Walls Are Mirrors: Messages Delivered in Physical Environments

Creating diverse, equitable and inclusive (DEI) environments is essential for thriving in academic medicine. However, it was unclear if and how physical environments in academic medicine convey DEI messages consistently. This study investigated how the physical environment at a medical school represents DEI values.

We adopted an autophotography research methodology where we took photos and shared experiences and emotions through group reflections. Photographs included pictures, statues, artwork and physical space arrangements of clinical, administrative and teaching sites. Researchers with diverse backgrounds reflected on the 190 photos during four group reflection sessions. Discussions were recorded, transcribed and analysed using thematic analysis.

The physical environment was a mirror of the past and the present, representing what we value, who we are, what we do and whom we serve. The walls exclusively demonstrated the value of excellence, predominantly from one group, despite commonly shared DEI values throughout the school. Power inequality on the walls was apparent in subtle ways, including the size and permanence of photos or letters and the selection of words based on gender, position and race. Sterile spaces or walls with random, stock photographs were also observed. Some unintentionally inconsiderate physical environments were hurtful, undermined our values and sense of identity and weakened relationships.

This project was instrumental in leading to several meaningful changes at the school. Creating and sustaining inclusive learning environments are not possible without consistent messages in physical environments. We continue to implement changes that facilitate DEI values in our physical environment.