Student-nominated educator practices that foster inclusion in the clinical learning environment: A qualitative study with URiM and LGBTQ+ medical students

Efforts to increase diversity in medical school have outpaced progress in creating inclusive clinical learning environments (CLEs), particularly for students underrepresented in medicine (URiM) and those who identify as LGBTQ+. While the benefits of additive approaches, like increasing faculty diversity, are well described, they take significant time and effort to implement. This study aims to identify and characterize educator behaviors that can create, improve, and promote inclusion for URiM and LGBTQ+ students by leveraging insights and experiences from students and standout positive deviants.

The authors conducted a three-phase exploratory qualitative study at a single U.S. medical school, guided by Positive Deviance Inquiry and informed by a four-domain CLE framework. Phase 1 consisted of focus groups with medical students who self-identified as URiM, LGBTQ+, or both to identify inclusion-promoting practices and exemplary educators. In Phase 2, the authors conducted semi-structured interviews with student-nominated faculty and residents across multiple specialties. In Phase 3, a separate group of students reviewed the thematic framework and discussed its resonance with their experiences.

Through discussions with identified standout educators, the authors identified a set of behaviors that promoted inclusion, predominantly within the social domain of the CLE. These behaviors organized into two categories: (1) patient care and advocacy behaviors, including modeling compassionate care and actively addressing biases, and (2) clinical teaching behaviors, including recognizing additional burdens on marginalized students, engaging in intentional teaching, coaching students for success, and promoting intentional socialization.

This single-center qualitative study develops a context-bound thematic framework describing how the behaviors students observe, alongside their experiences receiving teaching directly, may support inclusion for URiM and LGBTQ+ students in the CLE. By identifying observable practices in clinical settings, it offers a strengths-based complement to broader institutional efforts to advance inclusion in medical education.