Inclusive, Innovative and Engaging Education on Human Difference

August 20, 2021

Pamela Bivens, assistant director for diversity and inclusion, reflects on the joint effort between the Duke University Health System Department of Clinical Education and Professional Development, and the Office for Institutional Equity, that has evolved over the past six years into a successful diversity course.

Pam Bivens, assistant director for diversity and inclusion

“How many seconds is our brain wired to categorize people by race after seeing a face?” If you attended a version of The Office for Institutional Equity’s (OIE) required Duke Health education course on diversity, this question may sound familiar. Since 2016, over 10,000 staff and leadership have engaged in awareness and understanding of the many dimensions of human difference. The required course encompasses not only implicit bias, intersectionality, emotional intelligence, self-reflection, and more, but it also includes three standards required by the accrediting body – The Joint Commission on cultural competency, culturally and linguistically appropriate services (CLAS), and LGBTQ+ Care. Meeting the LGBTQ+ Care standard of The Joint Commission allows Duke’s three hospitals to apply for and receive national recognition by the Human Rights Campaign's Healthcare Equality Index, “a benchmarking tool that evaluates healthcare facilities’ policies and practices related to the equity and inclusion of their LGBTQ patients, visitors, and employees.”

The initial joint effort between the Duke University Health System Department of Clinical Education and Professional Development and the Office for Institutional Equity began in 2015, during which I had the opportunity to form part of the design and delivery of the original 2.5 hour, in-person curriculum of the diversity course. Eventually, OIE took the lead on course delivery. This transition offered the unique opportunity to establish a cohort of volunteer educators who have served on OIE’s Curriculum Development Steering Committee. Together, we have designed blended learning opportunities that align with Duke University Health System’s core value to “care for our patients, their loved ones, and each other.” This core value runs deeply within the committee, whose members share a passion for integrating diversity, equity, inclusion and belonging in health care. Lisa Lewis, assistant professor in the School of Nursing, is one of the longest serving committee members with whom I've had the honor to work. When I asked her why she has stayed on the committee as long as she has, she said, “I learn and grow through the process of helping to create a curriculum that is current, meaningful and delivered in an engaging and pedagogically sound format." The structure of the in-person format qualified it for continuing education credits for Duke's health care professionals in compliance with Joint Accreditation policies and requirements for health professionals. But, "an added bonus," she continued, "is seeing how this work brings the university and the health system together in shared values."

The success of the program hinged on the twenty-seven volunteer educators who have, over the years, delivered the in-person education at Duke’s three hospitals, Duke HomeCare and Hospice, Lenox Baker Children’s Hospital, the Patient Revenue Management Organization (PRMO), and the Private Diagnostic Clinics (PDCs). Their dedication and leadership was honored at a formal reception in 2018 by Dr. A. Eugene Washington, chancellor for health affairs, and president and chief executive officer for Duke University Health System. We have interviewed new educators on a quarterly basis and have trained them using a “Train the Trainer” instruction model we developed. This training model includes two sessions, held one week apart. The first session reiterates a focus on adult learning pedagogy, a brief lesson on emotional intelligence to create a learning environment of psychological safety, and provides tools for management of the class environment. The second session focuses on teach-backs for potential educators during which they receive productive peer feedback that helps to develop their confidence to teach the curriculum. Upon completion, educators receive a certificate that acknowledges and celebrates their competency. Initially, we require new educators to observe and co-educate with seasoned educators, at least twice, prior to educating solo. This training has created a cohort of diversity educators from within the workforce, which was “an important step in our holistic approach to build an inclusive culture, encourage participation, and boost buy-in from team members and the leadership team,” mentioned committee member Nouria Belmouloud, manager for International Patient Services. “The journey to form trainers was a testament to the importance of collaboration between people of different cultures, backgrounds, and positions. It taught us to look for ways to find strength in our differences in order to advance the common goal of inclusivity, belonging, and cultural humility,” said Belmouloud.

Bundled Course Completion Data
Completion data of three course bundle.

The pandemic abruptly halted in-person instruction of the Duke Health diversity education course in early 2020. Despite the priority of the health system to deliver emergency medical care at the height of the outbreak, the need for the required course persisted. We needed to quickly figure out how to condense a 2.5-hour course into an attainable online model. The Curriculum Committee worked throughout the spring and the fall until we successfully adapted the content from the original course into two robust, innovative, and relevant online modules. I faced my greatest challenge when I overcame my apprehension and technical limitations to narrate the modules, which were integrated into Duke’s Learning Management System. Each 30-minute module ends with a five-question quiz to celebrate the learner’s knowledge, which was not part of the original course but became a necessary enhancement for the virtual versions. In late January, Duke Health launched an email campaign targeted at new and existing staff that included the two courses the Curriculum Committee worked on, as well as a third module focusing on sexual orientation and gender identity developed by the Fenway Institute for Duke HR. The campaign tied the bundled modules with Moments to Movement. Existing staff were given a deadline of June 30th to complete the education, while new staff receive a 90-day deadline from their hire date. To date, over 72% of health system employees have completed the training.

For Duke Health employees, the modules have become an attainable tool to help them learn more about the varying dimensions of difference that informs each of our unique perspectives and capabilities to engage in active listening as we honor, hear, and see each other. That prompts me to circle back to, “How many seconds is our brain wired to categorize people by race after seeing a face?” The answer is one-fifth of a second. That question, inspired by an article I read a few years ago in The New York Times about “Our Biased Brains” initiated the journey of collaborating with the many talented volunteers from the health system to build together the successful curriculum for the diversity course. The course stands as a successful model for expansion throughout the enterprise. To address the need for additional education, the Office for Institutional Equity is working on a scaffolded approach to DEI education designed for the varied needs of the community. Members of the Duke community can complete the OIE Educational Request form to request education. We are here to make a difference and provide you with education that enhances understanding as we navigate different paths that merge into our shared humanity.


By Pam Bivens
© 2021 Duke Office for Institutional Equity

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