Formation of the Student Advocates for Diversity and Inclusion
In Fall 2017, eight second-year students opened the discussion on diversity and inclusivity at UofSC SOM Greenville. We students, leaders of UIM student interest groups, came together with the shared appeal for promoting an inclusive student environment and establishing a comprehensive curriculum that would adequately prepare students to work with diverse populations. Following informal discussions among ourselves as well as productive meetings with leaders in the medical school and physicians at the associated healthcare system, we took action to fill the gaps we observed in the school infrastructure and curriculum.
Faculty and staff were overwhelmingly supportive upon learning of our concerns. We first requested the formation of a formally recognized student committee on diversity and inclusion. The Student Advocates for Diversity and Inclusion (SADI) was thence formed with dual aims of improving diversity within both the curriculum and the school community. SADI commenced quarterly meetings to serve as the liaison between the school administration (including professors, administrators, physicians, and Student Affairs staff) and the involved student interest groups (including Lesbian, Gay, Bisexual and Transgender (LGBT) Health, SNMA, Medical Students for Health Advocacy, and the LMSA). Our short-term goals included curricular changes and extracurricular programs to expose students to the experiences of diverse patients and providers, which would contribute to meeting the committee’s stated mission of:
“…advancing the integration of diversity and inclusion within the medical school’s curriculum; supporting those student organizations with an emphasis on diversity; and fostering an environment for meaningful discussions centered on diversity and inclusion at UofSC SOM Greenville.”
Curricular changes
One key component of the UofSC SOM Greenville curriculum is the Integrated Practice of Medicine (IPM) course, which teaches students throughout the four years of medical school clinical skills, professionalism standards, and patient-centered care. IPM is a team-taught course that contains the majority of the behavioral, social, and population health curriculum, including cultural competence content. Course faculty continually review class sessions for areas of improvement with regards to LCME requirements and opportunities for method and content development. This review process, combined with the advocacy of SADI, yielded new class sessions on topics of diversity and expansion of the cultural competence curriculum (e.g. in the first year, Introduction to LGBTQ Populations and Social Determinants in Population Health During Pregnancy; in second year, Loss of Trust: History of Medicine, Race, and Discrimination, and a Patients with Obesity panel).
For the same course, we created a checklist (Supplement 1) to guide case presentations so that they better reflect the diversity of our future patient populations. The checklists itemize various patient characteristics including race/ethnicity, sexual/gender identity, English language fluency, religion, socioeconomic status, disability, education level, and neighborhood. IPM faculty members were asked to ensure each of their case scenarios incorporated at least two characteristics from the list and to consider these characteristics in guiding student discussions about how health disparities influence the delivery of patient-centered care. The diversity checklists now guide clinical case development and classroom discussion on how diversity and discrimination create health disparities and affect health outcomes.
Opportunities to interact with diverse patients in preclinical years
During the preclinical years, students in the IPM course learn history-taking and clinical exam skills through interactions with standardized patients. Student leaders of the LGBT Interest Group and the LMSA joined together through SADI to advocate for the inclusion of diverse patient populations in the standardized patient setting. Hispanic/Latino and LGBT populations face particular health disparities for various reasons, including physician prejudice, discrimination, lack of training, and language barriers (Snowdon, 2010; Morales et al., 2015). Understanding these disparities, we combined efforts with IPM teachers to take steps to include interactions with LGBTQ, Hispanic/Latino, and Limited English Proficiency populations in the standardized patient curriculum to provide students practice in caring for these populations. Teachers and administrators also introduced new lectures and trainings focused on Hispanic/Latino, non-English speaking, and LGBT patients; these innovations ensure students are exposed to these populations early, often, and throughout all four years of medical school.
Extracurricular programs
We recognized another avenue for positive change in our medical school – extracurricular programs to facilitate conversations about diversity and inclusion. To provide a platform for students to ask difficult questions, we developed an event entitled Between Two Palms, loosely based on the popular celebrity talk show Between Two Ferns; the palms are representative of the state of South Carolina as displayed on the state flag (Figure 1).
Figure 1. South Carolina State Flag

This image of the South Carolina State Flag is available through the Creative Commons CC0 1.0 Universal Public Domain Dedication and can be found at https://commons.wikimedia.org/wiki/File:Flag_of_South_Carolina.svg
We collected anonymous student questions, on topics of adversity, socioeconomic barriers, immigration, religion, race, and gender in medicine. We invited respected physicians, faculty members, and community leaders to serve as guest speakers to answer the students’ questions. Between Two Palms debuted at UofSC SOM Greenville in February 2018 as a 90-minute evening event. We have since hosted four additional iterations of the program to facilitate deeper discussions, create protected space for dialogue on differing perspectives, and broaden students’ awareness of issues facing medicine today.
Between Two Palms was created to foster dialogue among students and bring visibility to the diversity within the UofSC SOM Greenville community. We obtained feedback from attendees of the event using audience response technology, by which attendees were invited to submit one- to three-word descriptors in response to the program. Feedback from over 80 students at the first event was overwhelmingly positive, as highlighted by the following descriptors: “provoking”, “honesty”, “worthwhile”, “encouraging”. In all iterations of the program, negative feedback has been exceedingly rare and typically reinforces the need for more open, respectful conversations among students with differing perspectives. Faculty members and physicians who participated as panelists for the events have offered their excitement that these important conversations are happening in medical school now; most also lamented the fact they did not have these opportunities during medical school. We now host Between Two Palms bi-annually to continue to provoke thoughtfulness and dialogue about diversity, discrimination, inclusivity, and bias.