary issues in a practical way. Despite my reservations I would recommend this be read by anyone involved in curriculum management. It would be good to have the opportunity to discuss these issues - the topic may be appropriate for a conference symposium.

Reviewer Expertise:

NA

No decision status is available

Articles from MedEdPublish are provided here courtesy of Association for Medical Education in Europe

RESOURCES